MRCOG Part 2 – Mini Combo – Operative Vaginal Delivery GTG 26 – SBA

1. 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 2 h and is exhausted. CTG shows a baseline of 150 bpm, normal baseline variability, occasional accelerations and infrequent typical variable 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 management step?

2. A primigravida is in spontaneous preterm labour at 35 + 1 weeks of gestation. She has progressed satisfactorily in labour and has been pushing for ten minutes. Fifteen minutes prior to pushing, a fetal blood sampling had been performed due to a suspicious CTG and the result was normal. You have been asked to attend as the CTG shows prolonged bradycardia. You are not able to feel the fetal head abdominally and the vertex is at +2 station and is less than 45∘ from the occipito-anterior position. 
What is the most appropriate course of action? 

3. Sequential use of instruments increases neonatal trauma. 
By what factor is the incidence of subdural and intracranial haemorrhage increased in this situation? 

4. Following a prolonged second stage of labour, a primigravida at term is examined in order to make a decision about operative vaginal delivery. Abdominal examination indicates that the fetal head is not palpable. Vaginal examination shows the presenting part to be in a direct occipito-anterior position with a station of +3, and a decision is made to perform a ventouse (vacuum extraction) delivery. 
How would you classify this operative vaginal delivery? 

5. A 28-year-old primigravida spontaneously labours at 40+6 weeks’ gestation. The first 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. The cervix is fully dilated, direct OP position with 2+ caput, 3+ moulding and station −1. She is contracting strongly at 4:10. The CTG is normal, and the epidural is working well. 
Which would be the best management?