Management of Labour & Delivery Extra Questions Batch C – MCQ

1. An F2 doctor is interested in obstetrics. He performs an SVD with the midwife, and he asks you to do a case-based discussion with him on the mechanisms of normal labour. You have a fetal skull model to help.
What is the length of the suboccipitobregmatic diameter?

2. An obese 36-year-old primigravid Jehovah’s Witness labours spontaneously at term. T e fetal head is delivered but, with the next contraction, the midwife cannot deliver the shoulders. A shoulder dystocia is announced, and help is called for. T e woman is put into McRoberts’ position.

What is the next most appropriate immediate course of action?

3. A senior obstetric trainee spends the day with an obstetric anaesthetist as part of his training in advanced labour ward practice. During a caesarean section the spinal block is not su ciently e ective, and a decision is made to perform a general anaesthetic.

What is the most commonly used induction agent in obstetric anaesthetic practice in the UK?

4. A 29-year-old para 2 with a booking BMI of 56 presents at 39+3 weeks’ gestation in labour. She is found to be 4 cm dilated and contracting 3:10 regularly. The presentation is uncertain, and the obstetric S 3 is called to con rm fetal presentation. During the ultrasound the woman has a spontaneous rupture of membranes. Ultrasound suggests a footling breech presentation. On examination the woman is dysmorphic looking. Vaginal examination con rms 4 cm dilatation, but with a cord prolapse, and an emergency call is made. The S 3 anaesthetist and S 7 paediatrician attend immediately, and the midwife telephones the consultant obstetrician and anaesthetist to come in from home. The S 3 anaesthetist is concerned and alerts you to an antenatal assessment examination that includes ‘Mallampati 3, thyromental distance 5 cm’. The C Ghasabaselinerateof140,variabilitygreaterthan5,noaccelerations and variable decelerations with fast recovery lasting less than a minute with every contraction.

What would be the most appropriate immediate course of action?

5. A 29-year-old para 2 with a booking BMI of 56 presents at 39+3 weeks’ gestation in labour. She is found to be 4 cm dilated and contracting 3:10 regularly. The presentation is uncertain, and the obstetric S 3 is called to con rm fetal presentation. During the ultrasound the woman has a spontaneous rupture of membranes. Ultrasound suggests a footling breech presentation. On examination the woman is dysmorphic looking. Vaginal examination con rms 4 cm dilatation, but with a cord prolapse, and an emergency call is made. The S 3 anaesthetist and S 7 paediatrician attend immediately, and the midwife telephones the consultant obstetrician and anaesthetist to come in from home. The S 3 anaesthetist is concerned and alerts you to an antenatal assessment examination that includes ‘Mallampati 3, thyromental distance 5 cm’. The C Ghasabaselinerateof140,variabilitygreaterthan5,noaccelerations and variable decelerations with fast recovery lasting less than a minute with every contraction.

What would be the most appropriate immediate course of action?

6. A 27-year-old primigravida from Somalia presents in labour, 5 cm dilated. T e midwife suspects female genital mutilation (FGM) and, a er discussion with the woman, con rms that this took place as a child. On examination there is evidence of clitoridectomy. T e labia are fused together, having apparently been stitched together as a child leaving a small introitus. She explains that intercourse took numerous painful episodes before it was possible a er her marriage. An epidural is given and a midline anterior episiotomy is performed. She goes on to have an SVD.

What type of FGM?

7. A 28-year-old primigravida spontaneously labours at 40+6 weeks’ gestation. The rst stage of labour is augmented at 5 cm labour and lasts for 11 hours. After 1 hour of passive second stage, she pushes for 2 hours and is exhausted. On examination the fetus is cephalic with 2/5 of the head palpable per abdomen. T e cervix is fully dilated, direct OP position with 2+ caput, 3+ moulding and station −1. She is contracting strongly at 4:10. T e C G is normal, and the epidural is working well.

Which would be the best management?

8. A 33-year-old primigravida with an IVF pregnancy labours spontaneously at 38+6 weeks’ gestation. Despite augmentation and good contractions her labour does not progress past 6 cm, and a category 2 caesarean section is arranged. T e woman consents to caesarean but is distressed to be told that hysterectomy is a possible complication. She asks how common this is.

How would you best describe the frequency of caesarean hysterectomy?

9. A 25-year-old para 1 is on her frst day after a forceps delivery and is reviewed on the postnatal ward. She is obese, and the epidural in labour had been difficult. There were extensive vaginal tears that took some time to repair. She now complains of le foot drop with paraesthesia over the dorsum and calf over this side. Other than this, peripheral neurologic examination is normal, and she has been mobilizing.

What is the most likely cause?

10. A 32-year-old primigravida with paraplegia after a 5 spinal cord injury presents in spontaneous labour at 37+0 weeks’ gestation having self-palpated her contractions. On examination the cervix is 6 cm dilated. Her BP is 102/68 mm Hg. Fifteen minutes later her BP is found to be 145/93 mm Hg. T e C G is normal.

What is the best immediate management?