The B-Lynch technique used in the management of postpartum haemorrhage is a:

Uterine compression suture at laparotomy

Balloon placed into the uterine cavity

Ligation of the internal iliac arteries

Pressure garment applied to the legs

Before manual removal of a retained placenta, WHO recommends which preventive measure?

A single dose of prophylactic antibiotic

A blood transfusion of two units

A course of oral iron for three days beforehand

An injection of anti-D to all women

On day 4 after a caesarean section, a woman suddenly develops sharp right-sided chest pain and breathlessness. Pulse 118/min, respiratory rate 28/min, SpO2 89% on air, BP 112/70 mmHg; her left calf was noted to be swollen yesterday. What is the nurse's priority?

Sit her up, give oxygen and get urgent medical help for suspected PE

Help her walk to the toilet to improve her circulation

Massage the left calf to ease the swelling and the pain

Give an analgesic and reassess her in one hour

In normal labour, the ridge that forms at the junction of the thickened upper uterine segment and the thinned lower segment is called the:

Constriction (contraction) ring

A woman at 37 weeks has a breech presentation and wishes to try external cephalic version. Which finding makes ECV unsuitable for her?

Major placenta praevia on her scan

Amniotic fluid index is in the normal range

She has had one previous vaginal birth

The breech is frank, with extended legs

Labour, obstetric emergencies and puerperium

50 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Labour, obstetric emergencies and puerperium, part of Obstetric 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 · Easy
The B-Lynch technique used in the management of postpartum haemorrhage is a:
1. ABalloon placed into the uterine cavity
2. BLigation of the internal iliac arteries
3. CPressure garment applied to the legs
4. DUterine compression suture at laparotomy
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Answer: D · Uterine compression suture at laparotomy
The B-Lynch suture is a brace suture placed around the uterus at laparotomy, usually at caesarean section, to compress an atonic uterus mechanically. It is used when uterotonics and less invasive measures have failed, and it can save the uterus and fertility. It is one of the conservative surgical steps tried before hysterectomy. The nurse prepares for theatre and keeps blood products available.
- A: A balloon in the uterine cavity is uterine balloon tamponade, done vaginally.
- B: Internal iliac artery ligation is a separate surgical step that reduces pelvic blood flow.
- C: A pressure garment on the legs and abdomen is the non-pneumatic anti-shock garment.
Question 2 · Medium
Before manual removal of a retained placenta, WHO recommends which preventive measure?
1. AA blood transfusion of two units
2. BA single dose of prophylactic antibiotic
3. CA course of oral iron for three days beforehand
4. DAn injection of anti-D to all women
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Answer: B · A single dose of prophylactic antibiotic
Manual removal introduces the hand and organisms from the vagina into the uterine cavity, so the risk of endometritis rises. WHO recommends a single prophylactic dose of antibiotic, such as ampicillin or a first-generation cephalosporin. The procedure is done under anaesthesia with the bladder empty and a uterotonic given afterwards. The placenta is then checked for completeness.
- A: Transfusion is given for blood loss, not as routine prophylaxis.
- C: Oral iron treats anaemia later; it does not prevent infection.
- D: Anti-D is for Rh-negative women only and does not prevent infection.
Question 3 · Hard
On day 4 after a caesarean section, a woman suddenly develops sharp right-sided chest pain and breathlessness. Pulse 118/min, respiratory rate 28/min, SpO2 89% on air, BP 112/70 mmHg; her left calf was noted to be swollen yesterday. What is the nurse's priority?
1. AHelp her walk to the toilet to improve her circulation
2. BMassage the left calf to ease the swelling and the pain
3. CGive an analgesic and reassess her in one hour
4. DSit her up, give oxygen and get urgent medical help for suspected PE
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Answer: D · Sit her up, give oxygen and get urgent medical help for suspected PE
Caesarean birth, the puerperium and a swollen calf put her at high risk of deep vein thrombosis, and sudden pleuritic chest pain, tachypnoea, tachycardia and hypoxia point to pulmonary embolism. The priority is airway, breathing and circulation: sit her up, give oxygen, call the doctor urgently and prepare for anticoagulation and imaging. Venous thromboembolism is a leading direct cause of maternal death in the puerperium. Prevention with early mobilisation, stockings and LMWH for at-risk women is part of postnatal care.
- A: Walking her increases oxygen demand and risk while she is hypoxic.
- B: Massaging a calf with suspected DVT can dislodge more clot.
- C: Analgesia alone delays treatment of a life-threatening embolism.
Question 4 · Easy
In normal labour, the ridge that forms at the junction of the thickened upper uterine segment and the thinned lower segment is called the:
1. APhysiological retraction ring
2. BInternal cervical os
3. CConstriction (contraction) ring
4. DBandl's pathological ring
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Answer: A · Physiological retraction ring
As labour progresses, the upper segment contracts and retracts and becomes thicker, while the lower segment is stretched and thinned. The boundary between them is the physiological retraction ring, which is normal and is not felt abdominally. In obstructed labour this ring rises and becomes visible as Bandl's ring, a warning of impending rupture. The distinction matters because one is normal physiology and the other an emergency.
- B: The internal os is part of the cervix and is taken up into the lower segment during effacement.
- C: A constriction ring is a localised spasm of circular fibres, often around a fetal part.
- D: Bandl's ring is the pathological form seen abdominally in obstructed labour.
Question 5 · Medium
A woman at 37 weeks has a breech presentation and wishes to try external cephalic version. Which finding makes ECV unsuitable for her?
1. AAmniotic fluid index is in the normal range
2. BShe has had one previous vaginal birth
3. CMajor placenta praevia on her scan
4. DThe breech is frank, with extended legs
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Answer: C · Major placenta praevia on her scan
ECV is offered from about 36-37 weeks to reduce breech births and caesarean sections. It is unsuitable when caesarean section is needed anyway, as in major placenta praevia, or when there is antepartum bleeding, ruptured membranes or an abnormal fetal heart. Placenta praevia also carries a risk of bleeding during manipulation. Before and after ECV the fetal heart is monitored, and an Rh-negative woman receives anti-D.
- A: A normal amniotic fluid volume favours a successful version.
- B: A previous vaginal birth makes ECV more likely to succeed.
- D: A frank breech can be turned; it is not a contraindication.
Question 6 · Medium
A woman who had a massive postpartum haemorrhage with prolonged shock cannot establish breastfeeding because her breasts never fill. This most strongly suggests:
1. ABreast engorgement blocking the ducts
2. BPhysiological delay in the coming in of milk
3. CAsherman's syndrome (intrauterine adhesions)
4. DSheehan's syndrome (postpartum pituitary necrosis)
Answer and explanation in LearnFree account
Question 7 · Medium
After the placenta is delivered, bleeding from the placental site is controlled mainly by:
1. APressure of the empty bladder on the uterus
2. BFormation of a clot in the uterine cavity
3. CSpasm of the uterine arteries outside the uterus
4. DRetraction of the interlacing myometrial fibres
Answer and explanation in LearnFree account
Question 8 · Medium
In a brow presentation at term with an average-sized baby, the diameter that presents is the:
1. ABiparietal
2. BMentovertical
3. CSubmentobregmatic
4. DSuboccipitobregmatic
Answer and explanation in LearnFree account
Question 9 · Medium
For atonic PPH that continues despite uterotonics and tranexamic acid, WHO recommends which next measure while surgery is being arranged?
1. ARepeated ergometrine every 5 minutes
2. BHot water bottle over the abdomen
3. CPacking the vagina with dry gauze
4. DUterine balloon tamponade
Answer and explanation in LearnFree account
Question 10 · Easy
At the 6-week postnatal check, a woman has a 3-finger-wide gap between the two rectus muscles above the umbilicus. This is:
1. ADiastasis recti abdominis
2. BUterine subinvolution
3. CLinea nigra
4. DAn incisional hernia
Answer and explanation in LearnFree account
Question 11 · Easy
At term, especially in a primigravida, the most common type of breech presentation is the:
1. AKnee presentation
2. BFootling breech
3. CComplete (flexed) breech
4. DFrank (extended legs) breech
Answer and explanation in LearnFree account
Question 12 · Easy
Compared with foremilk, the hindmilk that comes towards the end of a breastfeed is especially rich in:
1. AFat
2. BLactose
3. CImmunoglobulin A
4. DWater
Answer and explanation in LearnFree account
Question 13 · Easy
The non-pneumatic anti-shock garment (NASG) is used in postpartum haemorrhage to:
1. AReplace blood loss so transfusion can be avoided
2. BReduce bleeding and support circulation during transfer
3. CCompress the uterus from inside the cavity
4. DContract the uterus in place of uterotonic drugs
Answer and explanation in LearnFree account
Question 14 · Medium
On day 4 after birth, a first-time mother cries easily, feels anxious and says she is not a good mother, but she sleeps when the baby sleeps and cares for him well. The nurse's best explanation is that:
1. AShe has postnatal depression and needs an antidepressant
2. BThese are signs of postpartum psychosis needing admission
3. CHer feelings mean she should stop breastfeeding to rest
4. DThese are maternity blues, which usually settle within two weeks
Answer and explanation in LearnFree account
Question 15 · Easy
After delivery of the placenta, copious milk secretion (lactogenesis II) begins mainly because the level of which hormone falls?
1. AProgesterone
2. BProlactin
3. COxytocin
4. DCortisol
Answer and explanation in LearnFree account
Question 16 · Medium
Internal rotation of the fetal head in normal labour is brought about mainly by:
1. AThe gutter-shaped pelvic floor muscles
2. BPressure of the full bladder on the fetal head
3. CTraction applied by maternal pushing
4. DContraction of the round ligaments
Answer and explanation in LearnFree account
Question 17 · Hard
An intrauterine pressure catheter records 4 contractions in 10 minutes with peak pressures of 70, 75, 65 and 70 mmHg; the resting tone is 15 mmHg. What are the Montevideo units, and is the activity adequate (adequate = 200 or more)?
1. A280 units, adequate
2. B55 units, inadequate
3. C220 units, adequate
4. D165 units, inadequate
Answer and explanation in LearnFree account
Question 18 · Medium
A multipara in labour at term has a transverse lie. The membranes have ruptured and a fetal arm has prolapsed through the cervix; the fetal heart is 140/min. What is the appropriate management?
1. AAwait spontaneous evolution of the fetus
2. BPrepare her for an emergency caesarean section
3. CPush the arm back and start oxytocin
4. DPerform internal podalic version under sedation
Answer and explanation in LearnFree account
Question 19 · Hard
During an assisted breech birth, a student midwife starts to pull on the baby's legs as soon as the buttocks are born. Why should she stop and keep her hands off until the umbilicus is born?
1. ATraction causes the cord to prolapse in front of the buttocks
2. BTraction makes the cervix dilate too quickly
3. CTraction makes the arms extend and the head deflex
4. DTraction rotates the sacrum to a posterior position
Answer and explanation in LearnFree account
Question 20 · Easy
In the Schultze method of placental separation, separation starts at the centre and the placenta appears at the vulva with its:
1. ALower margin first
2. BFetal surface first
3. CMaternal surface first
4. DCord insertion hidden
Answer and explanation in LearnFree account
Question 21 · Hard
Forty-five minutes after a normal birth with AMTSL, the placenta is still undelivered. The bladder has been emptied, oxytocin repeated and controlled cord traction tried twice without success, and she has now lost about 400 mL with fresh bleeding. What is the next step?
1. AFirm fundal pressure to push the placenta out
2. BInjection of oxytocin into the umbilical vein
3. CManual removal of the placenta under anaesthesia
4. DWait another hour for spontaneous placental separation
Answer and explanation in LearnFree account
Question 22 · Medium
When an episiotomy is needed, the mediolateral cut is preferred to the midline cut in Indian practice mainly because it:
1. AIs less likely to extend into the anal sphincter
2. BNeeds no local anaesthetic before cutting
3. CHeals with less pain and a better cosmetic appearance
4. DBleeds less and is easier to repair
Answer and explanation in LearnFree account
Question 23 · Hard
A primigravida in labour at 4 cm has had contractions 2-3 in 10 minutes for 9 hours, with no change since admission. Her vital signs are normal, the fetal heart is 140/min with no decelerations and membranes are intact. Following WHO 2018 recommendations, the appropriate plan is:
1. ASupportive care and monitoring, without intervention to speed labour
2. BAn oxytocin infusion, as the latent phase is prolonged
3. CArtificial rupture of membranes to establish active labour
4. DCaesarean section for failure to progress
Answer and explanation in LearnFree account
Question 24 · Hard
A woman with asthma and pre-eclampsia (BP 158/104 mmHg) has atonic PPH after a vaginal birth. Oxytocin is running and tranexamic acid has been given, but the uterus remains soft. Which additional uterotonic is safest for her?
1. AMisoprostol 800 micrograms sublingually
2. BCarboprost 250 micrograms intramuscularly
3. CDinoprostone gel into the posterior fornix
4. DErgometrine 0.2 mg intramuscularly
Answer and explanation in LearnFree account
Question 25 · Medium
In an occipito-posterior position the head is often deflexed. The anteroposterior diameter that then tends to engage is the:
1. ASubmentobregmatic, 9.5 cm
2. BMentovertical, about 14 cm
3. CSuboccipitobregmatic, 9.5 cm
4. DOccipitofrontal, 11.5 cm
Answer and explanation in LearnFree account

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Labour, obstetric emergencies and puerperium

The B-Lynch technique used in the management of postpartum haemorrhage is a:

Before manual removal of a retained placenta, WHO recommends which preventive measure?

On day 4 after a caesarean section, a woman suddenly develops sharp right-sided chest pain and breathlessness. Pulse 118/min, respiratory rate 28/min, SpO2 89% on air, BP 112/70 mmHg; her left calf was noted to be swollen yesterday. What is the nurse's priority?

In normal labour, the ridge that forms at the junction of the thickened upper uterine segment and the thinned lower segment is called the:

A woman at 37 weeks has a breech presentation and wishes to try external cephalic version. Which finding makes ECV unsuitable for her?

A woman who had a massive postpartum haemorrhage with prolonged shock cannot establish breastfeeding because her breasts never fill. This most strongly suggests:

After the placenta is delivered, bleeding from the placental site is controlled mainly by:

In a brow presentation at term with an average-sized baby, the diameter that presents is the:

For atonic PPH that continues despite uterotonics and tranexamic acid, WHO recommends which next measure while surgery is being arranged?

At the 6-week postnatal check, a woman has a 3-finger-wide gap between the two rectus muscles above the umbilicus. This is:

At term, especially in a primigravida, the most common type of breech presentation is the:

Compared with foremilk, the hindmilk that comes towards the end of a breastfeed is especially rich in:

The non-pneumatic anti-shock garment (NASG) is used in postpartum haemorrhage to:

On day 4 after birth, a first-time mother cries easily, feels anxious and says she is not a good mother, but she sleeps when the baby sleeps and cares for him well. The nurse's best explanation is that:

After delivery of the placenta, copious milk secretion (lactogenesis II) begins mainly because the level of which hormone falls?

Internal rotation of the fetal head in normal labour is brought about mainly by:

An intrauterine pressure catheter records 4 contractions in 10 minutes with peak pressures of 70, 75, 65 and 70 mmHg; the resting tone is 15 mmHg. What are the Montevideo units, and is the activity adequate (adequate = 200 or more)?

A multipara in labour at term has a transverse lie. The membranes have ruptured and a fetal arm has prolapsed through the cervix; the fetal heart is 140/min. What is the appropriate management?

During an assisted breech birth, a student midwife starts to pull on the baby's legs as soon as the buttocks are born. Why should she stop and keep her hands off until the umbilicus is born?

In the Schultze method of placental separation, separation starts at the centre and the placenta appears at the vulva with its:

Forty-five minutes after a normal birth with AMTSL, the placenta is still undelivered. The bladder has been emptied, oxytocin repeated and controlled cord traction tried twice without success, and she has now lost about 400 mL with fresh bleeding. What is the next step?

When an episiotomy is needed, the mediolateral cut is preferred to the midline cut in Indian practice mainly because it:

A primigravida in labour at 4 cm has had contractions 2-3 in 10 minutes for 9 hours, with no change since admission. Her vital signs are normal, the fetal heart is 140/min with no decelerations and membranes are intact. Following WHO 2018 recommendations, the appropriate plan is:

A woman with asthma and pre-eclampsia (BP 158/104 mmHg) has atonic PPH after a vaginal birth. Oxytocin is running and tranexamic acid has been given, but the uterus remains soft. Which additional uterotonic is safest for her?

In an occipito-posterior position the head is often deflexed. The anteroposterior diameter that then tends to engage is the: