EBCOG part 1 Pre Assessment mock

A.Administer terbutaline to the mother
B.Ask the attendant midwife to perform a vaginal examination and artificial rupture of fetal membranes
C.Commence oxytocin infusion and reassess progress of the labour in 2 hours
D.Commence oxytocin infusion and reassess progress of the labour in 30 minutes
E.Commence oxytocin infusion and reassess progress of the labour in 4 hours
F.Deliver by category 1 Caesarean section
G.Deliver by category 2 Caesarean section
H.Epidural analgesia to be commenced followed by oxytocin infusion
I.Immediate transfer to the operating theatre for a reassessment with a view to delivery
J.Induce labour by ARM and commence oxytocin infusion
K.Manual cervical dilation prior to instrumental delivery in theatre
L.Perform fetal blood sample for a pH estimation
M.Prepare for assisted/instrumental delivery in the labour room
N.Reassess progress of the labour in 2 hours
O.Reasses progress of the labour in 30 minutes
P.Ultrasound scanning to confirm the fetal presenting part and placental localisation
Q.none of the above

The above options explain the different options for intrapartum management ,the Follwing scenarios explain women in different soatuations,Kindly choose the appropriate anagement for all the below scenarios .

1.A 23-year-old P1 has undergone an induction of labour at 41 weeks + 6 days in her first pregnancy. The antenatal care was complicated with an admission to hospital with a small painful antepartum haemorrhage at 34 weeks of gestation. The symptoms settled spontaneously and all investigations and monitoring were normal; her blood group is AB Rh positive. Vaginal prostaglandin gel insertion established labour within 3 hours and the labour progressed such that 4 hours later the cervix was 5 cm dilated with meconium-stained liquor with a satisfactory CTG, and epidural anaesthesia was instigated. Two hours later, the fetal head was nought-fifths palpable abdominally; the cervix was 9 cm dilated; the position was left occipto-anterior with minimal caput and moulding; the CTG had a baseline of 165 beats per minute with no baseline variability; no accelerations or decelerations and a small amount of post-examination vaginal bleeding was noted. The fetal heart rate then unexpectedly drops to 85 beats per minute and does not recover

2.A 34-year-old woman, P2, is is admitted in strong labour at 37 weeks of gestation. She has had all her antenatal care with her community midwife. She has had two normal births of healthy babies both weighing over 3.3 kg. There have been no problems during this pregnancy. As she arrives she begins involuntary pushing, meconium-stained liquor is draining and the attending midwife examines her and diagnoses a breech presentation with sacro-anterior position. The fetal heart rate is dropping to 80 beats per minute with each contraction with recovery back to 120 beats per minute in between contractions. She is contracting three times every 10 minutes and is distressed with pain but pushing well. The breech is descending through the birth canal satisfactorily and the station is now well below the ischial spines. The fetal heart rate baseline is now 110 beats per minute with decelerations down to 50 beats per minute during maternal pushing effort

3.A 31-year-old woman in her first pregnancy and with a BMI of 25 is admitted in spontaneous labour at 41 weeks of gestation after a straightforward normal pregnancy. She has had most of her antenatal care with her community midwife. She reports reduced fetal movements for the last 24 hours and a small amount of fresh vaginal bleeding prior to admission. She is distressed and contracting four times every 10 minutes. On examination: SFH is 34 cm; longitudinal lie; presenting part is cephalic with two-fifths palpable. A vaginal examination reveals that the cervix is 5 cm dilated; presenting part vertex; right occipto-lateral position with minimal caput and moulding; blood-stained liquor is draining. The CTG shows 60 minutes of trace with a normal baseline rate of 140; little or no baseline variability, no accelerations; no decelerations

4.21-year-old woman, P1 and with a BMI of 22, is admitted in spontaneous labour at 37 weeks of gestation after a straightforward normal pregnancy. She has had all her antenatal care with her community midwife and had a normal birth of her first child, birthweight 3305 g. She reports reduced fetal movements for the last 24 hours; there is no history of any vaginal bleeding. She is contracting twice every 10 minutes. On examination: symphysial fundal height (SFH) is 38 cm; longitudinal lie; presenting part is cephalic with three-fifths palpable. The fetal heart rate is 140 beats per minute and regular with one audible deceleration. The CTG shows 20 minutes of trace with a normal baseline rate of 140; little or no baseline variability, no accelerations; no decelerations

5.A 17-year-old woman, in her first pregnancy and with a BMI 21, is admitted from home at 22+6 weeks of gestation in spontaneous labour after a large amount of vaginal bleeding and abdominal pain, which woke her up. Prior to this episode her pregnancy had been progressing normally. She is very distressed and pale. On examination her BP is 140/85 mmHg; pulse is 104 beats per minute; uterus hard and tender; fetal heat rate 104 beats per minute with audible decelerations to 60 beats per minute; vaginal examination cervix is 6 cm dilated; presenting part breech with absent membranes and fresh bleeding and clots

6.A 41-year-old woman, in her first pregnancy and with a BMI of 32, is admitted in spontaneous labour at 39 weeks of gestation after a straightforward normal pregnancy. She has had most of her antenatal care with her community midwife. She reports reduced fetal movements for the last 24 hours; there is no history of any vaginal bleeding. She is distressed and contracting four times every 10 minutes. On examination: symphysial fundal height (SFH) is 35 cm; longitudinal lie; presenting part is cephalic with one-fifth palpable. The fetal heart rate is 140 beats per minute and regular with one audible deceleration. A vaginal examination reveals the cervix is 8 cm dilated; presenting part vertex; occipto-anterior position with minimal caput and moulding; clear liquor is draining. The CTG shows 40 minutes of trace with a normal baseline rate of 140; reduced baseline variability, no accelerations and regular variable decelerations

A. AFP, LDH, Hcg
B. Ca 125
C. combined oral contraceptive pill
D. expectant management
E. further imaging with CT scan
F. IOTA scoring
G. laparoscopic removal of uterus
H. laparoscopic removal of ovary
l. laparotomy
J. laparotomy and ovarian cystectomy
K. progesterone only pill
L. repeat ultrasound and CA-125 in 4-6months
M. TAH and BSO
N. ultrasound-guided aspiration
O. MRI
P. Discharge from F/U
For each of the following questions, choose the best option:

7. A 54-year-old woman presents with abdominal pain and has had an ultrasound scan done. It showed an ovarian cyst which triggered a transvaginal scan. Pain has resolved now. A 46-mm cyst with a thin wall with normal CA 125 is noted. She has a repeat scan after 4 months that shows a 58 mm cyst with similar features and normal tumour markers. No new symptoms are noted.

8.A 60-year-old woman has an ultrasound scan done for non-specific abdominal pain and is found to have an ovarian cyst of 28 mm which is fluid filled. The Ca 125 is normal and the RMI is 100. She is advised a further scan after 4 months. The cyst has now resolved.

A.Ovarian hyperthecosis
B.Premature ovarian failure
C.Prolactin secreting adenoma
D.Drug-induced hyperprolactinaemia
E.Post-pill amenorrhoea
F.Depo-medroxyprogesterone acetate induced amenorrhoea
G.Unexplained infertility
H.Late onset congenital adrenal hyperplasia
I.Androgen secreting tumour
J.Cushing’s syndrome
K.Asherman’s syndrome
L.Sheehan’s syndrome


The following clinical scenarios show various causes of amenorrhoea . Chose the appropriate diagnosis for the situation.

9. A healthy 32 yr old with secondary amenorrhoea. She had been using depo-inj for contraception, last injection was 2 yrs ago. Her BMI is 24 kg/m2. Pelvic ultrasound shows increased ovarian volume. Serum prolactin = 50 ng/ml, testosterone = 3.6 nmol/L, FSH = 2.2 IU/L, LH = 2.0 IU/L, TSH = 1.5 mIU/L, SHBG = 12 nmol/L. All other investigations normal

10.A healthy 35 yr old with secondary infertility. Her only child was delivered by CS for placenta previa 3 years ago. She has period every 32– 50 days & has not used contraception for 3 yrs. Pelvic ultrasound and her partner’s semen analysis are normal. Follicular phase FSH = 25 IU/L, LH = 18 IU/L, day 21 progesterone = 3 ng/ml, prolactin = 15 ng/ml.