A 24-year-old primigravida at term is admitted to a district hospital labour room at 10 am with the cervix 4 cm dilated, and labour is plotted on the modified WHO partograph. At 6 pm the cervix is 6 cm, the head is 3/5 palpable, membranes are intact, contractions are 2 in 10 minutes lasting 20 seconds, there is no caput or moulding and the fetal heart rate is 140/min. What is the most appropriate next step?

Amniotomy and oxytocin augmentation

Observation for four more hours

Emergency lower segment caesarean

A 21-year-old primigravida has received a high-dose oxytocin infusion in 5% dextrose for 14 hours for a prolonged labour. She becomes confused, vomits and has a generalised convulsion. BP is 128/82 mm Hg and urine shows no protein. Serum sodium is 118 mmol/L. Which property of oxytocin explains this event?

Antidiuretic effect on the renal collecting ducts

Inhibition of aldosterone release

Direct excitatory action on cortical neurons

Vasoconstriction of cerebral arteries

A 30-year-old second gravida at 38 weeks wants a vaginal birth after her previous caesarean. Her records show the earlier caesarean was done at 28 weeks for severe pre-eclampsia. Which detail of the previous surgery would rule out a trial of labour?

A classical (upper segment) uterine incision

A lower segment transverse incision

An interval of 3 years since the caesarean

Pre-eclampsia as the previous indication

Labour: partograph, malpresentations and operative delivery

41 NEET-PG practice questions on Labour: partograph, malpresentations and operative delivery, part of Obstetrics & Gynaecology. 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
A 24-year-old primigravida at term is admitted to a district hospital labour room at 10 am with the cervix 4 cm dilated, and labour is plotted on the modified WHO partograph. At 6 pm the cervix is 6 cm, the head is 3/5 palpable, membranes are intact, contractions are 2 in 10 minutes lasting 20 seconds, there is no caput or moulding and the fetal heart rate is 140/min. What is the most appropriate next step?
1. AAmniotomy and oxytocin augmentation
2. BObservation for four more hours
3. CEmergency lower segment caesarean
4. DTrial of vacuum extraction now
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Answer: A · Amniotomy and oxytocin augmentation
On the modified WHO partograph the alert line starts at 4 cm and rises 1 cm per hour, and the action line lies 4 hours to its right, so at 8 hours the action line stands at 8 cm; at 6 cm she has crossed it. Contractions fewer than 3 in 10 minutes and shorter than 40 seconds, with no caput, no moulding and a normal fetal heart, point to inefficient uterine action rather than obstruction. Rupturing the membranes and augmenting with an oxytocin infusion, then reassessing, is the correct response. Caesarean is kept for obstruction, fetal compromise or failure of augmentation; the newer WHO Labour Care Guide (2020) starts active labour at 5 cm and uses time limits per centimetre instead of alert and action lines.
- B: She has already crossed the action line; waiting longer is not appropriate.
- C: Caesarean is for obstruction, fetal distress or failed augmentation, none present here.
- D: Vacuum needs a fully dilated cervix and an engaged head.
Question 2 · Medium
A 27-year-old primigravida in labour is in the right occipitoposterior position. In the second stage the head flexes well, and the occiput rotates forward to come to lie under the pubic symphysis. Through what arc does the occiput rotate?
1. AOne-eighth of a circle
2. BHalf a circle
3. CThree-eighths of a circle
4. DTwo-eighths of a circle
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Answer: C · Three-eighths of a circle
In the right occipitoposterior position, the occiput lies at the right sacroiliac joint. With good flexion and strong contractions it rotates anteriorly through three-eighths of a circle (135 degrees) to reach the symphysis (long anterior rotation), and delivery then proceeds as in an occipitoanterior position. In an occipitoanterior position, the rotation is only one-eighth of a circle. If flexion is poor, the occiput may rotate backward to the sacrum and deliver face to pubis.
- A: One-eighth is the rotation from an occipitoanterior position.
- B: Half a circle overstates the arc from the sacroiliac joint.
- D: Two-eighths would bring the occiput only to the transverse position.
Question 3 · Medium
A medical college audits its caesarean rate using the Robson ten-group classification recommended by WHO. A 30-year-old with one previous caesarean has a singleton cephalic pregnancy at 39 weeks and is in spontaneous labour. In which Robson group is she placed?
1. AGroup 10
2. BGroup 1
3. CGroup 3
4. DGroup 5
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Answer: D · Group 5
The Robson classification places every woman in one of ten groups by parity, previous caesarean, number of fetuses, presentation, gestation and onset of labour. Group 5 is all multiparous women with at least one previous uterine scar and a singleton cephalic pregnancy at 37 weeks or more, whatever the onset of labour. Groups 1, 2 and 5 usually contribute most caesareans in a hospital, so audits target them. Group 3 is multiparous women without a previous caesarean in spontaneous labour at term.
- A: Group 10 is a singleton cephalic pregnancy below 37 weeks.
- B: Group 1 is nulliparous women in spontaneous labour.
- C: Group 3 excludes women with a previous caesarean.
Question 4 · Hard
A 21-year-old primigravida has received a high-dose oxytocin infusion in 5% dextrose for 14 hours for a prolonged labour. She becomes confused, vomits and has a generalised convulsion. BP is 128/82 mm Hg and urine shows no protein. Serum sodium is 118 mmol/L. Which property of oxytocin explains this event?
1. AInhibition of aldosterone release
2. BDirect excitatory action on cortical neurons
3. CVasoconstriction of cerebral arteries
4. DAntidiuretic effect on the renal collecting ducts
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Answer: D · Antidiuretic effect on the renal collecting ducts
Oxytocin is structurally close to vasopressin and, in high doses, acts on renal V2 receptors to retain free water. When it is given for many hours in large volumes of hypotonic fluid such as 5% dextrose, dilutional hyponatraemia develops, causing water intoxication with confusion, vomiting and seizures. Normal BP and no proteinuria make eclampsia unlikely. Prevention is to give concentrated oxytocin in isotonic saline or Ringer lactate and to monitor fluid balance; treatment is to stop the infusion and correct sodium carefully.
- A: Hyponatraemia here comes from water retention, not aldosterone.
- B: Oxytocin causes seizures through hyponatraemia, not by exciting neurons.
- C: Cerebral vasoconstriction suggests eclampsia, which the normal BP argues against.
Question 5 · Medium
A 30-year-old second gravida at 38 weeks wants a vaginal birth after her previous caesarean. Her records show the earlier caesarean was done at 28 weeks for severe pre-eclampsia. Which detail of the previous surgery would rule out a trial of labour?
1. AA lower segment transverse incision
2. BAn interval of 3 years since the caesarean
3. CPre-eclampsia as the previous indication
4. DA classical (upper segment) uterine incision
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Answer: D · A classical (upper segment) uterine incision
A previous classical or upper-segment (including inverted T or J) incision carries a high risk of rupture in labour, because the thick, active upper segment heals with a weaker scar; these women are delivered by planned caesarean. Very preterm caesareans sometimes need such incisions because the lower segment is not yet formed, so the operative note must be checked. A single previous lower segment transverse incision with a non-recurring indication is the ideal situation for a trial of labour. An interval of 18 months or more since the last caesarean reduces the rupture risk.
- A: A lower segment transverse scar is suitable for trial of labour.
- B: A three-year interval lowers rather than raises the rupture risk.
- C: A non-recurring indication favours a trial of labour.
Question 6 · Medium
A 24-year-old primigravida has been fully dilated for 3 hours 15 minutes in a labour room using the WHO Labour Care Guide. She has been pushing for the last hour; the head is 1/5 palpable at station +2 in the occipitoanterior position, the fetal heart is normal and contractions are good. What should the team do now?
1. AProceed directly to caesarean section
2. BContinue pushing for two more hours
3. CStart oxytocin and reassess in four hours
4. DAssess for assisted vaginal birth
Answer and explanation in LearnFree account
Question 7 · Medium
A 25-year-old primigravida's partograph is reviewed at 8 cm. The midwife has recorded that the parietal bones overlap at the sagittal suture but can be separated by gentle pressure. How is this moulding graded on the partograph?
1. A++ (two plus)
2. B+ (one plus)
3. C+++ (three plus)
4. D0 (no moulding)
Answer and explanation in LearnFree account
Question 8 · Hard
A 23-year-old primigravida has been fully dilated for 3 hours at a district hospital. On abdominal palpation, 3/5 of the head is palpable above the brim. Vaginal examination shows the caput at the level of the ischial spines with marked caput and +++ moulding, the occiput is in the left occipitotransverse position, and the bladder has been emptied. The fetal heart shows late decelerations. What is the most appropriate management?
1. AOxytocin augmentation for one hour
2. BKielland's forceps rotation and delivery
3. CVacuum delivery with rotation
4. DEmergency caesarean section
Answer and explanation in LearnFree account
Question 9 · Easy
At a PHC labour room, a 27-year-old second gravida in labour at 6 cm has spontaneous rupture of membranes, and a pulsating loop of cord is seen at the introitus. Referral transport has been called. What should be done first?
1. APush the presenting part up off the cord
2. BStart oxytocin to hasten delivery
3. CPush the cord back into the uterus
4. DApply fundal pressure to deliver
Answer and explanation in LearnFree account
Question 10 · Medium
After a forceps delivery, a 25-year-old primigravida is examined for perineal injury. The tear involves the perineal muscles and the full thickness of the external anal sphincter, and the internal anal sphincter is also torn; the anal mucosa is intact. How is this tear classified?
1. AThird-degree tear, grade 3b
2. BFourth-degree tear
3. CThird-degree tear, grade 3c
4. DSecond-degree tear
Answer and explanation in LearnFree account
Question 11 · Hard
A 25-year-old second gravida at a district hospital is fully dilated, with the head 0/5 palpable at station +2 in the direct occipitoanterior position, when a loop of cord prolapses at spontaneous rupture of the membranes. The fetal heart rate is 80/min. An operating theatre is available but needs 20 minutes to prepare. What is the most appropriate management?
1. AFill the bladder and wait for theatre
2. BImmediate assisted vaginal birth
3. CKnee-chest position and transfer for caesarean
4. DPush the cord back and continue pushing
Answer and explanation in LearnFree account
Question 12 · Medium
A 30-year-old second gravida at term in labour has a face presentation. She is now fully dilated with the chin pointing towards the sacrum, and there has been no rotation after an hour of good contractions. The fetal heart is normal. What is the most appropriate management?
1. ACaesarean section
2. BVacuum extraction
3. CLow forceps delivery
4. DWait for anterior rotation for 4 more hours
Answer and explanation in LearnFree account
Question 13 · Medium
In the labour room, a resident considers vacuum delivery in four women, all fully dilated with the head engaged: 1. A woman at 30 weeks. 2. A face presentation. 3. A direct occipitoposterior position. 4. A fetus whose mother has a history of an inherited fetal bleeding disorder. In which of these is vacuum contraindicated?
1. A1 and 2 only
2. B1, 2 and 4 only
3. C1, 2, 3 and 4
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 14 · Hard
A 32-year-old fourth gravida has been in labour for 16 hours at a CHC. The partograph shows the cervix at 8 cm for the last 4 hours despite 4 strong contractions in 10 minutes lasting 50 seconds. The head is 3/5 palpable, with +++ moulding and marked caput. Her pulse is 112/min, she has ketonuria and the fetal heart rate is 156/min. The medical officer considers starting oxytocin. What should be done?
1. ACaesarean section without oxytocin
2. BVacuum delivery at 8 cm
3. CWait two more hours with IV fluids
4. DOxytocin augmentation and reassessment
Answer and explanation in LearnFree account
Question 15 · Hard
A 29-year-old primigravida has a spinal anaesthetic for an emergency caesarean at a medical college. Five minutes later she is nauseated and her BP is 82/48 mm Hg (baseline 124/76) with a heart rate of 112/min. She is already in left lateral tilt with IV fluid running. Which drug is the first choice to correct the hypotension?
1. APhenylephrine
2. BAtropine
3. CDopamine infusion
4. DAdrenaline
Answer and explanation in LearnFree account
Question 16 · Easy
A 23-year-old primigravida in labour has a well-flexed head in the left occipitoanterior position. Which diameter of the fetal head engages, and what is its length?
1. ASuboccipitobregmatic, 9.5 cm
2. BMentovertical, 14 cm
3. COccipitofrontal, 11.5 cm
4. DBiparietal, 11 cm
Answer and explanation in LearnFree account
Question 17 · Medium
A 27-year-old primigravida is to have an elective caesarean section at a district hospital. The anaesthetist and obstetrician discuss antibiotic prophylaxis. When should the prophylactic antibiotic be given?
1. ABefore the skin incision
2. BAt the end of surgery
3. CAfter the cord is clamped
4. DOnly if fever develops later
Answer and explanation in LearnFree account
Question 18 · Medium
A 34-year-old sixth gravida has laboured for 18 hours at home before being brought to a CHC. She suddenly felt a tearing pain, after which her contractions stopped. Pulse is 136/min and BP 80/50 mm Hg; fetal parts are felt easily under the abdominal wall and no fetal heart is heard. On vaginal examination the presenting part has receded. What is the definitive management?
1. AObserve after blood transfusion
2. BOxytocin infusion to restart contractions
3. CVaginal delivery by craniotomy
4. DResuscitation and immediate laparotomy
Answer and explanation in LearnFree account
Question 19 · Medium
During delivery of a 4.1 kg baby to a 32-year-old with gestational diabetes, shoulder dystocia occurs. McRoberts manoeuvre and suprapubic pressure have failed. An episiotomy has been made. What is the next appropriate step?
1. AZavanelli manoeuvre
2. BStronger lateral traction on the head
3. CFundal pressure
4. DDelivery of the posterior arm
Answer and explanation in LearnFree account
Question 20 · Medium
During an assisted vaginal breech delivery at a district hospital, the trunk and arms of a 3 kg baby have been delivered and the head is in the pelvis. The obstetrician lays the baby on her forearm, places a finger on each malar bone to flex the head, and an assistant gives suprapubic pressure. What is this manoeuvre called?
1. ABurns-Marshall manoeuvre
2. BMauriceau-Smellie-Veit manoeuvre
3. CModified Prague manoeuvre
4. DLovset manoeuvre
Answer and explanation in LearnFree account
Question 21 · Easy
A 24-year-old primigravida at a district hospital has a prolonged second stage, and the obstetrician considers a vacuum delivery. Which condition is essential before the cup is applied?
1. AFull dilatation of the cervix
2. BOccipitoanterior position
3. CEpidural analgesia in place
4. DIntact fetal membranes
Answer and explanation in LearnFree account
Question 22 · Medium
A 28-year-old primigravida has been fully dilated for 2 hours. On examination the head is 0/5 palpable, the vertex is at the level of the ischial spines, the sagittal suture lies transversely and there has been no descent for an hour despite good contractions. The pelvis is adequate and the fetal heart is normal. What is the most appropriate management?
1. AFundal pressure with the next contraction
2. BWait two more hours for spontaneous rotation
3. CRotational vacuum by a skilled operator
4. DOutlet forceps (Wrigley's) delivery
Answer and explanation in LearnFree account
Question 23 · Medium
A 29-year-old with one previous lower segment caesarean is in spontaneous labour at 7 cm at a district hospital. Over 10 minutes the CTG changes from normal to a prolonged deceleration to 80/min, and she has new continuous pain over the scar. What is the earliest and most consistent sign of the likely complication?
1. AAn abnormal fetal heart rate pattern
2. BBlood-stained urine
3. CCessation of contractions
4. DHeavy vaginal bleeding
Answer and explanation in LearnFree account
Question 24 · Easy
In a 28-year-old multigravida in labour, the examining finger feels the anterior fontanelle, the frontal suture and the orbital ridges, but not the mouth or the posterior fontanelle. Which diameter of the fetal head presents?
1. AOccipitofrontal
2. BSuboccipitobregmatic
3. CSubmentobregmatic
4. DMentovertical
Answer and explanation in LearnFree account
Question 25 · Hard
A 26-year-old primigravida is fully dilated for 2 hours with the head 0/5 palpable at station +2, left occipitoanterior. A vacuum is applied correctly by a trained resident; after two pulls with good contractions and maternal effort there is no descent of the head, and the fetal heart is normal. What is the most appropriate next step?
1. AIncrease the vacuum pressure and pull harder
2. BContinue pulling until the cup detaches
3. CAbandon and perform a caesarean section
4. DChange to forceps and try again
Answer and explanation in LearnFree account

16 more Labour: partograph, malpresentations and operative delivery questions

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Labour: partograph, malpresentations and operative delivery

A 27-year-old primigravida in labour is in the right occipitoposterior position. In the second stage the head flexes well, and the occiput rotates forward to come to lie under the pubic symphysis. Through what arc does the occiput rotate?

A medical college audits its caesarean rate using the Robson ten-group classification recommended by WHO. A 30-year-old with one previous caesarean has a singleton cephalic pregnancy at 39 weeks and is in spontaneous labour. In which Robson group is she placed?

A 30-year-old second gravida at 38 weeks wants a vaginal birth after her previous caesarean. Her records show the earlier caesarean was done at 28 weeks for severe pre-eclampsia. Which detail of the previous surgery would rule out a trial of labour?

A 25-year-old primigravida's partograph is reviewed at 8 cm. The midwife has recorded that the parietal bones overlap at the sagittal suture but can be separated by gentle pressure. How is this moulding graded on the partograph?

At a PHC labour room, a 27-year-old second gravida in labour at 6 cm has spontaneous rupture of membranes, and a pulsating loop of cord is seen at the introitus. Referral transport has been called. What should be done first?

After a forceps delivery, a 25-year-old primigravida is examined for perineal injury. The tear involves the perineal muscles and the full thickness of the external anal sphincter, and the internal anal sphincter is also torn; the anal mucosa is intact. How is this tear classified?

A 30-year-old second gravida at term in labour has a face presentation. She is now fully dilated with the chin pointing towards the sacrum, and there has been no rotation after an hour of good contractions. The fetal heart is normal. What is the most appropriate management?

A 23-year-old primigravida in labour has a well-flexed head in the left occipitoanterior position. Which diameter of the fetal head engages, and what is its length?

A 27-year-old primigravida is to have an elective caesarean section at a district hospital. The anaesthetist and obstetrician discuss antibiotic prophylaxis. When should the prophylactic antibiotic be given?

During delivery of a 4.1 kg baby to a 32-year-old with gestational diabetes, shoulder dystocia occurs. McRoberts manoeuvre and suprapubic pressure have failed. An episiotomy has been made. What is the next appropriate step?

A 24-year-old primigravida at a district hospital has a prolonged second stage, and the obstetrician considers a vacuum delivery. Which condition is essential before the cup is applied?

In a 28-year-old multigravida in labour, the examining finger feels the anterior fontanelle, the frontal suture and the orbital ridges, but not the mouth or the posterior fontanelle. Which diameter of the fetal head presents?