Labour: neglected transverse lie: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

OBG · Labour: neglected transverse lie

Sample item

A multiparous woman at term in labour for 20 hours has a transverse lie with the back down, a prolapsed arm, the shoulder impacted in the pelvis and a tender uterus with a retraction ring. The fetal heart is absent. What is the safest management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Resuscitate and deliver by caesarean section after excluding rupture

Neglected shoulder presentation with a retraction (Bandl) ring is at risk of uterine rupture, and internal version in this setting is hazardous. After resuscitation and antibiotics, caesarean delivery, with a vertical incision where the lower segment is poorly accessible, is usually safest. Destructive procedures such as decapitation are reserved for a dead fetus when skilled hands and no surgical options exist.

Option by option

  • A. Resuscitate and deliver by caesarean section after excluding rupture (correct)

    Correct. Caesarean after resuscitation avoids the risk of rupture during manipulation.

  • B. Attempt external cephalic version

    External version is not possible once the shoulder is impacted in labour.

  • C. Internal podalic version and breech extraction

    Internal version with a retraction ring risks uterine rupture.

  • D. Allow spontaneous expulsion

    Spontaneous expulsion is impossible with an impacted transverse lie at term.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Resuscitate and deliver by caesarean section after excluding rupture. Neglected shoulder presentation with a retraction (Bandl) ring is at risk of uterine rupture, and internal version in this setting is hazardous.

Why is "Attempt external cephalic version" not the answer?

External version is not possible once the shoulder is impacted in labour.

Why is "Internal podalic version and breech extraction" not the answer?

Internal version with a retraction ring risks uterine rupture.

Why is "Allow spontaneous expulsion" not the answer?

Spontaneous expulsion is impossible with an impacted transverse lie at term.

What concept does this question test?

It tests Labour: neglected transverse lie in OBG. After resuscitation and antibiotics, caesarean delivery, with a vertical incision where the lower segment is poorly accessible, is usually safest. Destructive procedures such as decapitation are reserved for a dead fetus when skilled hands and no surgical options exist.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Labour: neglected transverse lie?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.