Labour Abnormalities, Induction and Operative Delivery MCQs

Obstetrics & Gynaecology · 175 free questions with answers & explanations.

A 26-year-old primigravida at 41 weeks of gestation is being induced with dinoprostone gel. She is in active labor; cervix is 6 cm dilated, fully effaced, and the head is at 0 station. Over the next 2 hours, there is no further cervical dilation. CTG shows category II tracing. Which of the following best describes this pattern?
A 30-year-old G2P1 at 40 weeks develops a Category III CTG with persistent late decelerations and absent variability. The cervix is 9 cm dilated, fully effaced, and the fetal head is at +2 station in an OA position. Which is the MOST appropriate management?
A Bishop score is used to assess cervical favorability before labor induction. Which combination of cervical parameters gives the HIGHEST Bishop score component contribution?
During a forceps delivery, which of the following represents an absolute contraindication?
A primigravida at 41 weeks has a Bishop score of 3 and unfavourable cervix. Which agent achieves the most effective cervical ripening with lowest risk of uterine hyperstimulation compared to prostaglandin E2 gel?
A patient in active labour has been pushing for 2 hours (primipara) with no descent. The fetal head is at +2 station, OA position. CTG shows recurrent late decelerations. The MOST appropriate operative delivery is:
Which partogram criterion defines 'active phase arrest' according to the latest ACOG/NICHD redefined labour guidelines?
During shoulder dystocia, which manoeuvre involves suprapubic (not fundal) pressure combined with maternal McRobert's position and is the FIRST-LINE intervention?
A primigravida is in active labour. Cervix is 6 cm dilated, 80% effaced, vertex at 0 station. After 2 hours of adequate uterine contractions (3 in 10 min, each >40 sec), there is no change in cervical dilation. This pattern is BEST described as:
A woman at 41+3 weeks is being considered for induction of labour. Her Bishop score is 3. Which of the following is the MOST appropriate cervical ripening agent considering her intact membranes and no contraindication to prostaglandins?
Vacuum extraction is being applied to deliver a fetus in occiput posterior (OP) position at +2 station. Which of the following complications is MOST specifically associated with vacuum delivery compared to forceps delivery?
A patient at 41 weeks undergoes induction of labor with dinoprostone (PGE2) pessary. After 12 hours, the cervix is 2 cm dilated, soft, and effaced 70%. Fetal CTG is normal. What is the appropriate next step?
During a vacuum-assisted vaginal delivery, the cup detaches three times ('three pop rule'). What is the recommended action at this point?
In a patient with protracted active phase, oxytocin augmentation at maximum dose fails to achieve adequate uterine contractions (Montevideo units <200). Intrauterine pressure catheter confirms MVU = 150 mmHg×min in 10 minutes. What is the MOST accurate characterization of this finding?
A patient with one previous lower segment cesarean section presents at 39 weeks requesting a trial of labor (TOLAC). Her previous cesarean was for non-recurrent indication. The factor that MOST SIGNIFICANTLY increases the risk of uterine rupture in TOLAC is:
A 29-year-old G2P1 at 41 weeks is undergoing labour induction for post-term pregnancy. She has a Bishop score of 4. Following cervical ripening with dinoprostone, her cervix is now 2 cm dilated, 50% effaced, station -1, medium consistency, posterior position (Bishop score 6). Which is the most appropriate next step?
During the second stage of labour, a term fetus in occiput posterior (OP) position fails to rotate spontaneously. The vertex is at +2 station and the patient has been pushing for 90 minutes with regional anaesthesia. Which rotational instrument specifically designed for this presentation offers the lowest risk of maternal perineal trauma?
A multiparous woman in active labour at 39 weeks suddenly develops a severe variable deceleration to 60 bpm lasting 3 minutes following spontaneous rupture of membranes revealing cord prolapse. The cord is visible at the introitus. What is the correct immediate sequence of management?
According to ACOG Partogram guidelines and Zhang et al. (2010) re-evaluation of labour curves, which major revision to Friedman's classic labour curve is most clinically relevant for reducing unnecessary cesarean sections?
In the ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management), elective induction of labour at 39 weeks in low-risk nulliparous women compared to expectant management resulted in:
Which of the following correctly describes the 'wedge' (turtle neck/recoil) sign of shoulder dystocia, and the first manoeuvre that should be attempted?
The Friedman curve defines active phase arrest in a nullipara as lack of cervical dilation for how many hours at ≥6 cm with adequate contractions and ruptured membranes?
When performing outlet forceps delivery, which of the following station and position criteria must ALL be met?
A primigravida at 41+3 weeks is post-dates. The Bishop score is 3. Which of the following cervical ripening agents is MOST appropriate if she is not in active labour?
A 38-year-old primigravida at 41+3 weeks has a Bishop score of 3. She is to be induced. Dinoprostone (PGE2) gel is applied intracervically. She is being monitored. After 6 hours, she develops uterine tachysystole (>5 contractions in 10 minutes) and fetal heart rate decelerations. What is the first-line tocolytic to reverse dinoprostone-induced uterine hyperstimulation?
A 26-year-old G1P0 at 39 weeks is in active labor. Cardiotocography shows a variable deceleration pattern with 'shoulders' and rapid return to baseline. Cervix is 7 cm dilated with intact membranes. What is the pathophysiology of variable decelerations with shoulders (pre- and post-decelerations accelerations)?
A cesarean section is being performed for fetal distress at full dilation. Difficulty is encountered extracting the fetal head. The 'push' method (an assistant pushes the fetal head up vaginally) is associated with complications. What is the recommended alternative technique (Patwardhan's maneuver)?
The ARRIVE trial (NEJM 2016) evaluated routine induction at 39 weeks versus expectant management in low-risk nulliparous women. What was the primary conclusion of this trial?
The ARRIVE trial (2018, NEJM) randomized nulliparous low-risk women at 39 weeks to elective induction versus expectant management. The most clinically important finding of this trial was:
Shoulder dystocia has occurred. After McRoberts maneuver and suprapubic pressure fail to release the anterior shoulder. The next maneuver that should be attempted first, as it has the highest success rate as a secondary maneuver, is:
A trial of labor after cesarean (TOLAC) is being offered to a woman with one previous low transverse cesarean for fetal malpresentation. She is now at 39 weeks with a favorable cervix (Bishop score 8) and an estimated fetal weight of 3.6 kg. Her uterine rupture risk for TOLAC in this scenario is approximately:
During forceps delivery, the cup slip (forceps slipping off the fetal head 3 times) is a recognized indication for abandonment of the procedure. According to RCOG/ACOG guidelines, operative vaginal delivery (OVD) should be abandoned and cesarean performed if which criterion is met?
The ARRIVE trial compared elective induction at 39 weeks versus expectant management in low-risk nulliparous women. Its key finding regarding cesarean delivery rate was:
In the management of second stage arrest, a patient is fully dilated at 9 cm, has been pushing for 3 hours with epidural anesthesia, and the fetal head is at +2 station in OA position. The safest next step is:
The Bishop score is used to assess cervical favorability for induction. A Bishop score of ≥8 is considered favorable. Which component of the Bishop score is assigned the highest possible weight (0–3 points) and most strongly predicts induction success?
During difficult breech extraction in a cesarean, fetal head entrapment occurs at a classical uterine incision. The Patwardhan maneuver would involve:
In shoulder dystocia, the McRoberts maneuver fails and suprapubic pressure is applied without success. The operator decides to perform the Rubin II maneuver. This involves:
The ARRIVE trial (A Randomized Trial of Induction versus Expectant Management) demonstrated that elective induction of labor at 39 weeks in low-risk nulliparas compared to expectant management resulted in:
During an attempted vacuum-assisted delivery for fetal distress at +2 station, the cup detaches three times ('pop-offs'). The correct action is:
In active management of the third stage of labor, the component MOST responsible for reducing postpartum hemorrhage compared to physiological management is:
A patient at 41 weeks with oligohydramnios (AFI 4 cm) and a Bishop score of 4 requires cervical ripening. Which method has evidence for both cervical ripening and reducing the need for oxytocin augmentation in post-term pregnancy?
A 38-week primigravida undergoes induction with 25 mcg misoprostol vaginally. After 4 doses, the Bishop score has risen from 3 to 7. Oxytocin augmentation is commenced. After 2 hours of regular contractions, electronic fetal monitoring shows late decelerations with reduced variability. The pattern most consistent with this CTG is categorized as:
A multiparous woman at 41+2 weeks is in active labor. Station is 0, position is OT (occiput transverse) at full dilation for 2 hours. Fetal head is not rotating. Which of the following is the MOST appropriate first maneuver to attempt before considering operative delivery?
When performing vacuum-assisted delivery (VAD), which of the following represents a 'pop-off' (cup detachment) scenario that should prompt abandonment rather than reattempt?
Shoulder dystocia occurs after delivery of the head. After McRoberts maneuver and suprapubic pressure fail, which subsequent maneuver delivers the posterior shoulder FIRST, thereby providing the quickest resolution of the dystocia?
The Confidential Enquiry into Maternal Deaths (CEMD) reports have identified which of the following as the leading modifiable factor in maternal deaths from uterine rupture following induction of labor?
The ARRIVE trial (2018, NEJM) compared elective induction at 39 weeks versus expectant management in low-risk nulliparous women. The primary perinatal outcome was not significantly different, but the perinatal death/serious complication composite trended lower with induction. What was the most clinically significant finding regarding maternal outcomes?
A G2P1 woman at 41+2 weeks with a Bishop score of 3 requires cervical ripening and induction. A transcervical Foley catheter is placed. What is the mechanism by which mechanical cervical ripening causes cervical effacement and dilation?
During an instrumental delivery attempt with vacuum extraction, which of the following fetal complications is specifically more common with vacuum compared to forceps delivery?
In the management of shoulder dystocia, the HELPERR mnemonic is used. If initial manoeuvres (McRoberts, suprapubic pressure) fail, the Zavanelli manoeuvre is considered as a last resort. What does the Zavanelli manoeuvre involve?
A multigravida at 41+2 weeks has a favourable cervix (Bishop score 7). Oxytocin induction is started. After 8 hours of regular uterine contractions, she remains at 4 cm cervical dilatation. CTG shows a normal pattern. Per ACOG/RCOG active phase dystocia criteria, the minimum duration of adequate (>200 Montevideo units) contractions in the active phase before labelling as arrested active phase is:
During a vacuum-assisted delivery, which fetal scalp application point is biomechanically most appropriate for traction to reduce the risk of cup detachment and fetal injury?
The Maternal Fetal Medicine Unit (MFMU) Network defined a novel labour curve (Zhang curve) in 2010 that contrasts with the classic Friedman curve. Which is the most clinically significant difference between the two?
A woman with a prior vertical classical uterine incision requests a trial of labour. Which is the key reason that uterine rupture risk is substantially higher (~8–9%) with a classical incision compared to a lower segment caesarean scar (~0.7%)?
A 26-year-old primigravida at 41+3 weeks with a Bishop score of 3 is planned for induction of labour. Cervical ripening is performed with a 25 mcg intravaginal misoprostol every 4 hours. After 3 doses, uterine hyperstimulation occurs (>5 contractions in 10 minutes lasting >90 seconds). Which receptor mechanism underpins misoprostol's efficacy for cervical ripening and which tocolytic should be given for hyperstimulation?
During a vaginal delivery, the fetal head delivers but the shoulders fail to restitute. The McRoberts maneuver and suprapubic pressure fail to release the anterior shoulder after 60 seconds. What is the most appropriate NEXT step in managing this shoulder dystocia?
A woman in active second stage of labour for 90 minutes (nullipara with epidural) has the fetal head at +2 station, occiput anterior. CTG shows recurrent late decelerations. The obstetrician decides on operative vaginal delivery. Which of the following correctly characterizes the conditions under which vacuum extraction is preferred over forceps in current clinical practice?
The ARRIVE trial (2018) demonstrated which finding about elective induction of labour at 39 weeks in low-risk nulliparous women compared to expectant management?
The ARRIVE trial (2018) compared elective induction of labour at 39 weeks versus expectant management in low-risk nulliparous women. Its key finding was:
A vacuum delivery is attempted but fails after three pulls without descent and two cup detachments. According to RCOG Green-top guideline 26, which statement regarding subsequent management is correct?
According to the Robson Ten Group Classification System (TGCS), a primigravida at term in spontaneous labour with a cephalic singleton presentation belongs to which Robson group, and why is this group considered the 'key group' for LSCS audit?
During active management of the third stage of labour (AMTSL), the correct sequence of steps according to the WHO 2012 recommendation is:
A multiparous patient at 41+3 weeks has cervical assessment: dilatation 1 cm, effacement 20%, station –3, consistency firm, position posterior. A Bishop score is calculated. Which score does this cervix yield, and which ripening method is MOST appropriate?
During a prolonged second stage, a nulliparous woman who has been pushing for 3 hours with regional analgesia has no descent. Fetal head is at +2 station, direct occiput anterior. CTG is Category II. What is the MOST appropriate operative decision?
The Friedman labour curve was re-examined by Zhang et al. (2010). What key finding from the Zhang curve changed the management of labour dystocia in modern obstetrics?
Shoulder dystocia is encountered after delivery of the fetal head. The McRoberts manoeuvre and suprapubic pressure fail after 30 seconds. Which is the CORRECT sequence of next internal manoeuvres according to the HELPERR mnemonic?
The ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) demonstrated that elective induction of labour at 39 weeks in low-risk nulliparous women compared to expectant management resulted in:
In Friedman's labour curve, the active phase of labour officially begins at full cervical dilation of 4 cm. However, WHO's 2018 intrapartum care guidelines revised this threshold based on evidence from MANA and other studies. The revised threshold for active phase onset is:
Shoulder dystocia with a 'turtle sign' is managed using the HELPERR mnemonic. Which manoeuvre involves suprapubic pressure with maternal hip hyperflexion to flatten the lumbar lordosis and widen the pelvic inlet?
In vacuum-assisted delivery, the 'chignon' (caput succedaneum under the cup) is an expected finding. The most serious complication specific to vacuum extraction (not seen with forceps) is:
A nulliparous woman at 41+2 weeks is being induced with a Bishop score of 3. Cervical ripening is initiated with dinoprostone 0.5 mg intracervical gel. Six hours later, Bishop score is 5 but FHR shows uterine hyperstimulation with late decelerations. What is the immediate management?
During vacuum-assisted delivery for prolonged second stage, after three pulls on the same contraction without descent, the suction cup detaches twice (pop-offs). What is the most appropriate action?
Shoulder dystocia occurs after delivery of the fetal head. The McRoberts maneuver and suprapubic pressure fail after 60 seconds. What is the next maneuver in the structured HELPERR protocol?
Trial of labour after cesarean (TOLAC) is planned for a woman with one prior low transverse cesarean section. Which factor is associated with the HIGHEST risk of uterine rupture during TOLAC?
A multigravida at 40+6 weeks undergoes cervical assessment. Bishop score components: cervical dilation 1 cm (score 1), effacement 40% (score 1), consistency firm (score 0), position posterior (score 0), station -3 (score 0). What is the total Bishop score, and what does it predict?
During the second stage of labor, a fetal head at station +3 is in occiput posterior position. Attempted rotational vacuum extraction fails after three pop-offs. What is the MOST appropriate next step according to current ACOG guidelines?
The Robson classification system categorizes women into 10 groups based on obstetric characteristics to allow standardized audit of cesarean rates. A primigravida with a singleton cephalic pregnancy at term in spontaneous labor belongs to which Robson group, and what is its WHO benchmark target for cesarean rate?
A G1P0 woman at 38 weeks gestation undergoes induction of labor with oxytocin. Cardiotocography shows a baseline FHR of 145 bpm, moderate variability, no accelerations for 40 minutes, and three late decelerations in 20 minutes with return to baseline within 30 seconds. According to NICHD classification, this CTG is categorized as:
A 34-year-old primigravida at 41 weeks has a cervix that is mid-position, firm, 50% effaced, 1 cm dilated, and the fetal head is at -2 station. Calculate the Bishop Score and determine the appropriate management.
A multiparous woman in active labour has been fully dilated for 2.5 hours without delivery. Fetal heart rate shows variable decelerations. The fetal head is at +2 station, occiput anterior, moulding 1+. Which mode of operative vaginal delivery is most appropriate?
During delivery of a macrosomic baby, after the head delivers, the anterior shoulder fails to deliver despite routine traction. The turtle sign is noted. Which maneuver should be attempted FIRST?
A 26-year-old primigravida at term presents with a transverse lie confirmed on ultrasound. Membranes are intact. The most appropriate management at this gestational age is:
A 33-year-old G2P1 with a previous lower segment cesarean section presents in spontaneous labour at 39 weeks. Her previous cesarean was for non-recurrent indication. She is keen for VBAC. A contraindication to a trial of labour after cesarean (TOLAC) in this patient would be:
A primigravida at 41+3 weeks is undergoing induction of labour. Her Bishop score is calculated: cervical dilatation 1 cm (1 point), effacement 40% (1 point), consistency firm (0 points), position posterior (0 points), station -3 (0 points). Total Bishop score = 2. The MOST appropriate initial induction method is:
During operative vaginal delivery with a Kielland's forceps, the fetus is LOT (left occiput transverse) position. The forceps are applied correctly and rotation to OA is performed. Which complication is SPECIFICALLY associated with Kielland's forceps compared to Neville-Barnes forceps?
A multiparous woman at 40 weeks in active labour has been in the second stage for 90 minutes with no progress. The fetal head is at +2 station, OA position, no caput or moulding. CTG is reassuring. The obstetrician elects ventouse (vacuum) delivery. The cup is placed 3 cm anterior to the posterior fontanelle (flexion point). After 3 consecutive pulls without descent, the procedure is abandoned. This is called a:
The ARRIVE trial (2018) compared elective induction of labour at 39 weeks to expectant management in low-risk nulliparous women. Its key finding was:
A primigravida at 41+0 weeks has Bishop score assessed as follows: Cervical dilation 0 cm (0), effacement 30% (1), station -3 (0), consistency firm (0), position posterior (0). What is her Bishop score, and what does it indicate?
During a vacuum-assisted delivery, which of the following conditions is an ABSOLUTE contraindication to using a ventouse/vacuum?
A woman at 39 weeks with a clinically estimated fetal weight of 4.3 kg presents in labour. She is a non-diabetic multipara. The head delivers with the next contraction, but the shoulders do not follow. Mc Roberts' manoeuvre and suprapubic pressure have failed after 60 seconds. What is the NEXT recommended step according to shoulder dystocia drill protocols?
The ARRIVE trial evaluated elective labour induction at 39 weeks versus expectant management in low-risk nulliparous women. The primary finding was that induction at 39 weeks:
A primigravida at 41+2 weeks has a Bishop score of 3. She is scheduled for cervical ripening. Her Bishop score components are: cervical dilation 0 cm (0 points), effacement 30% (0 points), consistency firm (0 points), position posterior (0 points), station -3 (1 point). The modified Bishop score is 1. The most appropriate cervical ripening agent with the best evidence for outpatient use and lowest uterine hyperstimulation risk at term in this scenario is:
During a forceps delivery for prolonged second stage, the blades of Kielland's forceps are applied. What is the unique anatomical feature of Kielland's forceps that allows correction of asynclitism and facilitates rotation?
A woman in active labour has a cervix that is 6 cm dilated for the last 3 hours with adequate uterine contractions (>200 Montevideo units) and vertex at station 0. Membranes are intact. The cardinal movement of descent that is not yet occurring is the clinical definition of which labour abnormality?
During trial of scar (trial of labour after cesarean, TOLAC), which single intrapartum finding is the most specific sign of complete uterine rupture as opposed to uterine dehiscence?
A primigravida at 40+5 weeks has a Bishop score calculated as follows: cervical dilatation 1 cm (score 1), effacement 50% (score 1), consistency soft (score 2), position anterior (score 2), station −1 (score 1). What is her total Bishop score and is cervical priming required?
The CORONIS trial was a large multinational RCT assessing various aspects of caesarean section technique. Which of the following was a conclusion of CORONIS regarding caesarean technique?
In the Friedman labour curve, which of the following constitutes an arrest disorder in the active phase for a nulliparous woman in modern obstetrics (ACOG 2014 definitions)?
A fetal head is palpated at the left occiput posterior position at station +2 on vaginal examination with no further progress for 2 hours in the second stage. The most appropriate instrumental delivery technique is:
In the management of uterine rupture, which structure, when torn, most reliably predicts the need for emergency hysterectomy over uterine repair?
A primigravida at 41 weeks has an unfavourable cervix (Bishop score 3). Her cervix is 1 cm dilated, 50% effaced, -2 station, firm consistency, and posterior position. What is her total Bishop score?
A 30-year-old woman at 40 weeks is in active labour with good contractions. CTG shows variable decelerations with slow recovery. Cervix is 6 cm, head at -1 station. Fetal scalp blood pH is 7.18. The appropriate management is:
Which condition is an absolute contraindication to the use of vacuum extractor (ventouse) for operative vaginal delivery?
The Kristeller manoeuvre (fundal pressure during the second stage) is associated with which specific perineal complication that has led to its abandonment in modern obstetric practice?
According to the Royal College of Obstetricians and Gynaecologists (RCOG) classification, which category of caesarean section requires delivery within 30 minutes of the decision?
A 26-year-old primigravida at 40+3 weeks has a Bishop score of 4. Her obstetrician plans cervical ripening. Which agent acts via prostaglandin E1 receptor agonism and is administered vaginally or sublingually for cervical ripening in an unfavourable cervix?
A 30-year-old G2P1 at 39 weeks is in active labour (6 cm) with oxytocin augmentation. CTG suddenly shows prolonged deceleration to 70 bpm lasting 4 minutes. On examination the cervix is 6 cm and the cord is palpated below the presenting part. Immediate action is:
A 35-year-old woman has an uncomplicated vaginal delivery. At 1 hour postpartum the uterine fundus is above the umbilicus and soft, vaginal bleeding is 650 mL. Bimanual compression and IV oxytocin 20 units have been given. The NEXT pharmacological agent of choice per WHO guidelines is:
During a mid-cavity vacuum-assisted delivery, the cup detaches (pop-off) after three pulls without descent. The fetal head is at +1 station, occiput anterior. Appropriate management at this point is:
A woman at 40+5 weeks has a Bishop score of 6. She undergoes induction with low-dose oxytocin. After 8 hours she is 3 cm dilated. CTG is reactive. What is the most appropriate next step?
A 26-year-old primigravida at 41+2 weeks presents for induction of labour. Cervical examination shows: dilation 1 cm, effacement 40%, station -3, consistency firm, position posterior. Calculate her Bishop score and determine the appropriate cervical ripening method.
During vacuum-assisted delivery, which of the following is considered an ABSOLUTE contraindication to the use of vacuum extractor?
In the Prospective Optimum Fetal Monitoring (INFANT) trial, the use of computer decision support (INFANT system) during intrapartum fetal monitoring with CTG was associated with:
A 32-year-old woman with one previous lower segment cesarean section (LSCS) presents at 39 weeks for counselling about trial of labour after cesarean (TOLAC). The factor that MOST significantly reduces the likelihood of successful vaginal birth after cesarean (VBAC) is:
A woman at 41+3 weeks gestation has an unfavorable cervix (Bishop score 3). She is scheduled for induction of labour. What is the MOST appropriate initial cervical ripening agent?
During the second stage of labour, fetal heart rate tracing shows variable decelerations with slow return to baseline. The station is +2, vertex presentation, OA position. An operative vaginal delivery is planned. Which condition must be confirmed BEFORE applying forceps?
A primigravida in active labour is noted to have arrest of active phase — no cervical change for 4 hours with adequate contractions (>200 Montevideo units). She is at 7 cm with intact membranes. The fetal head is at station 0 in OA position. What is the MOST appropriate next management step?
In shoulder dystocia, the McRoberts manoeuvre combined with suprapubic pressure is applied first. If unsuccessful, the next step in the HELPERR mnemonic involves internal rotation. Which manoeuvre involves rotating the fetus by pressure on the posterior aspect of the anterior shoulder to rotate the fetal trunk?
The ARRIVE trial (2018) assessed elective induction at 39 weeks in low-risk nulliparous women. Its main finding was:
A 30-year-old G2P1 has an occiput posterior position diagnosed at full dilation after 2 hours of pushing. Station is +2. The MOST appropriate immediate action is:
Which fetal head position is an absolute contraindication to the use of a ventouse (vacuum extractor) in operative vaginal delivery?
The maximum number of 'pulls' (tractions) permitted in a single ventouse application attempt before abandoning the procedure is:
The ARRIVE trial (2018) evaluated elective induction at 39 weeks versus expectant management in low-risk nulliparous women. The key finding was that elective induction at 39 weeks:
A vacuum delivery attempt fails after three pop-offs. The clinician should next:
During active phase of labor, a primigravida's cervix fails to dilate beyond 6 cm despite 4 hours of adequate uterine contractions (>200 Montevideo units) with ruptured membranes. This is best classified as:
Which of the following is a prerequisite for safe application of obstetric forceps?
During the second stage of labor, a sustained deceleration to 70 bpm lasting 5 minutes occurs with a 4/5 fetal head palpable abdominally and complete cervical dilatation. Maternal pushing efforts are effective. Which is the MOST appropriate immediate intervention?
The Kjelland forceps is specifically designed for which indication among the following?
According to the Robson classification for cesarean sections (10-group classification), which group comprises the largest contributor to overall cesarean section rates in most high-resource settings?
In shoulder dystocia management, the HELPERR mnemonic is used. After calling for help (H) and evaluating for episiotomy (E), which maneuver is listed next as the primary maneuver?
The ARRIVE trial (NEJM 2018) compared elective induction at 39 weeks versus expectant management in low-risk nulliparous women. What was the primary finding?
During vacuum-assisted delivery, the chignon refers to which structure?
The modified Lovset's maneuver is employed during vaginal breech delivery. What is its purpose?
The partograph has a 'action line' drawn 4 hours to the right of the 'alert line.' When cervical dilatation reaches the action line in active labor, what is the recommended response?
According to ACOG (2014) guidelines on labor dystocia, active phase arrest (failure to progress) is defined as no cervical change after at least how many hours of adequate contractions in the active phase?
A woman has a previous lower segment cesarean section (LSCS) and is at 39 weeks with an unfavorable cervix (Bishop score 3). Her obstetrician plans induction of labor for post-dates concern. Which cervical ripening agent is CONTRAINDICATED in this setting?
Kjelland's forceps differs from standard outlet forceps in that it has a sliding lock mechanism. The primary clinical indication for Kjelland's forceps is:
The ARRIVE trial (2018) randomized low-risk nulliparous women with uncomplicated pregnancies to elective induction at 39 weeks versus expectant management. The primary finding was:
A 38-year-old primigravida at 41 weeks with a cephalic presentation and adequate pelvis has a Bishop score of 3. She is to be induced. Which cervical ripening agent causes fewer uterine hyperstimulation episodes when compared with misoprostol?
During active labour, partogram shows the cervix has been at 7 cm for 3 hours despite adequate uterine contractions (> 200 Montevideo units). The head is at station 0, occiput is in the transverse position, and pelvis is adequate. The most likely diagnosis is:
A vacuum extraction is attempted for a prolonged second stage. After three pull attempts with no descent, the cup detaches. The most appropriate next step is:
The Robson 10-group classification system for caesarean sections is used primarily for:
In shoulder dystocia, which manoeuvre directly enlarges the true conjugate of the pelvis by flattening the lumbar lordosis?
A woman at 39 weeks with an unfavourable cervix is assessed before induction of labour. Examination reveals: cervical dilation 3 cm, effacement 60%, consistency soft, position mid, and fetal station −1. What is the Bishop score?
A shoulder dystocia occurs during a vaginal delivery. After McRoberts manoeuvre and suprapubic pressure fail, the obstetrician delivers the posterior arm. This is correctly described as:
Regarding vacuum-assisted delivery (ventouse), which of the following is a MATERNAL indication (not a fetal contraindication) for preferring forceps over ventouse?
A 30-year-old G1P0 at 41 weeks is being induced with vaginal misoprostol. She suddenly develops uterine tachysystole (>5 contractions/10 min) with fetal bradycardia. The most appropriate immediate step is:
The Zavanelli manoeuvre is a last-resort procedure in which of the following obstetric emergencies?
A primigravida at 40 weeks gestation has a Bishop score of 3. Induction of labour is planned. The PREFERRED agent for cervical ripening in this case is:
Which of the following is the DEFINING criterion for active phase arrest (protracted active phase per contemporary ACOG/SMFM criteria)?
A fetal heart rate pattern shows variable decelerations occurring with most contractions, with return to baseline, no loss of variability, and no late component. Duration of deceleration is less than 30 seconds. This Category I/II/III classification and the MOST appropriate management is:
The ORACLE trials on preterm prelabour rupture of membranes (PPROM) evaluated antibiotic use. The key finding regarding erythromycin versus co-amoxiclav was:
At 38 weeks gestation, a woman in active labour has second stage arrest. The fetal head is at station +2, occiput anterior, with adequate maternal effort. An attempt at operative vaginal delivery is made. Which of the following is a CONTRAINDICATION to vacuum-assisted delivery?
The ARRIVE trial evaluated elective induction of labour at 39 weeks compared to expectant management. Its main finding was:
A woman in active labour at 7 cm dilation has epidural analgesia. The CTG shows baseline FHR 135 bpm, reduced variability (3 bpm), and late decelerations following each contraction. The oxytocin infusion is running at 10 mU/min. The MOST appropriate immediate management is:
During a delivery, shoulder dystocia is encountered. The McRoberts maneuver and suprapubic pressure have been applied for 60 seconds without success. The NEXT appropriate maneuver in the HELPERR algorithm is:
A woman is in active labour at 8 cm dilatation. Partograph shows cervical dilatation has crossed the action line. She has had adequate uterine contractions (4 in 10 minutes, each lasting >45 seconds). The fetal head is at station -1. What does crossing the action line mandate?
During a vacuum-assisted delivery at full dilatation, the cup detaches twice despite correct technique. The fetal head is at station +2. What should be done?
The ARRIVE trial demonstrated which finding regarding elective labour induction at 39 weeks in low-risk nulliparous women?
A persistent occiput posterior (OP) position is confirmed at full dilatation. The fetal head is at +2 station and caput is present. Manual rotation to occiput anterior position is attempted but fails. Which forceps is most appropriate for rotational delivery?
A woman is receiving oxytocin augmentation for slow progress. The CTG shows late decelerations with reduced variability. Contractions are 5 in 10 minutes. What is the first action?
A 26-year-old primigravida at 41 weeks has a Bishop score of 4. Which of the following is the MOST appropriate cervical ripening agent to use in an outpatient or low-intensity monitoring setting, given that uterine hyperstimulation should be rapidly reversible?
In a persistent occiput posterior (OP) position at full dilatation, the MOST common mechanism by which spontaneous rotation to occiput anterior (OA) occurs is:
A ventouse cup is applied to the fetal head at the flexion point (3 cm anterior to the posterior fontanelle) and two pulls are performed. The cup detaches with the third pull (pop-off). What is the correct management?
The Friedman curve defines protracted active-phase dilatation as cervical dilation progressing slower than which threshold in a nulliparous woman?
A nulliparous woman at 38 weeks is in active labour with cervix 7 cm, 100% effaced, vertex at +1 station, and membranes intact. CTG shows repetitive late decelerations with reduced variability. She is taken for emergency caesarean. What is the minimum umbilical cord arterial pH that defines perinatal asphyxia per ACOG criteria?
In a non-reactive NST (no accelerations in 40 minutes), the next appropriate step is to perform a biophysical profile (BPP). A BPP score of 6/10 (with amniotic fluid index of 5 cm, absent fetal tone, 1 fetal movement, 1 breathing episode, and a non-reactive NST) at 35 weeks indicates:
A 28-year-old nulliparous woman at 39 weeks undergoes elective induction of labour. The ARRIVE trial (2018, NEJM) evaluated elective induction at 39 weeks versus expectant management in low-risk nulliparas. The primary finding was:
During the second stage of labour, a multiparous woman develops prolonged fetal bradycardia to 90 bpm for 5 minutes. Station is +2, vertex presentation, occiput anterior, cervix fully dilated. The quickest method to achieve expeditious delivery is:
The ARRIVE trial (NEJM 2018) studied elective induction of labour at 39 weeks versus expectant management in low-risk nulliparous women. What was its primary finding regarding caesarean section rates?
A 29-year-old in second stage of labour has a prolonged deceleration to 80 bpm lasting 8 minutes. The cervix is fully dilated, station +3, OA position, and outlet is adequate. She cannot push due to epidural. Which intervention is MOST appropriate?
A prolonged second stage of labor is defined as how long in a nulliparous woman with epidural analgesia (current ACOG 2014 guidelines)?
In managing shoulder dystocia, which maneuver involves suprapubic pressure combined with flexion-abduction-external rotation of the posterior fetal hip to decrease the shoulder circumference and deliver the posterior arm?
According to the Friedman curve revised criteria (Zhang et al., 2010) for active labour, which threshold of cervical dilation marks the onset of the active phase in nulliparous women?
A CTG in active labour shows: baseline 155 bpm, reduced variability (<5 bpm for 45 minutes), recurrent late decelerations after every contraction, no accelerations. According to NICE 2022 CTG classification, this trace is:

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