Labour: compound presentation: 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.

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OBG · Labour: compound presentation

Sample item

A woman at term in early labour is found to have a hand lying alongside the vertex presenting part. Labour is progressing and the fetal heart is normal. What is the usual management?

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

The answer and the reasoning

B. Observe progress, as most resolve spontaneously, and perform a caesarean for arrest or cord prolapse

In compound presentation a limb prolapses next to the presenting part. Most cases resolve as the head descends and the limb retracts, so expectant management with careful monitoring is used, and caesarean section is performed for arrest of labour, cord prolapse or fetal distress. Forceps and fundal pressure are not appropriate.

Option by option

  • A. Immediate caesarean section in all cases

    Routine caesarean is not required when labour is progressing normally.

  • B. Observe progress, as most resolve spontaneously, and perform a caesarean for arrest or cord prolapse (correct)

    Correct. Watchful management with caesarean for complications is the norm.

  • C. Push the hand up and apply fundal pressure

    Fundal pressure risks trauma and is not recommended.

  • D. Immediate forceps delivery

    Forceps are not used with an unengaged presentation and a prolapsed hand.

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 B, Observe progress, as most resolve spontaneously, and perform a caesarean for arrest or cord prolapse. In compound presentation a limb prolapses next to the presenting part.

Why is "Immediate caesarean section in all cases" not the answer?

Routine caesarean is not required when labour is progressing normally.

Why is "Push the hand up and apply fundal pressure" not the answer?

Fundal pressure risks trauma and is not recommended.

Why is "Immediate forceps delivery" not the answer?

Forceps are not used with an unengaged presentation and a prolapsed hand.

What concept does this question test?

It tests Labour: compound presentation in OBG. Most cases resolve as the head descends and the limb retracts, so expectant management with careful monitoring is used, and caesarean section is performed for arrest of labour, cord prolapse or fetal distress. Forceps and fundal pressure are not appropriate.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: compound presentation?

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.