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MRCOG PART 2 SBAs and EMQs

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Labour--Paul Pls explain

Labour--Paul Pls explain Posted by Aafia A.
Options for Questions 9-10 A No additional intervention at this stage B Deliver by caesarean section C Increase dose of oxytocin D Artificial rupture of membranes E Decrease dose of oxytocin F Fetal blood sampling G Controlled artificial rupture of membranes in theatre H Intra-muscular analgesia I Continue oxytocin at current dose J Inhaled salbutamol K Sub-cutaneous terbutalline L Administer maternal facial oxygen Instrunctions:For each of the case histories described below, choose the single most appropriate management from the above list. Each option may be used once, more than once, or not at all. Explanation Question 10 A 34 year old primigravida presents in spontaneous labour at 39 weeks gestation. The cervix is 4cm dilated with thin meconium stained liquor. The CTG over 25 minutes shows a base-line fetal heart rate of 135bpm with variability of 3-4bpm, no accelerations and variable decelerations. There are 3-4 uterine contractions every 10 minutes. (Correct answer: F) EXPLANATION GIVEN- NICE guidlines--2 non reasuring features (low variability and variable decelerations)= pathological CTG.FBS or delivery.at 4cm FBS possible. NICE guidline-Non Reasuuring Features include variability reduced for 40-90 minutes and variable decelrations with over 50% of contractions occuring for over 90 minutes. This CTG is for 25minutes,does it still qualify as pathological? Thanks Paul.
u misunderstand Posted by Stanley T.

poor btbv more than 90 minutes pathological but that is without variable deceleration

throw in a variable deceleration in the poor btbv and it become pathological immediately no time frame here

Posted by Aafia A.

Thanks a lot for ur reply Stanley,i was pretty sure i am not going to get one before my exam on 11th.

i am still confused,if variabilty is reduced for 25 mins or

variable decelrations r present fr less than 90 mins do they qualify as non reassuring features as a definite time frame is given by guidline?

secondly is there no time frame required whenever two features occur together to classify them as nonreassuring or abnormal ?

please reply as soon as possible as i have a few days left before exam.

thanks