Operative Vaginal Delivery MCQs

Pelvic cellular tissue around the vaginalvault, supravaginal part of the cervix and into the layers of the broad ligament is called parametrium. Condensation occurs especially near the cervicovaginal junction to form ligaments which extend from the viscera to the pelvic walls on either side. These are Mackenrodt’s ligaments/ cardinal ligament, uterosacral ligaments and vesicocervical ligaments (fascia). All these constitute important supports of the uterus to keep it in position. Reference: DC Dutta textbook of obstetrics, 8th edition; chapter 1

All are seen with scar dehiscence, except (A) Maternal bradycardia. Maternal bradycardia is not typically associated with scar dehiscence; the other options, such as fetal bradycardia, vaginal bleeding, and hematuria, can occur. Uterine rupture typically is classified as either complete (all layers of the uterine wall separated) or incomplete (uterine muscle separated but visceral peritoneum is intact). Incomplete rupture is commonly referred to as scar dehiscence. Scar dehiscence is an intraoperative finding always. The greatest risk factor for either complete or incomplete uterine rupture is prior cesarean delivery. "The most common sign of uterine rupture is a non-reassuring fetal heart rate pattern with variable deceleration evolving into late decelerations, bradycardia and undetectable fetal heart rate pattern". Reference: John Hopkins Manual of Obs. and Gynae 4/e, p 86

In this method the placenta separation is actively facilitated and powerful uterine contractions are initiated to reduce the incidence of third stage complications (like PPH) Duration is reduced to 5 mins so less bleeding, less chances of PPH and less maternal mortality Active management of labor includes Administration of a uterotonic soon after birth of baby Delayed cord clamping Delivery of placenta by controlled cord traction Uterine message The only drawback of active management of 3rd stage of labor is , since uterotonic agent is given at the delivery of shoulder before the delivery placenta, it can lead to increased chances of Retained placenta. Reference : Williams 24/e, pg 513

This is a case of uterine inversion If the placenta is still attached, attempts are made to reposition the uterus with the placenta in situ. In theory, the uterus contracts to a lesser degree and placenta-site blood loss is less with an attached placenta. Reference: Williams obstetrics 26 th edition, chapter 42

M/C nerve injured during vaginal delivery - Lateral femoral cutaneous nerve followed by femoral nerve. Risk factors: Nulliparity, prolonged second stage of labor, pushing for a longer period in semi fowler position. M/C nerves injured during cesarean section - Iliohypogastric nerve and Ilioinguinal nerve. Reference: Williams Obstetrics, 24th Edition, Page Number-677.

Pain relief is important for heart disease patients as pain can cause tachycardia, which in turn can cause cardiac failure. Epidural and spinal techniques are the most effective means of providing pain relief for labor. These are also known as regional techniques because pain relief is limited to a specific anatomical region. These modalities are also known as neuraxial techniques, since both the approaches involve administration of drugs that exert their effects in the axial portion of the CNS. Reference: Williams, 22/e, p 483

Ans., B. To maintain acidic pH The importance of Doderlein's bacillus is that its presence is associated with production of lactic acid contained in the vaigna and this acidity inhibits the growth of other organisms." Doderlein's bacillus is the only organism which will grow at the pH of 4-4.5 (normal pH of vagina).

Quickening (feeling of life) denotes the perception of active fetal movements by the woman. It is usually felt about the 18 th week, 2 weeks earlier in multiparous. Its appearance is a useful guide to calculate the expected date of delivery with reasonable accuracy. Reference: DC Dutta's Textbook of Obstetrics, 7th Edition, Page Number 68-72.