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emq queries

emq queries Posted by H P.
Options for Questions 11-12

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

Instructions: 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.

Question 11 A 34 year old woman attends for induction of labour at 42 weeks gestation. 4hours after prostaglandin administration, she complains of painful contractions. The CTG shows contractions 6:10 lasting 30-45s with a baseline fetal heart rate of 170bpm and late decelerations. The cervix is 2cm dilated and there is thick fresh meconium on artificial rupture of membranes. Your answer: K

Correct answer: B

MY QUERY- before going to theatre, is it not appropraite to give a tocolytic?

Question 12 A 40 year woman with three previous vaginal deliveries attends for induction of labour at 42 weeks. She has artificial rupture of membranes at 09:00 (multiparous os) and oxytocin commenced at 11:00. Epidural analgesia is inserted at 13:00 but is ineffective. As a consequence, the maximum dose of oxytocin administered is 4mu/min. Epidural is re-sited at 19:00. At 23:00, she has adequate analgesia, the oxytocin dose is 16mu/min and she has 3-4 contractions every 10 minutes. The cervix is fully effaced, 2cm dilated and the CTG is reactive. Your answer: A

Correct answer: I

what is the difference between no additional intervention required and continue oxytocin at the current dose?

Posted by H P.
Thank you Dr Paul
yes, I would write continue oxytocin at the current dose, but i would rather not have the other option on my list!