Which one of the following is an obstetric emergency?

Correct Answer: D

Rationale: The correct answer is D, complete rupture of the uterus. This is an obstetric emergency due to the risk of severe bleeding and potential harm to both the mother and the fetus. A ruptured uterus can lead to life-threatening complications such as hemorrhage and shock. In contrast, options A, B, and C are not considered obstetric emergencies. Aftercoming head in breech, complete cephalic presentation, and complete breech presentation are normal variations in labor that do not typically require immediate intervention like a ruptured uterus does.

Correct Answer: C

Rationale: The correct answer is C: Secondary postpartum haemorrhage. This term refers to excessive bleeding from the genital tract after the first 24 hours but within the puerperium period (6 weeks postpartum). A: Primary postpartum haemorrhage occurs within the first 24 hours after delivery. B: Tertiary postpartum haemorrhage occurs more than 6 weeks postpartum. D: Incidental postpartum haemorrhage is not a recognized medical term for postpartum bleeding.

Correct Answer: C

Rationale: The correct answer is C: Chest radiography. In cases of acute abdomen, a chest radiograph is essential to rule out conditions like pneumothorax, pleural effusion, or pneumonia which may present with similar symptoms. This helps in identifying potential causes of abdominal pain outside the abdomen. Abdominal radiograph (A) may not provide enough information for diagnosis. Contrast radiography (B) and ultrasonography (D) are not universally essential for all cases of acute abdomen and may not be appropriate in certain situations.

Correct Answer: D

Rationale: The correct answer is D: Compound presentation. This term refers to the situation where there is more than one part of the fetus on the pelvic brim at the onset of labor. This can include a hand or arm alongside the head or another body part. The other choices are incorrect because: A: Unstable lie refers to the fetus being in a transverse position. B: Fetal malpresentation indicates an abnormal presentation of the fetus, such as breech or transverse. C: Fetal malposition refers to the fetus being in a suboptimal position, like occiput posterior. Thus, the best choice is D as it specifically describes the scenario of multiple fetal parts on the pelvic brim.

Correct Answer: D

Rationale: The correct answer is D, as all three choices are key indicators for cesarean section during labor. Fetal distress indicates the baby is not tolerating labor well. Failure to progress may lead to complications for the mother or baby. Breech presentation increases the risk of complications during vaginal delivery. Therefore, all three indicators warrant consideration for a cesarean section to ensure the safety of both the mother and the baby.

Correct Answer: A

Rationale: The correct answer is A: Irritable bowel syndrome. Mrs. Maroldo's history of recurrent left lower quadrant pain that usually resolves with antibiotics suggests a chronic condition rather than an acute one like diverticulitis, appendicitis, or inflammatory bowel disease. Her lack of nausea, vomiting, and severe symptoms, along with the presence of diarrhea and no bowel movements, align more with irritable bowel syndrome. Additionally, her vital signs are not significantly elevated, ruling out acute conditions like appendicitis. Discomfort to deep palpation in the left lower quadrant is common in irritable bowel syndrome due to visceral hypersensitivity. Therefore, based on her chronic symptoms, lack of severe signs, and typical presentation, the most likely diagnosis is irritable bowel syndrome.

Correct Answer: A

Rationale: Placenta praevia is more common in women with a history of multiple pregnancies (Grandmultiparity), as repeated stretching of the uterine wall can lead to abnormal placental implantation. Preeclampsia is a separate condition associated with hypertension in pregnancy. Placenta fenestrate and placenta increta are specific placental abnormalities but do not directly cause placenta praevia.

Correct Answer: B

Rationale: The correct answer is B: Mauriceau-Smellie-Veit. This method involves flexing the hips, extending the thighs, and applying suprapubic pressure to deliver the head in a complete breech presentation. This technique helps to avoid hyperextension of the neck and potential spinal cord injury. The Lovset maneuver (A) is used for delivering the arms in a breech presentation. The Burns Marshall method (C) involves performing an episiotomy and delivering the baby by flexion and traction on the legs. Gentle traction of the neck (D) is not recommended as it can cause spinal cord injury. Mauriceau-Smellie-Veit is the preferred method for safe delivery of the head in a complete breech presentation.

Correct Answer: B

Rationale: The correct answer is B: Captopril. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that can lead to oligohydramnios in pregnant women due to its effect on reducing fetal renal function. This can result in decreased amniotic fluid levels. Diazepam (A) is a benzodiazepine used for anxiety and is not associated with oligohydramnios. Ampicillin (C) is an antibiotic commonly used during pregnancy and does not cause oligohydramnios. Pethidine (D) is an opioid analgesic with no known association with oligohydramnios in pregnancy.