External rotation of the fetal head after its birth reflects:

Internal rotation of the shoulders

After the birth of a baby weighing 2.1 kg, the midwife notes that the uterus is still large, with the fundus near the xiphisternum. Before giving oxytocin for the third stage, she should:

Palpate the abdomen to exclude a second baby

Apply controlled cord traction at once

Normal and abnormal labour and puerperium

35 Kerala PSC Staff Nurse Gr II practice questions on Normal and abnormal labour and puerperium, part of Midwifery and Gynaecological Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
External rotation of the fetal head after its birth reflects:
1. ADescent of the breech
2. BSeparation of the placenta
3. CExtension of the fetal neck
4. DInternal rotation of the shoulders
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Answer: D · Internal rotation of the shoulders
After the head is born it first untwists (restitution) and then turns further as the shoulders rotate inside the pelvis to the anteroposterior diameter of the outlet. This movement of the head is called external rotation. The anterior shoulder is then born under the symphysis. Watching it tells the midwife which way to guide the shoulders.
- A: Vertex presentations have no breech descent.
- B: Placental separation is part of the third stage.
- C: Extension is how the head is born, before restitution.
Question 2 · Hard
After the birth of a baby weighing 2.1 kg, the midwife notes that the uterus is still large, with the fundus near the xiphisternum. Before giving oxytocin for the third stage, she should:
1. AApply controlled cord traction at once
2. BGive ergometrine IV instead
3. CMassage the fundus vigorously
4. DPalpate the abdomen to exclude a second baby
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Answer: D · Palpate the abdomen to exclude a second baby
A small baby and a uterus still far above the umbilicus suggest an undiagnosed second twin. Oxytocin given now would contract the uterus around the second baby and cause hypoxia. The abdomen is palpated, and the fetal heart checked, before any uterotonic is given. AMTSL always begins by excluding another baby.
- A: Cord traction is done only after a uterotonic and with a contracted uterus.
- B: Ergometrine would cause a sustained spasm and trap the second baby.
- C: Fundal massage is used after the placenta is delivered, not here.
Question 3 · Easy
In active management of the third stage of labour (AMTSL), the uterotonic of choice is:
1. AOxytocin 10 IU IM
2. BCarboprost 250 µg IM
3. CErgometrine 0.2 mg IV
4. DDinoprostone gel
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Answer: A · Oxytocin 10 IU IM
WHO recommends oxytocin 10 IU IM within one minute of birth for every woman, after a second baby has been excluded. Oxytocin acts quickly, is stable in a cold chain and has few side effects. Ergometrine raises BP and causes vomiting, and carboprost is kept for treatment of PPH. Dinoprostone is used for cervical ripening, not the third stage.
- B: Carboprost is a second-line drug for treating PPH.
- C: Ergometrine causes hypertension and vomiting, so it is not first choice.
- D: Dinoprostone gel ripens the cervix before induction.
Question 4 · Easy
On the WHO modified partograph, the action line is drawn parallel to the alert line and how many hours to its right?
1. A8 hours
2. B2 hours
3. C4 hours
4. D1 hour
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Answer: C · 4 hours
The alert line starts at 4 cm and represents dilatation of 1 cm per hour. The action line lies 4 hours to its right. Crossing the alert line means a referral or close review, and reaching the action line calls for a decision by the doctor. The lines make delay easy to see at a glance.
- A: Eight hours would allow dangerous delay.
- B: Two hours is not the standard gap.
- D: A 1-hour gap would trigger action too early.
Question 5 · Easy
In the contractions row of the WHO partograph, a fully shaded box means each contraction lasts:
1. A20 to 40 seconds
2. BMore than 40 seconds
3. CMore than 2 minutes
4. DLess than 20 seconds
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Answer: B · More than 40 seconds
The number of boxes filled shows how many contractions occur in 10 minutes, and the shading shows their length. Dots mean under 20 seconds, diagonal lines 20-40 seconds and solid shading more than 40 seconds. Strong, long contractions with no progress raise concern about obstruction. More than five in 10 minutes is hyperstimulation.
- A: Diagonal lines stand for 20-40 seconds.
- C: The partograph has no symbol for contractions over 2 minutes.
- D: Dots are used for contractions shorter than 20 seconds.
Question 6 · Medium
In a primigravida in labour, effacement of the cervix usually:
1. AComes before dilatation
2. BFollows full dilatation
3. COccurs only in the second stage
4. DDoes not happen at all
Answer and explanation in LearnFree account
Question 7 · Hard
After a rapid forceps delivery, a woman has a steady trickle of bright red blood. The placenta is complete and the uterus is firm and well contracted. What is the most likely cause?
1. AGenital tract trauma
2. BUterine atony
3. CCoagulation failure
4. DRetained placental tissue
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Question 8 · Hard
Three hours after a vaginal birth with an episiotomy, a mother has severe perineal pain. There is a tense, tender, bluish swelling beside the vulva, and her pulse has risen to 112/min. What is the most likely cause?
1. AHaemorrhoids
2. BEpisiotomy wound infection
3. CVulval haematoma
4. DPostpartum urinary retention
Answer and explanation in LearnFree account
Question 9 · Medium
A mother with a sutured episiotomy is advised warm sitz baths from the second day. Their main benefit is to:
1. ADissolve the stitches more quickly
2. BEase pain and help the wound heal
3. CPrevent engorgement of the breasts
4. DStop the flow of lochia
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Question 10 · Medium
During the second stage, 'crowning' is said to occur when the fetal head:
1. ABecomes engaged in the pelvic brim
2. BCompletes its external rotation
3. CFirst becomes visible at the vulva
4. DNo longer recedes between contractions
Answer and explanation in LearnFree account
Question 11 · Easy
The 'show' seen at the onset of labour is:
1. ALeaking clear amniotic fluid
2. BFresh bleeding from the placenta
3. CBlood-stained mucus from the cervix
4. DMeconium-stained vaginal discharge
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Question 12 · Medium
Which muscle is cut in a mediolateral episiotomy?
1. AExternal anal sphincter
2. BBulbospongiosus
3. CGluteus maximus
4. DObturator internus
Answer and explanation in LearnFree account
Question 13 · Easy
In a vertex presentation, the denominator used to name the position is the:
1. AAcromion
2. BSacrum
3. CMentum
4. DOcciput
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Question 14 · Easy
According to Dutta, the average duration of the first stage of labour in a primigravida is about:
1. A12 hours
2. B2 hours
3. C6 hours
4. D24 hours
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Question 15 · Medium
Three weeks after delivery, a mother's uterus is still felt above the symphysis and she has red lochia. This suggests:
1. ANormal involution
2. BLochia alba
3. CSubinvolution of the uterus
4. DPostpartum blues
Answer and explanation in LearnFree account
Question 16 · Easy
The first stage of labour ends with:
1. ABirth of the baby
2. BFull dilatation of the cervix
3. CExpulsion of the placenta
4. DRupture of the membranes
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Question 17 · Medium
On day 3, a mother has a painful crack on her nipple. Which advice best prevents it from recurring?
1. AStop breastfeeding until it heals
2. BLimit each feed to five minutes
3. CWash the nipples with soap before every feed
4. DCorrect the baby's attachment at the breast
Answer and explanation in LearnFree account
Question 18 · Easy
Lochia rubra is normally seen for how long after delivery?
1. A1 to 4 days
2. B3 to 6 weeks
3. C10 to 15 days
4. D5 to 9 days
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Question 19 · Medium
A perineal tear that involves the anal sphincter but not the rectal mucosa is classified as:
1. AFirst degree
2. BThird degree
3. CFourth degree
4. DSecond degree
Answer and explanation in LearnFree account
Question 20 · Hard
A woman's labour pains began at 02:00. Her cervix was fully dilated at 12:30, the baby was born at 13:20 and the placenta at 13:35. What was the total duration of labour?
1. A10 hours 30 minutes
2. B11 hours 35 minutes
3. C11 hours 20 minutes
4. D12 hours 35 minutes
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Question 21 · Medium
During controlled cord traction, the other hand is placed above the symphysis pubis to:
1. AFeel for the fetal heart
2. BPrevent inversion of the uterus
3. CMassage the bladder empty
4. DSpeed separation of the placenta
Answer and explanation in LearnFree account
Question 22 · Medium
Lovset's manoeuvre in an assisted breech delivery is used to deliver:
1. AThe aftercoming head
2. BExtended legs
3. CExtended arms
4. DThe anterior shoulder in a vertex birth
Answer and explanation in LearnFree account
Question 23 · Easy
When lactation has to be suppressed, for example after a stillbirth, the drug commonly used is:
1. ACabergoline
2. BOxytocin
3. CMetoclopramide
4. DDomperidone
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Question 24 · Hard
On day 10 after a caesarean, a mother has pain and swelling of the left calf with a low fever. What is the most appropriate nursing action?
1. AElevate the leg, avoid massage and inform the doctor
2. BEncourage brisk walking to improve circulation
3. CApply a hot pack and give a painkiller only
4. DMassage the calf firmly to relieve the cramp
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Question 25 · Hard
A mother who is HBsAg positive delivers a healthy term baby. The baby is to receive hepatitis B vaccine and hepatitis B immunoglobulin within 12 hours. What advice about feeding is correct?
1. AStart breastfeeding only after the third vaccine dose
2. BAvoid breastfeeding completely
3. CBreastfeed normally from birth
4. DExpress and discard the milk for 6 weeks
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Normal and abnormal labour and puerperium

External rotation of the fetal head after its birth reflects:

After the birth of a baby weighing 2.1 kg, the midwife notes that the uterus is still large, with the fundus near the xiphisternum. Before giving oxytocin for the third stage, she should:

In active management of the third stage of labour (AMTSL), the uterotonic of choice is:

On the WHO modified partograph, the action line is drawn parallel to the alert line and how many hours to its right?

In the contractions row of the WHO partograph, a fully shaded box means each contraction lasts:

In a primigravida in labour, effacement of the cervix usually:

After a rapid forceps delivery, a woman has a steady trickle of bright red blood. The placenta is complete and the uterus is firm and well contracted. What is the most likely cause?

Three hours after a vaginal birth with an episiotomy, a mother has severe perineal pain. There is a tense, tender, bluish swelling beside the vulva, and her pulse has risen to 112/min. What is the most likely cause?

A mother with a sutured episiotomy is advised warm sitz baths from the second day. Their main benefit is to:

During the second stage, 'crowning' is said to occur when the fetal head:

The 'show' seen at the onset of labour is:

Which muscle is cut in a mediolateral episiotomy?

In a vertex presentation, the denominator used to name the position is the:

According to Dutta, the average duration of the first stage of labour in a primigravida is about:

Three weeks after delivery, a mother's uterus is still felt above the symphysis and she has red lochia. This suggests:

The first stage of labour ends with:

On day 3, a mother has a painful crack on her nipple. Which advice best prevents it from recurring?

Lochia rubra is normally seen for how long after delivery?

A perineal tear that involves the anal sphincter but not the rectal mucosa is classified as:

A woman's labour pains began at 02:00. Her cervix was fully dilated at 12:30, the baby was born at 13:20 and the placenta at 13:35. What was the total duration of labour?

During controlled cord traction, the other hand is placed above the symphysis pubis to:

Lovset's manoeuvre in an assisted breech delivery is used to deliver:

When lactation has to be suppressed, for example after a stillbirth, the drug commonly used is:

On day 10 after a caesarean, a mother has pain and swelling of the left calf with a low fever. What is the most appropriate nursing action?

A mother who is HBsAg positive delivers a healthy term baby. The baby is to receive hepatitis B vaccine and hepatitis B immunoglobulin within 12 hours. What advice about feeding is correct?