EBCOG Part 1 – 3 months May 2022 – Labour and Delivery – Day 2

A. Antental corticosteroids
B.Antenatal glucocorticoids and antibiotics
C.Antenatal corticosteroids plus antibiotics plus inpatient monitoring for 48–72 hours
D.Emergency cervical cerclage
E.Elective cervical cerclage
F.Immediate induction of labour with the aim of vaginal delivery plus intravenous antibiotics
G.Immediate delivery by caesarean section plus intravenous antibiotics
H.Prophylactic tocolysis and intravenous antibiotics
I.Prophylactic tocolysis plus antenatal corticosteroids plus intrauterine transfer
J.Reasonable to deliver at 34 weeks of gestation or after
K.Transabdominal amnioinfusion
L.Transvaginal amniocentesis
M.Tocolysis and antenatal corticosteroids
N.Tocolysis
Instructions: For each scenario described below, choose the single most appropriate initial management from the list of options above. Each option may be used once, more than once, or not at all.

1.A 34-year-old multiparous woman presents to the labour ward with a gush of fluid through the vagina at 26 weeks of gestation. A speculum examination by the on-call registrar confirms a spontaneous rupture of membranes. Abdominal examination reveals no uterine activity. Clinically, she feels well and vitals are normal.

2.A 40-year-old multiparous woman presents to the labour ward with a history of premature rupture of membranes (PROM) at 29 weeks of gestation. She complains of regular uterine contractions coming every 3 minutes. Speculum examination confirms a rupture of membranes and her cervix appears to be 3 cm dilated. Clinically, there are no signs of chorioamnionitis.

3.A 38-year-old multiparous woman attends her antenatal clinic appointment at 35 weeks of gestation. She gives a history of PROM at 24 weeks of gestation. Abdominal examination reveals cephalic presentation with no signs of chorioamnionitis. An ultrasound scan reveals oligohydramnios. Her inflammatory markers are normal.

 4.A 40-year-old multiparous woman attends the obstetric day assessment unit with reduced fetal movements at 32 weeks of gestation. A cardiotocograph (CTG) reveals a normal baseline, variable deceleration with reduced variability and no acceleration. Abdominal examination reveals a cephalic presentation and vaginal examination reveals a 2 cm cervical dilatation. An ultrasound scan confirms the cephalic presentation but also reveals severe oligohydramnios. She is tachypnoeic and tachycardic with spiking temperatures of 38°C. A review of her notes indicates that she had PROM at 28 weeks of gestation.

 5.A 40-year-old multiparous woman attends the obstetric day assessment unit at 35 weeks of gestation. She gives a history of PROM at 30 weeks of gestation following which she received erythromycin for 10 days. She feels well in herself and her vitals are normal. However, her blood test results reveal a raised white blood cell count (19,000 per mm3) and C-reactive protein (104 mg/L). An ultrasound examination reveals cephalic presentation with some liquor around the baby. A fetal cardiotocograph is normal.

In each of the following scenarios, please select the single most appropriate next management step from the list below.
A. Re-calculate the Bishop score
B. Offer Caesarean section
C. Perform an admission CTG and record the Bishop score
D. Administer PGE2 gel vaginally
E. Administer misoprostol tablets vaginally
F. Start an infusion of artificial oxytocin
G. Consider a reduced dose of PGE2 administered vaginally
H. Give terbutaline, intravenous fluids and place the mother in a left lateral position


6.A 37-year-old nulliparous woman is being induced at 40 + 2 weeks’ gestation for reduced fetal movements. She has received 2 mg of PGE2 per vaginum 6 hours ago. Since then she has experienced some mild period-type cramping pains only. The CTG is normal.

 7.A 28-year-old woman attends the delivery unit at 38 + 4weeks in her first pregnancy with headache, 1+ proteinuria and BP 160/100

A. Antenatal corticosteroids
B. Antenatal glucocorticoids and antibiotics
C. Antenatal corticosteroids plus antibiotics plus inpatient monitoring for 48–72 hours
D. Emergency cervical cerclage
E. Elective cervical cerclage
F. Immediate induction of labour with the aim of vaginal delivery plus intravenous antibiotics
G. Immediate delivery by caesarean section plus intravenous antibiotics
H. Prophylactic tocolysis and intravenous antibiotics
I. Prophylactic tocolysis plus antenatal corticosteroids plus intrauterine transfer
J. Expectant management until 37 weeks of gestation or after
K. Transabdominal amnioinfusion
L. Transvaginal amniocentesis
M. Tocolysisandantenatalcorticosteroids
N. Tocolysis

Instructions: For each scenario described below, choose the single most appropriate initial management from the list of options above. Each option may be used once, more than once, or not at all.

8. A 40-year-old multiparous woman attends the obstetric day assessment unit with reduced fetal movements at 32 weeks of gestation. A cardiotocograph (CTG) reveals a normal baseline, variable deceleration with reduced variability and no acceleration. Abdominal examination reveals a cephalic presentation and vaginal examination reveals a 2 cm cervical dilatation. An ultrasound scan confirms the cephalic presentation but also reveals severe oligohydramnios. She is tachypnoeic and tachycardic with spiking temperatures of 38°C. A review of her notes indicates that she had PROM at 28 weeks of gestation.

9.A 38-year-old multiparous woman attends her antenatal clinic appointment at 35 weeks of gestation. She gives a history of PROM at 28 weeks of gestation. Abdominal examination reveals cephalic presentation with no signs of chorioamnionitis. An ultrasound scan reveals oligohydramnios. Her inflammatory markers are normal.

10.A 34-year-old multiparous woman presents to the labour ward with a gush of fluid through the vagina at 26 weeks of gestation. A speculum examination by the on-call registrar confirms a spontaneous rupture of membranes. Abdominal examination reveals no uterine activity. Clinically, she feels well and vitals are normal.