Labour complications: 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 complications

Sample item

During third stage of labour, excessive cord traction is followed by sudden shock, severe lower abdominal pain, and a mass is seen at the vulva with the fundus not palpable abdominally. What is the first step in management?

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

The answer and the reasoning

D. Immediate attempt to replace the uterus manually, with fluids and help called

Acute puerperal uterine inversion causes neurogenic shock disproportionate to blood loss. The uterus should be replaced immediately by pushing the fundus through the cervix (Johnson manoeuvre) before a constriction ring forms, with resuscitation. The placenta is left attached until replaced, and uterotonics are given after replacement.

Option by option

  • A. Administer oxytocin before any attempt at replacement

    Oxytocin before replacement would tighten the cervical ring and make replacement harder.

  • B. Give a tocolytic and wait

    A uterine relaxant may be needed if the ring prevents replacement, but waiting without replacement is wrong.

  • C. Remove the placenta forcibly before replacement

    Removing the placenta first increases haemorrhage.

  • D. Immediate attempt to replace the uterus manually, with fluids and help called (correct)

    Correct. Early replacement is the key, as delay allows a cervical ring and oedema.

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 D, Immediate attempt to replace the uterus manually, with fluids and help called. Acute puerperal uterine inversion causes neurogenic shock disproportionate to blood loss.

Why is "Administer oxytocin before any attempt at replacement" not the answer?

Oxytocin before replacement would tighten the cervical ring and make replacement harder.

Why is "Give a tocolytic and wait" not the answer?

A uterine relaxant may be needed if the ring prevents replacement, but waiting without replacement is wrong.

Why is "Remove the placenta forcibly before replacement" not the answer?

Removing the placenta first increases haemorrhage.

What concept does this question test?

It tests Labour complications in OBG. The uterus should be replaced immediately by pushing the fundus through the cervix (Johnson manoeuvre) before a constriction ring forms, with resuscitation. The placenta is left attached until replaced, and uterotonics are given after replacement.

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 complications?

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.