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MRCOG PART 2 SBAs and EMQs

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EMQ1476
SBA2074
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EMQ ans query

EMQ ans query Posted by Seema  S.

Q : 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.

NICE guideline states that variability of <5 bpm for 40-90 min & variable dec for >9o min are nonreassuring .So should we take these findings as nonreassuring as Q says  CTG over 25 min & the ans given is FBS explaination being pathological trace.

Please clarify

Q : A 34 year old woman with a dichorionic-diamniotic twin pregnancy presents in spontaneous labour at 37 weeks gestation. At 08:00, the cervix is 4cm dilated with intact membranes. At 12:00, the cervix is 5cm dilated with intact membranes. She is contracting 3-4 in 10.

Nice guidelines state that if delay in established first stage of labour is suspected amniotomy should be considered for all patients with intact membranes.But ans given is reassess in 2 hours.

Please explain

Posted by A K.

Hello

I think as follows:

First question ...variable decels is a indcation for FBS....the CTG is showing reduced variability only for 25 min but because of decels it becomes pathological....

Second: yes...0800-4 cms...1200 5 cms...then r/v at 1400 hrs if same then consider ARM...i agree because we do the same...

Pls correct if i am wrong

Thanks