Labour and delivery: triple descending gradient: 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 and delivery: triple descending gradient

Sample item

During normal labour the contraction starts near a cornual pacemaker and spreads downwards, with the strongest and longest contraction in the fundus. Which term describes this pattern?

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

The answer and the reasoning

D. Triple descending gradient

In normal labour the contraction wave is longest, strongest and begins earliest in the upper uterine segment, with progressive decline in all three towards the cervix. This fundal dominance is what pulls the cervix open and pushes the fetus down; reversed or uncoordinated patterns cause dysfunctional labour.

Option by option

  • A. Pathological retraction ring

    A retraction ring is a groove between the upper and lower segments seen in obstructed labour.

  • B. Polarity reversal pattern

    Polarity reversal is the abnormal pattern in which the lower segment contracts more strongly than the fundus.

  • C. Ferguson reflex arc

    Ferguson reflex is oxytocin release from stretching of the cervix and upper vagina.

  • D. Triple descending gradient (correct)

    Correct. Duration, intensity and onset all diminish from fundus to lower uterus.

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.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Triple descending gradient. In normal labour the contraction wave is longest, strongest and begins earliest in the upper uterine segment, with progressive decline in all three towards the cervix.

Why is "Pathological retraction ring" not the answer?

A retraction ring is a groove between the upper and lower segments seen in obstructed labour.

Why is "Polarity reversal pattern" not the answer?

Polarity reversal is the abnormal pattern in which the lower segment contracts more strongly than the fundus.

Why is "Ferguson reflex arc" not the answer?

Ferguson reflex is oxytocin release from stretching of the cervix and upper vagina.

What concept does this question test?

It tests Labour and delivery: triple descending gradient in OBG. This fundal dominance is what pulls the cervix open and pushes the fetus down; reversed or uncoordinated patterns cause dysfunctional labour.

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 and delivery: triple descending gradient?

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.