Labour and delivery for NEET PG: six figures from the first stage to the placenta

Answer: B. Assess the cause of delay

B. Assess the cause of delay. The labour care guide counts the active first stage from five centimetres and gives each centimetre its own time limit, reflecting the slower progress now accepted as normal. She has stayed at seven centimetres from hour four to hour eight, four hours against a limit of three. Passing a limit triggers a review of contractions, position, descent, moulding, hydration and fetal condition, and the plan follows from what that review finds.

Why the other options lose: Continue to observe (A) ignores a limit already passed; the guide has no alert or action line to wait for. Start oxytocin augmentation (C) is one possible plan after the assessment, not an automatic step. Immediate caesarean section (D) is likewise only one possible outcome of the review. From five centimetres the limits run six, five, three, two and a half and two hours.

Recallab question 56179 · Obstetrics › Normal Labour · reference: DC Dutta's Textbook of Obstetrics

Answer: D. Frame 3

D. Frame 3. At the brim the head lies across the pelvis, because that is the widest diameter there; lower down the widest diameter runs front to back, so the head must turn. It turns where it meets the muscular pelvic floor at the level of the spines: the gutter of the levator muscles slopes down and forwards, and the leading part slides forwards down that slope, carrying the occiput under the pubis. The floor turns the head; the brim only lets it in.

Why the other options lose: Frame 6 (A) is where the shoulders turn and the head follows them further round. Frame 2 (B) shows the head still descending with the occiput to one side, before it has reached the pelvic floor. Frame 5 (C) is the head untwisting after delivery, which follows the turn rather than causing it.

Recallab question 56372 · Obstetrics › Normal Labour & Delivery · reference: DC Dutta's Textbook of Obstetrics

Answer: D. Right occipitoposterior

D. Right occipitoposterior. The small triangular fontanelle, where three sutures meet, marks the occiput; the large diamond, where four meet, is the front of the head. Here the triangle lies towards the sacrum, so the occiput is posterior, and facing her, the examiner's left-hand side is the mother's right. The occiput therefore sits in her right posterior quadrant. Both fontanelles can be felt because an occipitoposterior head is usually deflexed.

Why the other options lose: Left occipitoanterior (A) takes the diamond for the occiput; the diamond is the sinciput, lying anteriorly on her left. Left occipitoposterior (B) finds the right fontanelle but names the side from the examiner's view instead of the mother's. Right occipitoanterior (C) makes both errors at once. Three sutures, triangle, occiput; four sutures, diamond, front of the head.

Recallab question 69842 · Obstetrics › Malpresentation · reference: DC Dutta's Textbook of Obstetrics

Answer: A. Scalp pH likely normal

A. Scalp pH likely normal. Strip 1 has a flat baseline with reduced variability and no accelerations. Strip 2 shows a clear rise beginning immediately after the stimulus marker, and an acceleration of that size and length provoked by stimulating the presenting part predicts a normal scalp pH, so fetal blood sampling can be avoided. The reverse inference does not hold: a trace that stays flat after stimulation still needs sampling or delivery.

Why the other options lose: Fetus merely asleep (B) would explain the flat first strip, but it does not explain away the reassurance the provoked rise gives. Fetus acidotic (C) is wrong because an acidotic fetus does not mount an acceleration to stimulation, which is exactly why the test works. Test invalid before second stage (D) is wrong because it is used through labour once the cervix admits an examining finger. A rise on stimulation reassures; no rise does not condemn.

Recallab question 58275 · Obstetrics › Abnormal Labour & Obstetric Emergencies · reference: Williams Obstetrics

Answer: A. Position 3

A. Position 3. The cup is centred on the flexion point: on the sagittal suture about 3 cm in front of the posterior fontanelle. The fontanelles are about 9 cm apart, so that is a third of the way forward, and a standard 6 cm cup placed there has its rim just at the posterior fontanelle. Traction through the flexion point flexes the head so that it presents its smallest diameter, the suboccipitobregmatic, and correct placement lowers the risk of the cup detaching and of scalp injury.

Why the other options lose: Position 4 (B) is off the midline, so traction tilts the head and causes asynclitism. Position 2 (C) is on the suture but too far forward, so traction still deflexes the head slightly. Position 1 (D) sits on the anterior fontanelle; traction there deflexes the head and presents a wider diameter. Cup rim on the posterior fontanelle, centre on the suture.

Recallab question 69251 · Obstetrics › Operative Obstetrics · reference: DC Dutta's Textbook of Obstetrics

Answer: D. Vessels ending at a hole in the membranes

D. Vessels ending at a hole in the membranes. Vessels that run off the edge of the disc and stop at a hole in the membranes mean a separate lobe has been torn off and left inside. Such an accessory lobe sits apart in the membranes, joined only by its vessels, so the cut vessel ends at the margin of the defect are the evidence. Retained tissue stops the uterus contracting down, so bleeding continues, and it is a focus for infection days later, with offensive lochia and fever.

Why the other options lose: A cord inserted off centre (A) is a normal variant. A complete maternal surface (B) can still be missing an accessory lobe: the disc being whole is exactly what makes this trap worth knowing. Calcification of the maternal surface (C) is a normal finding at term and retains nothing. Check the membranes as well as the disc.

Recallab question 55094 · Obstetrics › Normal labour and delivery · reference: DC Dutta's Textbook of Obstetrics