This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Operative Obs, Subject name: Gynaecology & Obstetrics
An elderly multigravida female presents in labor. She has multiple fibroids in lower uterine segment. Management is: 
Select and explain. 
A. Vaginal delivery, B. Trial of labor, C. LSCS, D. Classical cesarean followed by hysterectomy
D: Classical cesarean followed by hysterectomy
Answer: D: Classical cesarean followed by hysterectomy 
Explanation: Ans. is d, i.e. Classical cesarean section followed by hysterectomySince this female is multigravida with multiple fibroids in lower uterine segments - vaginal delivery is not possible as multiple fibroids are present in lower uterine segment. We will have to do cesarean - but LSCS is also not feasible due to fibroids in lower segment (a lot of bleeding will occur if we cut through fibroid). Hence classical cesarean section should be done. The treatment of multiple fibroids in a multipara is hysterectomy, so classical cesarean section should be followed by hysterectomy).