MRCOG Part 2 – Management of Labour & Delivery SBA

1. 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?

2. 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?

3. 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

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

5. 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?

6. 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?

7. Mrs. Rashida Khan, 24 year old pregnant woman with metallic 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?

8. Rebecca, primipara, low risk pregnancy,delivered yesterday, is up 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.

9. Sara, low risk multiparous lady is 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 &chin,and head started retracting. Midwife positioned sars thighs on her abdomen and tried with axial traction but it wasn’t successful.What’s the best manoeuvre Angel should try in this Situation?

10. 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?

11. A 24 primiparous patient with a spontaneous conception is seen in a booking antenatal clinic at 14 weeks gestation. Her BMI is 26 and she smokes 10 cigarettes a day. Her combined test gave a low risk for Down syndrome, however the PAPPA level was noted to be 0.3 MoM. What fetal growth surveillance would be most appropriate, according to the RCOG green Top Guideline No. 31 (Investigation and Management of the Small for Gestational Age Fetus)?

12. Which of the following is correct regarding a normal antenatal Doppler ultrasound study?