EBCOG Part 1-Management of Labour & Delivery

1.With regards to caesarean section:

A The incidence of postoperative morbidity is increased following classical caesarean section compared to lower segment caesarean section (LSCS)

B The risk of peripartum hysterectomy is quoted to be 1 in 500 with first caesarean section

C Dissection of the bladder is always required while performing classical caesarean section

D A subsequent trial of labour is allowed for women with previous classical caesarean section

E The risk of uterine rupture with vaginal birth after caesarean (VBAC) is less than 1% in women with one previous LSCS

2.With regards to shoulder dystocia:

A Fifty per cent of cases occur in babies weighing less than 4 kg

B It occurs due to obstruction at the pelvic outlet

C It resolves with simple manoeuvres (like McRoberts and suprapubic pressure) in more than 90% of cases

D It is increased in women who receive pethidine for pain relief in labour

E It is definitely a preventable condition

3.The following information should be given to women choosing epidural analgesia:

A It is associated with prolonged second stage of labour

B It is always associated with long-term backache

C Its effectiveness is less than parenteral opioids

D Epidural solutions containing opioids can cross the placenta and cause respiratory distress in the baby

E It is associated with longer first stage of labour

4. The following are indications to switch to continuous electronic fetal monitoring (EFM) from intermittent auscultation in low-risk women:

A Maternal pyrexia of 37.1°C on two occasions 2 hours apart

B Oxytocin use for augmentation of labour

C Maternal pyrexia of 38°C on two occasions

D Abnormal fetal heart rate (FHR) detected on intermittent auscultation

E The woman’s request

5.Concerning interventions to reduce perineal trauma during childbirth:

A Perineal massage should be routinely performed in the second stage of labour

B Episiotomy should be carried out for vaginal births

C Episiotomy should be performed to assist instrumental deliveries if necessary

D Unless fetal compromise is suspected, tested effective analgesia should be offered before undertaking episiotomy

E Episiotomy should be routinely offered to women with previous history of third- and fourth-degree tear

6.The third stage of labour is said to be:

A Actively managed if the cord is clamped and cut early

B Actively managed if the placenta is delivered by maternal effort

C Actively managed in the absence of use of oxytocin

D Actively managed if clamping of the cord is withheld until the pulsations cease

E Prolonged if the placenta is not delivered 30 minutes after the birth of the baby with physiological management

7. With regards to perineal trauma:

A Injury to the skin is classified as a first-degree tear

B injury to the anal sphincter <50% thickness and anal mucosa is classified as 3B (third-degree tear)

C Injury to the perineal muscles but not the perineal skin is classified as a first- degree tear

D Injury to the perineal muscles but not the anal sphincter is classified as a second-degree tear

E Injury to the perineal muscles and both external and internal sphincter is classified as 3B (third-degree tear)

8. With regards to prelabour spontaneous rupture of membranes (SROM) at term:

A Speculum examination should always be done irrespective of the history

B Digital examination should be done to check cervical dilatation in the absence

of contractions

C Women should be informed that 90% will go into spontaneous labour within

24 hours

D Women should be informed that there is a 1% risk of serious neonatal infection

E Lower vaginal swabs should be routinely done in women with SROM

9. With regards to FHR trace on cardiotocograph (CTG):

A It is said to be suspicious if two or more features are classified as non- reassuring

B It is said to be suspicious if there is reduced variability for more than 40 minutes and three accelerations in the last 30 minutes

C It is said to be suspicious if there is reduced variability for more than 90 minutes with baseline FHR of 165 bpm

D It is said to be pathological if it shows recurrent late deceleration down to 60 bpm with slow recovery for 35 minutes

E It is said to be suspicious if the CTG shows recurrent atypical variable decelerations for more than 30 minutes

10. With regards to Sheehan syndrome:

A The first sign may be failure of lactation in the puerperium

B The onset may be late with loss of axillary and pubic hair and atrophic vaginal changes

C It can present with hypothyroidism

D It can present with oligomenorrhoea or amenorrhoea

E Hormonal therapy may be used to achieve pregnancy in these women