Labour: fundal pressure: 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: fundal pressure

Sample item

A midwife is asked to apply Kristeller manoeuvre (fundal pressure) during the second stage to hasten delivery of a slowly descending head. What is the current recommendation?

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

The answer and the reasoning

A. Not recommended as routine, because of risks of uterine rupture, perineal trauma and fetal injury

WHO and other bodies advise against routine fundal pressure in the second stage because of risks including uterine rupture, anal sphincter injury, and neonatal trauma, with no clear benefit. It should not be used to shorten labour. Fundal pressure is also contraindicated in shoulder dystocia.

Option by option

  • A. Not recommended as routine, because of risks of uterine rupture, perineal trauma and fetal injury (correct)

    Correct. Routine fundal pressure is not recommended because of maternal and fetal harm.

  • B. Recommended only before full dilatation

    Fundal pressure before full dilatation has no role.

  • C. Recommended in all nulliparous women

    There is no indication for its routine use in nulliparae.

  • D. Mandatory when a vacuum is used

    It is not mandatory with a vacuum.

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, Not recommended as routine, because of risks of uterine rupture, perineal trauma and fetal injury. WHO and other bodies advise against routine fundal pressure in the second stage because of risks including uterine rupture, anal sphincter injury, and neonatal trauma, with no clear benefit.

Why is "Recommended only before full dilatation" not the answer?

Fundal pressure before full dilatation has no role.

Why is "Recommended in all nulliparous women" not the answer?

There is no indication for its routine use in nulliparae.

Why is "Mandatory when a vacuum is used" not the answer?

It is not mandatory with a vacuum.

What concept does this question test?

It tests Labour: fundal pressure in OBG. It should not be used to shorten labour. Fundal pressure is also contraindicated in shoulder dystocia.

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: fundal pressure?

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.