Labour And delivery ( Platinum ) - 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?

A. Abnormal CTG
B. Acute onset of scar tenderness
C. Haematuria
D. Loss of station of the presenting part
E. Severe abdominal pain Correct

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 ?

A. 64%
B. 72%
C. 90%
D. 84%
E. 50%

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

A. IntialCEFM for 30 minutes then intermittent auscultation
B. Intermittent auscultation using hand held Doppler
C. Intermittent auscultation using ctg machine
D. CEFM
E. US to see fetal heart

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

A. Hypernatremia
B. Hypoglycemia
C. Hypokalemia
D. Hypomagnesaemia
E. Hyponatremia

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?

A. 8 ml (80 mg)
B. 15ml (150 mg)
C. 18 ml (180 mg)
D. 25ml (250 mg)
E. 35ml (350mg)

6. Primary PPH is defined as

A. Loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby
B. Loss of 1000ml or more of blood from the genital tract within 12hours of the birth of a baby
C. Loss of 500 ml or more of blood from the genital tract within 48hours of the birth of a baby
D. A&B are correct
E. None of the above

7. Secondary PPH is defined as

A. Defined as abnormal or excessive bleeding from the birth canal between 24 hours and 6 weeks postnatally.
B. Defined as abnormal or excessive bleeding from the birth canal between 48 hours and 12 weeks postnatally.
C. Defined as abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally.
D. Defined as abnormal or excessive bleeding from the birth canal between 6 hours and 12 weeks postnatally.
E. Defined as abnormal or excessive bleeding from the birth canal between 48 hours and 6 weeks postnatally.

8. The most common cause of PPH is

A. Trauma
B. Coagulation disorders
C. Atonic uterus
D. Retained bits of placenta
E. Rupture uterus .

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 ?

A. Is a synthetic analog of the amino acid glycine
B. Increases conversion of plasminogen your plasmin
C. It promotes fibrin degradation
D. Tranexamic acid was effective in decreasing the incidence of blood loss greater than 1000 ml in women who had undergone vaginal birth
E. Tranexamic acid was effective in decreasing the incidence of blood loss greater than 1000 ml in women who had undergone caesarean section but not vaginal birth.

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 ?

A. <500ml
B. > 500 ml
C. 1000ml
D. 1000-1500 ml
E. >1500 ml

11. Shock index is

A. Late marker for hemodynamic compromise
B. Defined as SBP/HR
C. Value >0.5 associated with increased mortality
D. Calculated as Heart rate /Systolic blood pressure
E. None of the above

12. Regarding Postpartum Haemorrhage,

A. Secondary Postpartum Haemorrhage is the most common form of major obstetric haemorrhage
B. PPH can be major if blood loss is 500 ml
C. Secondary PPH is defined as abnormal or excessive bleeding from the birth canal wit in 24 hours
D. In women with lower body mass (e.g. less than 60 kg), a lower level of blood loss may be clinically significant.
E. Primary PPH is the loss of 500 ml or more of blood from the genital tract afer 24 hours of the birth of a baby.

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

A. All women at term with suspected macrosomia
B. Diabetic women with suspected macrosomia
C. Prelabour rupture of membranes at term
D. Previous shoulder dystocia
E. Women with previous two caesarean births

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

A. 5 fold higher than general population
B. 10 fold higher than general population
C. 11 fold higher than general population
D. 15 fold higher than general population
E. 18 fold higher than general population

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

A. The McRoberts’ manoeuvre with suprapubic pressure
B. Delivery of posterior arm
C. Wood screw
D. Rubin
E. All fours.

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 ?

A. Schema activation.
B. Schema refinement.
C. Small group discussion.
D. Show balling
E. Snowballing.

17. All are true regarding The McRoberts’ manoeuvre except

A. The McRoberts’ manoeuvre is flexion and adduction of the maternal hips, positioning the maternal thighs on her abdomen.
B. It straightens the lumbosacral angle, rotates the maternal pelvis towards the mother’s head
C. Increases the relative anterior-posterior diameter of the pelvis
D. The McRoberts’ manoeuvre is an effective intervention, with reported success rates as high as 90%.
E. It has a low rate of complication and is one of the least invasive manoeuvres.

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 ?

A. Offer ECV
B. Elective LSCS
C. Vaginal breech delivery
D. Mergency LSCS
E. Wait for spontaneous version

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.

A. <5 %
B. 8%
C. 10%
D. 11%
E. 20%

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?

A. 0.01 mg (0.1 ml of 1:10000)
B. 0.05 mg (0.5 ml of 1:10000)
C. 0.1 mg (0.1 ml of 1:1000)
D. 0.5 mg (0.5 ml of 1:1000)
E. 10 mg (10 ml of 1:1000)

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?

A. Central nervous system herpes simplex virus
B. Early onset Group B Streptococcus disease
C. Early onset listeriosis
D. Mycoplasmia hominis
E. Plasmodiumfalciparium

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?

A. 9:00
B. 10:00
C. 11:00
D. 12:00
E. 8:00 on the subsequent day

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?

A. Ask an assistant to perform vaginal examination and apply direct pressure to the fetal head over the posterior frontanelle
B. Perform a J or an inverted T incision, identify a fetal foot, and perform breech extraction
C. Request that the on-call consultant attends as soon as possible and wait for their arrival
D. Use a forcep blade to disimpact head by 'scooping the head'
E. Continue attempts to disimpact the fetal head from above

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

A. Risk of having severe headache is 1in 100
B. Can offer as Her Platelets count is 84
C. Can offer as her INR is >1.4
D. Availability of competent anasthetist in unit
E. It increases risk of Operative delivery

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

A. Woman should be reviewed by a doctor if one of the components of NEWS is 3 or more.
B. If MEOWS is 1white-needs to review patient hourly .
C. A MEOWS score of 3 is an indication for a senior midwife and junior obstruction to urgently review a woman with in 30minutes
D. MEOWS score showing more than 2 yellow or 1red , observations need to be reviewed in 1hour
E. MEOWS score showing more than 2red should be reviewed By ST3 and to be discussed with consultant

Labour And delivery ( Platinum ) – SBA

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