EBCOG Part-1-Managemnt of labour & delivery – DAY1(SBA)

1.You are the ST5 in the labour room.A primi is admitted with regular contractions 2 in 10 mins at 10.00 pm,she was 5 cm dilated at that time.4 hours later she is still 5 cm with contraction 2 in 10 mins.An amniotomy was done at 2 am.At 4 am a vaginal exam reveals she is 5 cm with contractions 2 in 10 mins.What is your next action?

2.A multiparous woman is seen by you in the labour suite,She has previous three normal vaginal deliveries & no other high risk factors.She is 39 weeks pregnant & complaining of labour like pain for the past 2 hours.On exam her general condition is satisfactory.The fetal heart is 140-150/min & regular.she has uterine contractions 3-4 in 10 mins with moderate intensity.Vaginal examination reveals a cervix which is 7 cm dilated &membranes are intact.What is the further management?

3.The midwife has admitted a primi to the labour room with no risk factors.At admission she was 4 cm dilated with intact membranes & contractions 2-3 every 10 min.The fetal heart is reassuring.The midwife tells you that 4 hours later the primi is 5 cm dilated with same contractions.What is your advise to the midwife?

4.A primi with 39 weeks pregnancy presents to the delivery suite with regular painful contractions for past 3 hours .On exam her findings are – strong contractions 4 in 10 mins.The fetus is in cephalic presentation & 3/5 palpable head.Initial vaginal exam shows a cervix with 60% effacement & 4 cm dilated.Membranes are intact ,station is -1 .Vaginal exam 4 hrs later – station -1,cervix 4 cm dilated ,membranes intact with same ongoing contractions.What is the most appropriate action?

5.A primi with 38+6 weeks gestation is seen in the delivery suite with h/o abdominal pain & vaginal leaking for 5 hours.She has no other risk factors.On exam her Pulse ,BP & temp are normal.She is having regular ,painful uterine contractions 3 in 10 mins & cervix is 4 cm dilated.Cardiotocography was performed due to concerns of fetal heart on auscultation.The CTG shows a baseline FHR of 140-150 bpm with no non-reassuring or abnormal features.What is the next appropriate step?

6.A primi 35 weeks gestation,is admitted at 10.30 in labour &is 3 cm dilated ,station is -1.She had SROM at 12.30.& liquor was clear.You are called to see the CTG at 13.00-baseline 140/min,variability 4,no accelerations & variable decels >60 beats & lasting >60 secs for last 40 mins for more than 50% of contractions. Vaginal exam revealed she was 5 cm dilated & liquor was blood stained.What will you do next?

7.A primi at 40 weeks gestation with pre-eclampsia is in spontaneous labour.She has immune thrombocytopenia.She is being monitored by CTG.At admission she was 4 cm dilated ,draining clear liquor & progressed to 7 cm in 4 hours.The CTG now shows baseline of 140 bpm,variability of 30 beats for past 30 minutes.she has already had IV fluids & her position was changed.What will be your first line of action?

8.Mrs Anita is a primi who has come in for an antenatal consultation at 32 weeks to discuss mode of birth.She has undergone Mitral valve replacement surgery for Rheumatic heart disease 2 years ago.She is now asymptomatic & on T.Warfarin 5 mg once a day.What will you advise her about Warfarin therapy in third trimester?

9.Mrs Anna who is a known asthmatic has just delivered by a normal vaginal delivery,She developed atonic postpartum hemorrhage which is not responding to oxytocin infusion.You are considering using prostaglandins.Which of the following prostaglandins can be used in women with bronchial asthma without exacerbating their symptoms?

10.You are the ST5 in the labour room & a have a lady with immune thrombocytopenic purpurawho is planned for a normal vaginal delivery.Which of the following instructions,except one ,will you ask your juiniors to follow to avoid post partum hemorrhage

11.A 25 year old primi comes to the labour suite with regular painful contractions,a temperature of 39.6 C & offensive liquor draining at 29 weeks of gestation.She had PPROM 2 weeks previously.The fetal heart rate is 170/min & there are late decelerations with >50% of contractions.The cervix is 2 cm dilated & uneffaced.what is the most appropriate course of action?

12.A 36 year old woman with uncontrolled diabetes & who is 29 weeks pregnant is admitted because of threatened preterm labour.What is your advise regarding preterm labour?

13.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

14. 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

15.With regards to FHR trace on cardiotocograph (CTG):
A It is said to be suspicious if two or more features are classified as nun-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

16.The following are recommended by the National Institute for Health and Clinical Excellence (NICE) with regards to first stage of normal labour:
A Once labour is established, the partogram should be initiated
B Check FHR after a contraction every 30 minutes
C Document frequency of contractions every 30 minutes
D Check vitals, including pulse and temperature, every 4 hours
E Check blood pressure every hour