Labour & Delivery – SBA

1. Ms. X, a 32-year-old woman is in labour in her second pregnancy. Her previous delivery was by caesarean section. What is the most consistent indicator of uterine rupture for this woman?

2. Mrs. X is 30 years old at36 weeks pregnancy in her third pregnancy. Her first pregnancy was low risk normal delivery with midwife, second pregnancy was emergency cesarean section for fetal distress. Now opted for VBAC, what is the success rate VBAC for her ?

3. Patient present in labour nulliparous, was low risk following with consultant, serial scan baby in 70th centile.How to follow her in labour:

4. The most common side effect of excessive use of oxytocin is

5. You are asked to repair a vaginal tear following a normal delivery. The mother’s weight is 50 kg. She is otherwise well with no allergies. What is the maximum dose of lidocaine 1% without epinephrine that you can use for perineal infiltration?

6. Primary PPH is defined as 

7. Secondary PPH is defined as 

8. The most common cause of PPH is

9. Clinicians should consider the use of intravenous tranexamic acid (0.5–1.0 g), in addition to oxytocin, at caesarean section to reduce blood loss in women at increased risk of PPH. Which statement is true about tranexamic acid ?

10. Mrs. Maria Has delivered by rotational forceps delivery 6hrs before . You have been called as staff noticed increased vaginal bleeding . On examination her pulse is 114/min .Blood pressure is 70/40 mm of Hg RR-24/min .she looks pale and very tired On examination – uterus is relaxed and atonic . What is the probable blood loss ?

11. Shock index is

12. Regarding Postpartum Haemorrhage,

13. Elective caesarean section is best recommended to prevent morbidity from shoulder dystocia in which of the following clinical situations: 

14. Ms.Rebecca , primipara low risk pregnancy ,delivered yesterday is for discharge. Her labour was complicated by shoulder dystocia .her baby had fracture clavicle managed conservatively, otherwise baby is doing good.she is asking you recurrence of shoulder dystocia in furtive pregnancies

15. Sara , low risk multiparous lady in her third pregnancy , she has been low risk ,EFW was 2800gms .she planned home delivery with her midwife , Ms, Angel.
Sara had spontaneous onset of labour , progressed well , delivered baby head but Ms. angel noticed difficulty with delivery of the face and chin & head started retracting . Midwife positioned sars thighs on her abdomen and tried with axial traction it wasn’t successful , what’s is best manoeuvre Angel should try in this Situation

16. You have been asked to teach a group ofFY1 about management of shoulder dystocia . When u checked their back ground knowledge , they have already a good knowledge .which method you will apply here ? 

17. All are true regarding The McRoberts’ manoeuvre except

18. Mrs sweetie , is primigravida now 36 weeks of pregnancy with breech presentation . recent scan shows Flexed breech with good cardiac activity .Estimatedfetal weight is 2450grams.what is advise you will give for delivery ?

19. Mrs. Rosy, primigravida with 36weeks gestation with persistent breech presentation. She has been offered External cephalic version . She wants to Know the
Risk of spontaneous re-version after successful External cephalic version.

20. A 25-year-old primigravida woman is admitted to the labour ward with regular contractions and draining clear liquor. She is a known carrier for Streptococcus B in this pregnancy. Shortly after being given a loading dose of benzylpenicillin, she becomes wheezy, develops a rash and has difficulty breathing.
What is the most appropriate initial dose of intramuscular adrenaline?

21. Mrs.Susan is primigravida relieved at 36 weeks .she had history spontaneous rupture of membranes 22 hours prior. developed a temperature of 38°C in the last hour of the labour. Six hours after delivery Mrs.Susan notices that the baby is lethargic and not feeding well
What is the most likely aetiology?

22. Ms. XY is a Para 1 who has had an emergency caesarean section for failure to progress. Her epidural catheter was removed at 8:00 AM today, 6 h after her CS. She is written up to have prophylactic LMWH daily, commencing today for 10 days. Her postnatal check is satisfactory. Which of the following times is most appropriate for her to have the LMWH?

23. As a senior O&G Speciality Trainee you are supervising a junior colleague who is performing a caesarean section in the second stage of labour following an unsuccessful attempt at operative vaginal delivery. Your colleague has some difficulty with delivery of the baby and you immediately take over the procedure. You are unable to disimpact the fetal head from the maternal pelvis.
What should you do next?

24. 28 year old Swati Patel, primigravida,38 weeks pregnancy, is in active labour. She is getting 3 strong contractions in 10minutes, she is now 4 cm dilated. She is requesting for epidural analgesia. She can be offered epidural analgesia in all scenarios except

25. MEOWS is important risk assessment tool. All regarding MEOWS score are true except

26. Ms.Rachel, primigravida in her first pregnancy admitted in labour room, 4cm dilated. On spontaneous rupture of membranes, prolonged fetal bradycardia is noted, on vaginal examination she is 5 cm dilated with cord prolapse, decoded for cesarean section
What is the category of cesarean section in this scenario?

27. Mrs. Pandey, is para1 Living 1 with 38 weeks in spontaneous labour. She was assessed at 23:00 hrs and had progressed to 5 cms cervical dilatation. She was examined at 03:00 h and was found to be 6 cms dilated, 0.5 long, with intact membranes, vertex at spines.
What is the next appropriate step in managing her labour?

28. Mrs. Rashida Khan, 24 year old pregnant woman withmetallic aortic valve is now at 32 weeks of pregnancy. She is on Tab warfarin 7mg once a day with well controlled INR. Her baby is small for gestation, recent Doppler is normal.Consultant has taken decision to deliver her by 35 weeks 0 days.
What is the ideal time to shift her to LMWH ?

29. Rachel, 38 weeks pregnancy has been induced because of Diabetes mellitus.Because of pathological CTG, forceps was applied, delivered baby’s head but shoulders not delivered with routine axial traction. With flexion and abduction of Rachel’s hips, positioning thighs on her abdomen. Shoulders got released. What is the success rate of this manoeuvre? 

30. What is the incidence of EOGBS in UK without implementing the screening program?

31. What is the risk of adverse outcome to the baby if a low risk primigravida opted for home delivery?

32. What is the risk of spontaneous reversion after successful ECV at 36 wks in a Primigravida?

33. Ms. Babitha, primigravida, now 38 weeks pregnant, has come to labour room with history of leaking in active labour. She has a history of multiple fibroids in lower segment. On examination she is 4 cm dilated,baby’s nose, mouth and malar process are felt.
What is the length of engaging diameter in this presentation ?

34. 26-year-old Margarita is primigravida with 39 weeks with Right occipito posterior in labour. What is the presenting diameter?

35. The emergency buzzer went off in the postnatal ward & you are called to see a patient who delivered 4 hours earlier via ventouse. You note a bulging haematoma has developed and patient is hypotensive. With regard to vulval haematomas what structure limits its spread?

36. Mrs. X had vacuum delivery previous day. She had blood loss of 500 ml. At what level of haemoglobin, she is said to be anaemic?

37. You are reviewing a G2P1 at  34weeks POA who come to you to discuss mode of delivery. You noticed in her previous pregnancy she sustained a third-degree tear. What percentage of women who sustain a third or fourth degree tear at their first birth will choose for elective Caesarean section for the birth of their second child?

38. Ms. Rebecca, para2 Living 2.Her 1st delivery was forceps delivery & 2nd was cesarean section for Fetal distress. In her current pregnancy, what is the most likely measure to reduce the chance of forceps delivery?

39. For assisted vaginal delivery…

40. A 35-year-old para 2 presents in spontaneous labour at 39 weeks gestation. Her baby is identified to be in the breech position and she is progressing well in labour with no evidence of fetal compromise. After discussion, and identification that there are no contraindications, she wishes to attempt vaginal breech delivery.When conducting her vaginal breech delivery, an experienced practitioner should routinely:

41. A 35-year-old woman (G3 P2 normal deliveries) presents to delivery suite with signs of labour at 36 weeks gestation. She was otherwise low risk in pregnancy. She mentions her contractions occur every 2-3 minutes and feel very strong. The student midwife examines her and she is fully dilated, with station at -1. She draws out her findings: What is the next most appropriate step?

42. The engaging diameter in Brow presentation is 

43. Ms XY is a primigravida, gestational diabetic, 38 weeks in spontaneous labour. She was assessed at 13:00 h and had progressed to 5 cms cervical dilatation. She was examined at 17:00 h and was found to be 6 cms dilated, 0.5 long, with intact mem- branes, vertex at spines.
What is the next appropriate step in managing her labour?

44. Which one of the following statements is correct in relation to the third stage of labour?

45. A 25 year old, who is 40 weeks pregnant in her first pregnancy, is in the second stage of labour. She has been actively pushing for 1 h. CTG shows a baseline of 180 bpm, reduced baseline variability, no accelerations and frequent atypical vari- able decelerations. She is contracting 3–4 every 10 min. Vaginal examination reveals a fully dilated cervix with the fetal head in a direct occipito-anterior position and at station +1 below spines. Which of the following is the most appropriate next man- agement step?

46. Ms. Mariam Ahmed, primigravida, now 36 pregnancy in active labour. she was here to pay a visit to her sister as she delivered recently. She has been booked at her home country. You are suspecting mitral valve stenosis on examination. All are true regarding her except –

47. Ms. Fatima, 24-year-old is in her first pregnancy, is on warfarin for her mechanical mitral valve. Otherwise her pregnancy has been uneventful. She is now 34 weeks pregnant. Her cardiologist has advised to switch to LMWH if needed. Her consultant has decided to deliver her by 38 weeks. What is the ideal time to switch over to LMWH?

48. Ms. Fatima, 24-year-old is in her first pregnancy, and she is on warfarin for her mechanical aortic valve. Otherwise her pregnancy has been uneventful. She is now 33 weeks pregnant. Her cardiologist has advised to switch to LMWH if needed. Her consultant has decided to deliver her by 36 weeks because of IUGR. What is the ideal time to switch over to LMWH?

49. Ms. Fatima, 24-year-old is in her first pregnancy, she is on warfarin for her mechanical aortic valve. Otherwise her pregnancy has been uneventful. She is now 33 weeks pregnant. Her cardiologist has advised to switch to LMWH if needed. Her consultant has decided to deliver her by 36 weeks because of IUGR. Her labour was induced. All are true regarding managing anticoagulation except-

50. 34-year-old Mrs Hasina is 38 weeks pregnant with mechanical aortic valve and previous cesarean section. It was done for Cepahlo pelvic disproportion. She is on therapeutic low-molecular weight heparin as she had an episode of Deep vein thrombosis at 8weeks gestation. After discussion with MDT, she is for elective cesarean section after 2 days at 09: 00hrs.She is on therapeutic low-molecular weight heparin. All are true regarding advise of Anticoagulation except –