NEET-PG Obstetrics & Gynecology Previous Year Questions (2017–2026)

Correct answer: B. Intrauterine fetal death. External cephalic version is pointless and unsafe when there is no live fetus to reposition.

External cephalic version aims to turn a live fetus to cephalic presentation to allow vaginal birth. When the fetus has already died, intrauterine fetal death, there is no benefit and the manoeuvre is contraindicated. Other absolute contraindications include any independent indication for caesarean section, antepartum haemorrhage, ruptured membranes, multiple pregnancy (except the second twin) and an abnormal cardiotocograph. A malpresentation such as transverse lie or breech is exactly what version is meant to correct.

Intrauterine fetal death: there is no live fetus to benefit, so version is contraindicated.

Incorrect Options:

• A. Transverse fetal lie: a transverse or oblique lie is actually one of the presentations for which external cephalic version is offered, so it is an indication rather than a contraindication.

  Transverse lie is an indication for version, not a contraindication.

• C. Complete breech presentation: breech presentation is the usual reason external cephalic version is attempted, so it supports rather than forbids the procedure.

  Complete breech is a common indication for attempting version.

• D. Nulliparity: being in a first pregnancy reduces the success rate because of firmer abdominal and uterine tone, but it is not a contraindication.

  Nulliparity lowers success rates but does not contraindicate version.

High-Yield Facts:

• External cephalic version is offered for breech or transverse lie at or near term to enable vaginal delivery.
• Absolute contraindications: any indication for caesarean, antepartum haemorrhage, ruptured membranes, abnormal cardiotocograph, intrauterine fetal death.
• It is usually attempted from about 36 to 37 weeks; anti-D is given to Rhesus-negative women afterwards.
• Nulliparity, obesity and an anterior placenta lower success but do not forbid the attempt.

Correct answer: A. Deliver at 39-40 weeks. Well-controlled, diet-only gestational diabetes is delivered at full term, 39 to 40 weeks.

For gestational diabetes controlled on diet alone with normal fetal growth, guidelines recommend delivery between 39 0/7 and 40 6/7 weeks. When medication (insulin or oral agents) is needed but control is good, delivery is a little earlier, at 39 0/7 to 39 6/7 weeks. Delivering before 39 weeks without an indication increases neonatal respiratory morbidity, whereas prolonging beyond 40 to 41 weeks raises the stillbirth risk. With a favourable cervix she is a good candidate for planned vaginal birth.

Diet-controlled gestational diabetes: deliver at 39 0/7 to 40 6/7 weeks.

Incorrect Options:

• B. Induce labour now: there is no maternal or fetal indication to deliver a well-controlled, diet-only pregnancy before 39 weeks, and doing so raises neonatal respiratory morbidity.

  Induction before 39 weeks is not indicated for well-controlled diet-only disease.

• C. Elective caesarean now: gestational diabetes alone, without macrosomia or another obstetric indication, does not justify a caesarean, and a favourable cervix favours vaginal birth.

  Caesarean is reserved for obstetric indications, not diet-controlled diabetes alone.

• D. Await labour to 42 weeks: expectant management to 42 weeks is unsafe in diabetic pregnancy because the stillbirth risk rises late in gestation, so delivery is planned by around 40 weeks.

  Waiting to 42 weeks increases stillbirth risk in diabetic pregnancy.

High-Yield Facts:

• Diet-controlled gestational diabetes: deliver 39 0/7 to 40 6/7 weeks.
• Medication-controlled but well-controlled: deliver 39 0/7 to 39 6/7 weeks.
• Poorly controlled or vascular complications: individualise, often 36 to 38 weeks after steroids as needed.
• Early-term delivery without indication increases neonatal respiratory morbidity.

Correct answer: C. Fetal cardiac activity seen. Visible fetal cardiac activity predicts methotrexate failure, so surgery is preferred.

Methotrexate is best for a stable woman with a small unruptured ectopic, a beta-hCG below about 5000 IU/L and no fetal cardiac activity. The presence of fetal cardiac activity reflects a more advanced, actively growing pregnancy and is a recognised relative contraindication to medical therapy because failure and rupture rates are higher, so surgery is preferred. Other features that push toward surgery include a mass above 3.5 to 4 centimetres, a beta-hCG above 5000 IU/L, and any haemodynamic instability.

Visible fetal cardiac activity is a relative contraindication to methotrexate, favouring surgery.

Incorrect Options:

• A. Serum beta-hCG 1200 IU/L: a relatively low beta human chorionic gonadotrophin (well under 5000 international units per litre) predicts a good response to methotrexate, so it favours medical management.

  A beta-hCG of 1200 IU/L is low and favours medical therapy.

• B. Adnexal mass of 2 cm: a small ectopic mass (below about 3.5 to 4 centimetres) is within criteria for methotrexate, not an indication to operate.

  A small mass under 3.5 cm suits medical therapy.

• D. No fluid in pouch of Douglas: the absence of free fluid suggests no significant rupture or haemorrhage, which is a reassuring feature that supports, rather than argues against, medical treatment.

  Absence of free fluid is reassuring and supports medical therapy.

High-Yield Facts:

• Methotrexate suits a stable ectopic with beta-hCG below 5000 IU/L, mass under 3.5 cm, and no fetal cardiac activity.
• Fetal cardiac activity, mass above 3.5 to 4 cm, or beta-hCG above 5000 IU/L favour surgery.
• Any haemodynamic instability or suspected rupture mandates immediate surgery.
• After methotrexate, monitor beta-hCG on days 4 and 7 (expect a fall of at least 15 percent between them).