1. Pelvis Favorable for Normal Delivery
Pelvis: AP diameter of the inlet is greater than transverse diameter
Correct Answer: c) Anthropoid
Gynecoid : Ideal shape, with round to slightly oval (obstetrical inlet slightly less transverse) inlet: best chances for normal vaginal delivery.
Android : triangular inlet, and prominent ischial spines, more angulated pubic arch.
Anthropoid : the widest transverse diameter is less than the anteroposterior diameter.
Platypelloid : Flat inlet with shortened obstetrical diameter.
2. Pelvis favorable to Vaginal Delivery
All the following characteristics are applied to a pelvis favorable to vaginal delivery EXCEPT :
a) Sacral promontory can not be felt.
b) Obstetric conjugate is 9.5 cm.
c) Ischial spines are not prominent.
d) Subpubic arch accepts 2 fingers.
e) Intertuberous diameter accepts 4 knuckles on pelvic exam.
Correct Answer: b) Obstetric conjugate is 9.5 cm. The line between the narrowest bony points formed by the sacral promontory and the inner pubic arch is termed obstetrical conjugate: It should be 11.5 cm or more. This anteroposterior line at the inlet is 2 cm less than the diagonal conjugate.
Which of the following terms best describes the pelvic type of small posterior saggital diameter, convergent sidewalls, prominent ischial spines, and narrow pubic arch ?
Correct Answer: a) Android. The android pelvis is a female pelvis with masculine features, including a wedge or heart shaped inlet caused by a prominent sacrum and a triangular anterior segment. The reduced pelvis outlet often causes problems during child birth.
4. Pelvis in DTA
In Deep transverse arrest most common type of pelvis found is
Correct Answer: b) Android. In Deep transverse arrest most common type of pelvis found is Android pelvis as it is the commonest type of abnormal pelvis found. It is found in 1/3rd of women and platypelloid is found in only 3% (Ref: William’s Textbook, Todd’s collection).
If we have 100 women with DTA, most will have android component and few will have platypelloid, as android is much more common.
If we have 100 women with android and 100 with platypelloid pelvis, AS OF NOW we do not have answer as to how many of them will have DTA. And it is not important also to know that in today’s obstetric practice.
5. Ritgen maneuver
The maneuver used to deliver fetal head during the conduct of normal vaginal delivery in cephalic presentation
a) Prague maneuver
b) Ritgen maneuver
c) Burns marshal maneuver
Correct Answer: b) Ritgen maneuver is when a towel draped gloved hand is used to exert forward pressure on the chin of the fetus through the perineum just in front of the coccyx. At the same time other hand exerts pressure superiorly against the occiput. It allows physician to control the delivery of the head. It also favors extension, so that the head is delivered with its smallest diameters passing through the introitus and over the perineum. The head is delivered slowly with the base of occiput rotating around the lower margin of symphasis pubis as a fulcrum. (Ref – Williams Obstetics)
6. Amniotic fluid embolism
Correct term for Amniotic fluid embolism should be
a) Anaphylactic syndrome of pregnancy
b) Anaphylaxis of pregnancy
c) Hypersensitivity reaction of pregnancy
d) Anaphylactic amniotic fluid embolism
Correct Answer: a) Anaphylactic syndrome of pregnancy. Amniotic fluid embolism is a complex condition characterized by abrupt onset of hypotension, hypoxia and consumptive coagulapathy (DIC). Classically it occurs in the late stages of labor or immediately postpartum. Amniotic fluid enters the circulation as a result of breach in the physiological barrier in placenta. Such exposure initiates a complex series of physiological reactions mimicking those seen in human anaphylaxis and sepsis.
Reference – Williams Obstetrics
7. Mechanism of Labor
The four cardinal movements, 1. flexion 2. internal rotation, 3. extension, 4. restitution and external rotation; constitute mechanism of labor in cephalic presentation. The chronological order in which they occur
Correct Answer: a) 1,2,3,4. 1. Flexion 2. internal rotation, 3. extension, 4. restitution and external rotation.
8. Deep Transverse Arrest
Deep transverse arrest is commonly associated with which of the following types of pelvis ?
Correct Answer: Wrong question/ a and b. Deep transverse arrest (DTA) is associated with platypelloid (flat shaped) and android pelvis (heart shaped) as there is no room for internal rotation that brings sagital suture in AP dimeter.
Android pelvis is found in 1/3rd of women and platypelloid is found in only 3%. And many pelves are not PURE but MIXED type (e.g. gynecoid pelvis with an android tendency). Small Android pelves are the one which causes max difficulty in labor (Ref: William’s Textbook, Todd’s collection).
Categorising pelvic shapes into four descriptive groups used to be a prominent part of obstetric teaching but is no longer considered perticularly useful, so as X-ray pelvimetry has no role in the management of labour. It is because of the much more straightforward approach to the complications of labour. If the labour is proving difficult as a result of pelvic abnormalities the solution now a days lies in much readier resort to delivery by cesarean section.(Ref: Munro Kerr’s).
I could not find a single research on this subject because of the reasons stated above. If we have 100 women with DTA, most will have android component and few will have platypelloid, as android is much more common. If we have 100 women with android and 100 with platypelloid pelvis, AS OF NOW we do not have answer as to how many of them will have DTA. And it is not important also to know that in today’s obstetric practice.
SO THE CORRECT STATEMENT WOULD BE ”In DTA most common type of pelvis found is android”.
But if this question is asked in exam, one needs to answer Android because they want you to answer Android.
9. Postdate Pregnancy
The most common reason for postdate pregnancy is :
a) Inaccurate gestational age.
b) Fetal anencephaly.
e) Advanced maternal age.
Correct Answer: a) Inaccurate gestational age. The causes of post-term births are unknown. Due dates are easily miscalculated when the mother is unsure of her last menstrual period. When there is a miscalculation, the baby could be delivered before or after the expected due date. Post-mature births can also be attributed to irregular menstrual cycles. Most post-mature pregnancies are because the mother is not certain of her last period, so in reality the baby is not technically post-mature. However in most first world countries where gestation is measured by ultrasound scan technology, this is less likely.
10. What should be the correct birthing position ?
a) Lying supine
f) Side lying
g) On hands and knees
h) Any position that woman find most comfortable
Correct Answer: h) Any position that woman find most comfortable. “Hands off” management of perineum, as well as free positioning during the second phase of labour is the recommended management by WHO. Unfortunately in most places, women are forced to give birth in lithotomy position which is against physiology but easier fordoctor to assist delivery. Lithotomy position assists doctor but not the woman. According to NHS/ NICe/RCOG, women should be discouraged from lying supine or semi-supine in the second stage of labour and should be encouraged to adopt any other position that they find most comfortable. Women should be informed that in the second stage they should be guided by their own urge to push. If pushing is ineffective or if requested by the woman, strategies to assist birth can be used, such as support, change of position, emptying of the bladder and encouragement. Of the other positions Squatting position is most physiological as it widens all pelvic dimensions.
"Authored By Dr.Niraj Mahajan"
MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.Read more [+]