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MRCOG PART 2 SBAs and EMQs

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EMQ1462
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Manegment of labour

Manegment of labour Posted by ghada S.

Options for Questions 8

 

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 8

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 correct answer G

Explanation

Confirmed delay in the first stage of labour in a primigravida. There are at least 6 contractions in 10 minutes. The CTG is otherwise normal. The upper limit for the frequency of contractions is already exceeded. The obstetrician will therefore need to provide clear instructions on increasing oxytocin dose and timing of next vaginal examination 

Dear Paul

CTG of this Q is showing 6 contraction in 10 m ,otherwise it is normal .So why do we use oxytocin despite good contractions & the presence of signs of obstruction caput & moulding ?? plz clarify  Thank you 

Posted by PAUL A.

1+ caput and 1+ moulding is not evidence of obstruction otherwise you will never do a vaginal operative delivery. Almost every woman who has laboured to full dilatation will have these features.

 

Good contractions? How did you determine that the contractions were good? They are frequent. This does not mean good.