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MRCOG PART 2 SBAs and EMQs

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EMQ1488
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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.
Explanation
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?

alt

Posted by Farrukh G.

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