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labour management emq doubt

labour management emq doubt Posted by MONA V.


Options for Questions 9-9
A Repeat vaginal examination in 2h B Repeat vaginal examination in 3h
C Repeat vaginal examination in 4h D Deliver by grade I caesarean section
E Deliver by grade II caesarean section F Deliver by grade III caesarean section
G Commence oxytocin H Perform fetal blood sampling
I Apply fetal scalp electrode J Perform membrane sweep
K Recommend epidural analgesia    

Instructions:For the scenario below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.
Question 9 A healthy 37 year old primigravida presents in spontaneous labour at 39 weeks gestation. At 20:00, the cervix is 7cm dilated with a direct occipito-posterior position 1cm above the ischial spines. At 00:08 the cervix is 8cm dilated and amniotomy is performed with consent. At 02:00, the midwife feels no progress has been made and CTG is commenced. You are asked to assess the patient at 02:30. You perform a vaginal examination and the cervix is 8cm dilated with a direct occipito-posterior position at the spines. There is 1+ caput, 1+ moulding and the liquor is clear. Click on the icon to view the CTG.



The explanation and ctg shows she already getting 6-7 contrations . why to commence oxytocin ?

please clarify thank you

Posted by Axie P.

In question No.42-why would we not perform an amniotomy?The rate of progress is < 2cm in 4 hours?why would we wait and reassess in 2 hours?Is multiple pregnancy monitoring different?


Posted by Farrukh G.

See NICE guidelines on management of first stage of labour and the diagnosis of delay.