Labour and Fetal Asphyxia

A 30 years old, G1 P0 is in spontaneous labour at 41 weeks gestation. Cervix is 8 cm dilated with vertex presentation and position is occipito-posterior. What is the presenting diameter?

• Occipito-frontal

• Submento-bregmatic

• Suboccipito-bregmatic

• Vertico-mental

By what mechanism is the head delivered in a face presentation?

• Extension

• Flexion

• Internal rotation

• Restitution

The followings are normal in the first stage of labour except

• Scalp pH of 7.24

• Base excess of -13 mmol/L

• Baseline variability in CTG of 5-10 bpm

• Baseline heart rate on CTG of 159 bpm

A 25 yo, G6 P5 at 39 weeks gestation complaints of continuous abdominal pain in labour room . Sha had one previous scar for failed instrumental delivery. CTG shows sudden FHR drop to 100 bpm from 140 bpm. Her cervix is 8cm dilated with irregular uterine contractions. What is your management plan?

• Perform fetal scalp blood sampling

• Trial of instrumental delivery in operation theatre

• Emergency caesarean section

• Start oxytocin augmentation and encourage active pushing when contractions re-establish

You are examining a woman who just had forcep delivery for prolonged second stage. Perineal examination reveals torn internal and external anal sphincters with intact anal epithelium. How would you classify perineal tear?

• 3a

• 3b

• 3c

• 4

A 29 years old, G3 P2 at 32 weeks gestation is admitted to labour room with os 6cm. CTG shows FHR 140bpm, deep variable deceleration to 60 bpm with slow recovery and normal variability. There is meconium stained liquor. What is your action?

• Category 1 LSCS

• Category 2 LSCS

• Category 3 LSCS

• Category 4 LSCS

A 34 years old, G2 P1 at 38 weeks gestation is in second stage of labour for the past one hour. Examination revealed direct OA position with station +1. Which of the following forceps is most suitable for her assisted vaginal delivery?

• Kielland's forcep

• Neville Barnes forceps

• Wrigley's forceps

• Piper forceps

A 38 years old, G6P5 at 41 weeks gestation presents with ROM for past five hours. Four hours later, her CTG reveals baseline FHR 165 bpm, variability 5 bpm and variable deceleration for last 60 mins. Os dilatation is 6cm. What is your next action?

• Left lateral position

• Facial oxygen therapy

• Fetal scalp blood sampling

• Intravenous hydration

Signs of inadequate pelvis include the following except

• subpubic angle < 2 finger breadths

• easily palpable sacral promontory

• non-engaged head at 38 weeks in multigravida

• bi-ischial diameter < 8cm

The followings are true for vacuum delivery except

• Chignon is caused by a collection of interstitial fluid

• It is contraindicated in gestation less than 34 weeks

• The flexion point is 3 cm posterior to anterior fontanelle

• Kneeling position is recommended for the accoucheur during traction