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- A 34-year-old para 2 woman with two previous normal deliveries comes in spontaneous labour at 40 weeks’ gestation. She was low risk and was found to be in established labour at 6 cm cervical dilatation with intact membranes. A few hours after this examination, she had spontaneous rupture of membranes, fully dilated cervix and a brow presentation. What is the diameter of the presenting part?
39 weeks’ gestation. She is low risk and wants to have water birth in the midwifery-led unit. The cervix is fully effaced with 4 cm dilatation and intact membranes. Which one of the statements is more appropriate for care of the women labouring in water?CorrectIncorrect
- Which one of the following statements is correct with regards to the postures in labour?
- A 35-year-old para 1 woman is in established labour with strong, regular contractions and a cervical dilatation of 4 cm. She is requesting stronger pain relief as Entonox is making her feel sick and is not very effective. She does not want an epidural and is asking about the alternative options. You have counselled her about the opioid analgesics in detail. Which one of the following statements is true with regards to the opioid analgesics?
- A 25-year-old nulliparous woman at 41 + 5 weeks’ gestation was induced for postdates with Prostin followed by artificial rupture of membranes and Syntocinon infusion. She collapsed 5 minutes after epidural insertion with bradycardia and hypotension. Immediate cardiopulmonary resuscitation measures were started after stopping the epidural infusion. The collapse was believed to be secondary to inadvertent intravenous administration of the local anaesthetic causing toxicity. What is the recommended drug of choice for the treatment of local anaesthetic toxicity?
- A 28-year-old woman with a past history of a third-degree tear was admitted in established labour and progressed well. She was in the second stage of labour and was actively pushing with good descent. Which one of the following would be most appropriate in preventing the obstetric anal sphincter injuries (OASIS)?
- A 30-year-old para 1 woman at 37 weeks’ gestation with breech presentation had an unsuccessful external cephalic version. She opted to have a vaginal breech delivery after counselling. What is the risk of umbilical cord prolapse in breech presentation?
- You were asked to see a para 2 woman in spontaneous labour at term who has been in the active second stage of labour for more than an hour and has maternal exhaustion. She is contracting 4–5 in 10 minutes and the cardiotocograph (CTG) is normal. Abdominal examination reveals that the head is not palpable per abdomen. She presents a fully dilated cervix, absent membranes, with a left occipitoanterior position with the vertex at +1 station. You have decided to proceed with an operative vaginal delivery with the woman’s consent. Which one of the operative vaginal deliveries would you be performing at this stage?
- A 20-year-old nulliparous woman at 26 weeks and 4 days of gestation attends triage with a history of spotting per vaginam. On speculum examination, the cervical os was open with bulging membranes in the vagina, but there were no signs of vaginal bleeding. Your neonatal unit is full and you are arranging an in utero transfer. What is the most appropriate initial management?
- A 38-year old para 1 woman at 40 weeks’ gestation attends triage with a 2-hour history of spontaneous rupture of membranes (SROM). She had a previous caesarean section 3 years ago for failure to progress at 5 cm dilation and is keen to have vaginal birth after caesarean (VBAC). She is having irregular contractions, one in 10–15 minutes lasting 20 seconds. SROM was confirmed and the cervix was noted to be fully effaced and 1 cm dilated. CTG was normal at admission. What is the most appropriate plan?