Normal Labour MCQs

The patient in the question is hypertensive and presenting with: History of pain in abdomen. Bleeding per vaginum. Loss of fetal movements. O/E = uterus is contracted. Increased uterine tone. Fetal heart sounds are absent. All these features confirm the diagnosis of abruptio placenta . As far as premature labour is concerned – Complaints of abdominal pain and vaginal bleeding will be present but loss of fetal movement, absence of fetal heart sounds and increased uterine tone go against it. (In normal labour - uterus contracts and relaxes intermittently i.e. tone increases and decreases intermittently). Reference: Dutta Obs. 7/e, p 255

Classification of Obstetric Anal Sphincter Injury (RCOG–2007) First degree: Injury to perineal skin only Second degree: Injury to perineum involving perineal body (muscles) but not involving the anal sphincter- episiotomy Third degree: Injury to perineum, involving the anal sphincter complex (both external and internal) 3a : 3b : >50% of EAS thickness torn 3c : Both EAS and IAS torn Fourth degree: Injury to perineum involving the anal sphincter complex (EAS and IAS) and anal epithelium Reference: Shaw's textbook of gynecology, 16th edition, chapter 1(figure 1.12,A)

Series of events that take place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called Labour . Mechanism of normal labour is defined as the manner in which the fetus adjusts itself to pass through the parturient canal with minimal difficulty. There are 8 cardinal movements of the head in normal labour. E very – E ngagement (Synclitic or Asynclitic) D ecent – D escent F emale – F lexion I – I nternal rotation C hoose to – C rowning E mploy – E xtension R ises – R estitution E xtremely – E xternal rotation Mnemonic : Every Decent Female I Choose to and Employ Rises Extremely. Reference : Dutta Obs. 7/e, pg 128

CBAVD(Congenital bilateral absence of seminal vesicles and vas deferens) is seen in Cystic fibrosis and is a cause of post testicular/obstructive azoospermia and absence of fructose in semen . Typical hormone testing reveals: Normal FSH, LH, Testosterone levels The next step of evaluation is genetic analysis for CFTR gene. Other options are not related.

Ans. A. 4.0 The vaginal acidity is due to lactic acid. The normal pH in the healthy women of the child bearing age group is 4.5

Ans. D. Usually improves with age Piebaldism Piebaldism is a rare autosomal dominant condition characterized by stable areas of vitiligo-like amelanotic skin associated with a white forelock. Present at birth and usually remain unchanged throughout life. Most common is a frontal median or paramedian patch, associated with a mesh of white hair (white Forelock). Often, white patches occur on the upper chest, abdomen and limbs, bilaterally but not necessarily symmetrically The hands and feet, as well as the back, remain normally pigmented Islands of normal or hypermelanotic skin occur in the white areas, or less often on normal skin.

The correct answer is (D): Vacuum delivery. Normal labor is characterized by being spontaneous, vertex presentation, and occurring without maternal or fetal complications. Vacuum delivery is an assisted delivery method and does not fit the criteria for normal labor. Normal Labor (EUTOCIA): Labor is called normal if it fulfills the following criteria. (1) Spontaneous in onset and at term. (2) With vertex presentation. (3) Without undue prolongation. (4) Natural termination with minimal aids. (5) Without having any complications affecting the health of the mother and/or the baby. Abnormal Labor (DYSTOCIA): Any deviation from the definition of normal labor is called Abnormal labor. Reference : Dutta Obs. 7/e, pg 113

Remember: Perineal infiltration with local anesthesia is most commonly used in (C) Episiotomy repair. This technique helps manage pain during the repair of episiotomy. Reference : Dutta Obs 7/e, pg 517-518 and William 23/e, pg 450