MRCOG Part 2 – Management of Delivery SBAs

Question 1 of 50

1. Question

What is the incidence of assisted vaginal birth in women in the UK?

15%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

25%

Correct Incorrect Correct answer

30%

Correct Incorrect Correct answer

35%

Correct Incorrect Correct answer

Question 2 of 50

2. Question

A woman presents in spontaneous labour at 40 weeks gestation in her second pregnancy, having had a previous vaginal birth. The baby is normally grown with cephalic presentation and she progresses rapidly to full dilatation. She commences active pushing and the CTG becomes abnormal with rising baseline rate to 165bpm, reduced variability <5bpm and late decelerations with >50% of contractions for 30 minutes. On examination, there are 0/5^ths of the fetal head palpable per abdomen and vaginal examination shows that the presenting part is +1 to the ischial spines with mento-anterior face presentation. What is the most appropriate management?

Caesarean section

Correct Incorrect Correct answer

Forceps birth with pudendal block

Correct Incorrect Correct answer

Forceps birth with regional analgesia

Correct Incorrect Correct answer

Ventouse birth with pudendal block

Correct Incorrect Correct answer

Ventouse birth with regional analgesia

Correct Incorrect Correct answer

Question 3 of 50

3. Question

Which of the following is not an indication for assisted vaginal birth?

BP of 195/140 in second stage of labour

Correct Incorrect Correct answer

Complete spinal cord injury L2

Correct Incorrect Correct answer

Maternal exhaustion

Correct Incorrect Correct answer

Maternal myasthenia gravis

Correct Incorrect Correct answer

Second stage of more than two hours in nulliparous woman without regional analgesia

Correct Incorrect Correct answer

Question 4 of 50

4. Question

Which of the following does not meet the safety criteria for assisted vaginal birth?

Fetal head 0/5th palpable per abdomen, occipito-anterior position, station at level of ischial spines, 2+ caput, 1+ moulding

Correct Incorrect Correct answer

Fetal head 0/5th palpable per abdomen, occipito-posterior position, station at +1 ischial spines, 3+ caput, 1+ moulding

Correct Incorrect Correct answer

Fetal head 0/5th palpable per abdomen, occipito-transverse position, station at +1 ischial spines, 2+ caput, 3+ moulding

Correct Incorrect Correct answer

Fetal head 1/5th palpable per abdomen, occipito-posterior position, station at level of ischial spines, 2+ caput, 1+ moulding

Correct Incorrect Correct answer

Fetal head 1/5th palpable per abdomen, occipito-transverse position, station at level of ischial spines, 2+ caput, 1+ moulding

Correct Incorrect Correct answer

Question 5 of 50

5. Question

Which of the following assisted vaginal births should be conducted in theatre?

Para 0, induction of labour for gestational diabetes, maternal BMI 29, estimated fetal weight 3.8kg, effective epidural analgesia, cervix fully dilated, prolonged second stage >2 hours, 0/5ths fetal head palpable per abdomen, station at +1, LOA position <45 degrees

Correct Incorrect Correct answer

Para 0, induction of labour for gestational diabetes, maternal BMI 29, estimated fetal weight 3.8kg, no regional analgesia, cervix fully dilated, prolonged second stage >2 hours, 0/5ths fetal head palpable per abdomen, station at +2, LOA position <45 degrees

Correct Incorrect Correct answer

Para 0, induction of labour for post-dates, effective epidural analgesia, fetal heart rate 70bpm for 8 minutes with no recovery to baseline, cervix fully dilated, 0/5ths fetal head palpable per abdomen, station at +2, LOT position

Correct Incorrect Correct answer

Para 1, induction of labour for post-dates, effective epidural analgesia, fetal heart rate 70bpm for 8 minutes with no recovery to baseline, cervix fully dilated, 0/5ths fetal head palpable per abdomen, station at +2, LOT position

Correct Incorrect Correct answer

Para 1, induction of labour for gestational diabetes, estimated fetal weight 4.4kg, fetal heart rate 70bpm for 8 minutes with no recovery to baseline, effective epidural analgesia, cervix fully dilated, 0/5ths fetal head palpable per abdomen, station at +1, LOT position

Correct Incorrect Correct answer

Question 6 of 50

6. Question

Which of the following is associated with an increased risk with Ventouse birth when compared to forceps birth?

Caesarean birth

Correct Incorrect Correct answer

Low APGAR scores at 5 minutes of age

Correct Incorrect Correct answer

Maternal concern about baby

Correct Incorrect Correct answer

Need for phototherapy

Correct Incorrect Correct answer

Vaginal trauma

Correct Incorrect Correct answer

Question 7 of 50

7. Question

A 30 year old woman presents with painful regular contractions at 37 weeks gestation in her second pregnancy, having previously had a uncomplicated vaginal delivery. She has been diagnosed antenatally with a complex cerebral arteriovenous malformation for which postnatal surgery is planned and she was booked for a planned Caesarean birth at 39 weeks gestation. On vaginal examination, the cervix is fully dilated, the baby is cephalic in an OA position and the presenting part is at +1 station. CTG monitoring is reassuring. What is the most appropriate management?

Active pushing

Correct Incorrect Correct answer

Category 1 EMCS under general anaesthesia

Correct Incorrect Correct answer

Category 1 EMCS under regional anaesthesia

Correct Incorrect Correct answer

Operative vaginal delivery with local anaesthesia

Correct Incorrect Correct answer

Operative vaginal delivery with regional anaesthesia

Correct Incorrect Correct answer

Question 8 of 50

8. Question

A 30 year old woman with a renal transplant has an emergency Caesarean section at 34 weeks gestation for fetal growth restriction with early onset pre-eclampsia. What is the risk of renal transplant injury at Caesarean section?

1.5%

Correct Incorrect Correct answer

3%

Correct Incorrect Correct answer

5%

Correct Incorrect Correct answer

7.5%

Correct Incorrect Correct answer

10%

Correct Incorrect Correct answer

Question 9 of 50

9. Question

A pregnant woman is consented for an emergency Caesarean section. Which of the following is the least common complication of Caesarean section?

Admission to an Intensive Care Unit

Correct Incorrect Correct answer

Bladder injury

Correct Incorrect Correct answer

Emergency hysterectomy

Correct Incorrect Correct answer

Fetal laceration

Correct Incorrect Correct answer

Ureteric injury

Correct Incorrect Correct answer

Question 10 of 50

10. Question

A pregnant woman is consented for an emergency Caesarean section. of the following is the most common complication of Caesarean section?

Bladder injury

Correct Incorrect Correct answer

Fetal Laceration

Correct Incorrect Correct answer

Increased risk of repeat Caesarean section

Correct Incorrect Correct answer

Postpartum haemorrhage

Correct Incorrect Correct answer

Venous thromboembolism

Correct Incorrect Correct answer

Question 11 of 50

11. Question

A pregnant woman is consented for an emergency Caesarean section. She is concerned about the risk of postpartum haemorrhage which is described as 5 in 1000. What term should be used to describe this risk?

Very common

Correct Incorrect Correct answer

Common

Correct Incorrect Correct answer

Uncommon

Correct Incorrect Correct answer

Rare

Correct Incorrect Correct answer

Very Rare

Correct Incorrect Correct answer

Question 12 of 50

12. Question

What is the incidence of assisted vaginal birth in nulliparous women in the UK?

15%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

25%

Correct Incorrect Correct answer

30%

Correct Incorrect Correct answer

35%

Correct Incorrect Correct answer

Question 13 of 50

13. Question

The on call obstetric registrar is performing an emergency Caesarean section but is concerned that the patient is high risk and has asked the consultant to attend. Which of the following factors is not associated with a higher risk of operative complications?

Advanced labour

Correct Incorrect Correct answer

Booking BMI of 45

Correct Incorrect Correct answer

Previous laparoscopic myomectomy

Correct Incorrect Correct answer

Placenta praevia

Correct Incorrect Correct answer

Use of antenatal therapeutic dose dalteparin

Correct Incorrect Correct answer

Question 14 of 50

14. Question

Which of the following is the most complication associated with instrumental delivery?

Fetal cephalohaematoma

Correct Incorrect Correct answer

Neonatal jaundice

Correct Incorrect Correct answer

Neonatal retinal haemorrhage

Correct Incorrect Correct answer

Postpartum haemorrhage

Correct Incorrect Correct answer

Third or fourth degree tear

Correct Incorrect Correct answer

Question 15 of 50

15. Question

Which of the following is the least common neonatal complication associated with instrumental delivery?

Cephalohaematoma

Correct Incorrect Correct answer

Facial laceration

Correct Incorrect Correct answer

Intracranial haemorrhage

Correct Incorrect Correct answer

Retinal haemorrhage

Correct Incorrect Correct answer

Subgaleal haemorrhage

Correct Incorrect Correct answer

Question 16 of 50

16. Question

Which of the following factors is associated with the highest risk of shoulder dystocia?

Diabetes mellitus

Correct Incorrect Correct answer

Induction of labour

Correct Incorrect Correct answer

Macrosomia >4.5kg

Correct Incorrect Correct answer

Maternal BMI >30

Correct Incorrect Correct answer

Previous shoulder dystocia

Correct Incorrect Correct answer

Question 17 of 50

17. Question

A woman is referred at 38 weeks gestation to antenatal clinic with a third trimester ultrasound scan suggestive of fetal macrosomia with an estimated fetal weight of 4.6kg. A random fasting glucose level is 6.9 and HbA1C is 61mmol/L. What is the most appropriate management?

Induction of labour at 38 weeks

Correct Incorrect Correct answer

Induction of labour at 39 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 38 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 39 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 40 weeks

Correct Incorrect Correct answer

Question 18 of 50

18. Question

What is the relative risk of recurrence of shoulder dystocia in women who have previously had a shoulder dystocia in a previous birth?

RR: 2

Correct Incorrect Correct answer

RR: 4

Correct Incorrect Correct answer

RR: 6

Correct Incorrect Correct answer

RR: 8

Correct Incorrect Correct answer

RR: 10

Correct Incorrect Correct answer

Question 19 of 50

19. Question

A woman in spontaneous labour is diagnosed with shoulder dystocia after delivery of the fetal head. An obstetric emergency call is put out, pushing discouraged and the woman is repositioned to lie flat with buttocks at the edge of the bed. What is the next most appropriate management?

All fours technique

Correct Incorrect Correct answer

Delivery of posterior arm

Correct Incorrect Correct answer

McRoberts manoeuvre

Correct Incorrect Correct answer

Routine axial traction

Correct Incorrect Correct answer

Suprapubic pressure

Correct Incorrect Correct answer

Question 20 of 50

20. Question

A woman in spontaneous labour is diagnosed with shoulder dystocia after delivery of the fetal head. An obstetric emergency call is put out, pushing discouraged and the woman is repositioned to lie flat with buttocks at the edge of the bed. McRoberts’ manoeuvre is performed. What is the success rate of McRoberts’ manoeuvre in relieving shoulder dystocia?

50%

Correct Incorrect Correct answer

60%

Correct Incorrect Correct answer

70%

Correct Incorrect Correct answer

80%

Correct Incorrect Correct answer

90%

Correct Incorrect Correct answer

Question 21 of 50

21. Question

What is the most common maternal complication of shoulder dystocia?

Cervical trauma

Correct Incorrect Correct answer

Obstetric anal sphincter injury

Correct Incorrect Correct answer

Postpartum haemorrhage

Correct Incorrect Correct answer

Symphyseal separation

Correct Incorrect Correct answer

Vaginal laceration

Correct Incorrect Correct answer

Question 22 of 50

22. Question

Which of the following documentation following a shoulder dystocia is most important?

Anterior shoulder at time of dystocia

Correct Incorrect Correct answer

Manoeuvres performed, timing and sequence

Correct Incorrect Correct answer

Staff in attendance and time of their arrival

Correct Incorrect Correct answer

Time of delivery of head and time of delivery of body

Correct Incorrect Correct answer

Umbilical cord gases

Correct Incorrect Correct answer

Question 23 of 50

23. Question

Which of the following factors is most likely to reduce the chance of assisted vaginal birth?

Continuous support during childbirth

Correct Incorrect Correct answer

Discontinuing epidural analgesia

Correct Incorrect Correct answer

Epidural analgesic in the latent phase of labour

Correct Incorrect Correct answer

Passive descent for women with epidural

Correct Incorrect Correct answer

Upright or lateral position in the second stage of labour

Correct Incorrect Correct answer

Question 24 of 50

24. Question

What is the perinatal mortality rate of umbilical cord prolapse?

0.1%

Correct Incorrect Correct answer

0.6%

Correct Incorrect Correct answer

1%

Correct Incorrect Correct answer

6%

Correct Incorrect Correct answer

9%

Correct Incorrect Correct answer

Question 25 of 50

25. Question

Which of the following is not a risk factor for umbilical cord prolapse?

Birthweight <2.5kg

Correct Incorrect Correct answer

Fetal duodenal atresia

Correct Incorrect Correct answer

Oblique lie

Correct Incorrect Correct answer

Monochorionic monoamniotic twin pregnancy

Correct Incorrect Correct answer

Velamentous cord insertion

Correct Incorrect Correct answer

Question 26 of 50

26. Question

Which of the following procedures is not a risk factor for umbilical cord prolapse?

Amniotomy

Correct Incorrect Correct answer

External cephalic version

Correct Incorrect Correct answer

Internal podalic version

Correct Incorrect Correct answer

Large balloon catheter induction of labour

Correct Incorrect Correct answer

Stabilising induction of labour

Correct Incorrect Correct answer

Question 27 of 50

27. Question

A woman is diagnosed with preterm prelabour rupture of membranes at 34 weeks gestation in her first pregnancy. Ultrasound scan confirms normal fetal growth with extended breech presentation. She is given antenatal corticosteroids for fetal lung maturation and started on oral erythromycin. After 48 hours as an inpatient, there is no evidence of infection and she is not contracting. What is the next most appropriate management?

Immediate Caesarean section

Correct Incorrect Correct answer

Inpatient expectant management with elective Caesarean at 37 weeks

Correct Incorrect Correct answer

Inpatient expectant management with external cephalic version at 36 weeks

Correct Incorrect Correct answer

Outpatient expectant management with elective Caesarean at 37 weeks

Correct Incorrect Correct answer

Outpatient expectant management with external cephalic version at 36 weeks

Correct Incorrect Correct answer

Question 28 of 50

28. Question

What percentage of women have a Caesarean birth in the UK?

10%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

30%

Correct Incorrect Correct answer

40%

Correct Incorrect Correct answer

50%

Correct Incorrect Correct answer

Question 29 of 50

29. Question

Which of the following maternal outcomes are more likely with Caesarean birth compared with vaginal birth?

Major obstetric haemorrhage

Correct Incorrect Correct answer

Maternal death

Correct Incorrect Correct answer

Pain after birth

Correct Incorrect Correct answer

Postnatal depression

Correct Incorrect Correct answer

Thromboembolic disease

Correct Incorrect Correct answer

Question 30 of 50

30. Question

Which of the following neonatal outcomes are more likely with Caesarean birth compared with vaginal birth?

Admission to neonatal unit

Correct Incorrect Correct answer

Childhood asthma

Correct Incorrect Correct answer

Infant mortality up to 1 year

Correct Incorrect Correct answer

Infection

Correct Incorrect Correct answer

Persistent verbal delay

Correct Incorrect Correct answer

Question 31 of 50

31. Question

Which of the following maternal outcomes are less likely with Caesarean birth compared with vaginal birth?

Major obstetric haemorrhage

Correct Incorrect Correct answer

Maternal death

Correct Incorrect Correct answer

Pain after birth

Correct Incorrect Correct answer

Postnatal depression

Correct Incorrect Correct answer

Thromboembolic disease

Correct Incorrect Correct answer

Question 32 of 50

32. Question

What percentage of women with a multiple pregnancy aiming for planned vaginal birth have a Caesarean section?

15%

Correct Incorrect Correct answer

25%

Correct Incorrect Correct answer

35%

Correct Incorrect Correct answer

45%

Correct Incorrect Correct answer

55%

Correct Incorrect Correct answer

Question 33 of 50

33. Question

Which of the following scenarios is an indication for Caesarean birth to reduce vertical transmission?

Concurrent maternal HIV and hepatitis B infection

Correct Incorrect Correct answer

Concurrent maternal HIV and hepatitis C infection

Correct Incorrect Correct answer

Maternal HIV infection

Correct Incorrect Correct answer

Maternal hepatitis B infection

Correct Incorrect Correct answer

Maternal hepatitis C infection

Correct Incorrect Correct answer

Question 34 of 50

34. Question

Which of the following factors is most likely to increase the chance of assisted vaginal birth?

Continuation of epidural analgesia in second stage of labour

Correct Incorrect Correct answer

Epidural analgesia

Correct Incorrect Correct answer

Epidural analgesia in the latent phase of labour

Correct Incorrect Correct answer

Supine position in second stage of labour

Correct Incorrect Correct answer

Use of oxytocin in first stage of labour

Correct Incorrect Correct answer

Question 35 of 50

35. Question

Which of the following reduces the risk of endometritis after Caesarean section?

Alcohol-based chlorhexidine skin preparation

Correct Incorrect Correct answer

Alcohol-based chlorhexidine vaginal preparation

Correct Incorrect Correct answer

Alcohol-based chlorhexidine vaginal preparation if ruptured membranes

Correct Incorrect Correct answer

Aqueous iodine skin preparation

Correct Incorrect Correct answer

Aqueous iodine vaginal preparation if ruptured membranes

Correct Incorrect Correct answer

Question 36 of 50

36. Question

What is the risk of fetal laceration at Caesarean section?

1%

Correct Incorrect Correct answer

2%

Correct Incorrect Correct answer

3%

Correct Incorrect Correct answer

4%

Correct Incorrect Correct answer

5%

Correct Incorrect Correct answer

Question 37 of 50

37. Question

Which of the following is the most common risk for women having planned Caesarean section for placenta praevia?

Bladder injury

Correct Incorrect Correct answer

Emergency hysterectomy

Correct Incorrect Correct answer

Future placenta praevia

Correct Incorrect Correct answer

Return to theatre for further laparotomy

Correct Incorrect Correct answer

Thromboembolic disease

Correct Incorrect Correct answer

Question 38 of 50

38. Question

Which of the following is the least common risk for women having planned Caesarean section for placenta praevia?

Bladder injury

Correct Incorrect Correct answer

Emergency hysterectomy

Correct Incorrect Correct answer

Future placenta praevia

Correct Incorrect Correct answer

Return to theatre for further laparotomy

Correct Incorrect Correct answer

Thromboembolic disease

Correct Incorrect Correct answer

Question 39 of 50

39. Question

A pregnant woman is consented for a planned Caesarean section for placenta praevia. She is concerned about the risk of emergency hysterectomy which is described as up to 11 in 100. What term should be used to describe this risk?

Very common

Correct Incorrect Correct answer

Common

Correct Incorrect Correct answer

Uncommon

Correct Incorrect Correct answer

Rare

Correct Incorrect Correct answer

Very Rare

Correct Incorrect Correct answer

Question 40 of 50

40. Question

Which of the following is not a contraindication to internal podalic version with breech extraction?

Cervix not fully dilated

Correct Incorrect Correct answer

First twin

Correct Incorrect Correct answer

High maternal BMI

Correct Incorrect Correct answer

Inadequate analgesia

Correct Incorrect Correct answer

Inexperienced accoucheur

Correct Incorrect Correct answer

Question 41 of 50

41. Question

A woman has an complicated emergency Caesarean section at full dilatation and the operating obstetrician suspects there may an injury to the dome of the bladder. What is the most appropriate immediate management?

Arrange follow up cystogram at 14 days post-operatively

Correct Incorrect Correct answer

Ask urologist to attend operating theatre to confirm injury

Correct Incorrect Correct answer

Indwelling catheterisation for 10-14 days with antibiotic cover

Correct Incorrect Correct answer

Retrograde instillation of methylene blue dye

Correct Incorrect Correct answer

Surgical repair of suspected bladder injury

Correct Incorrect Correct answer

Question 42 of 50

42. Question

A woman has an emergency Caesarean section at full dilatation complicated by a significant angle extension of the uterine incision into the broad ligament and the operating obstetrician suspects there may be a injury to the ureter. What is the most appropriate immediate management?

Arrange post-operative CT Urinary Tract with contrast

Correct Incorrect Correct answer

Ask urologist to attend operating theatre to confirm injury

Correct Incorrect Correct answer

Indwelling catheterisation for 10-14 days with antibiotic cover

Correct Incorrect Correct answer

Retrograde instillation of methylene blue dye

Correct Incorrect Correct answer

Surgical repair of suspected ureteric injury

Correct Incorrect Correct answer

Question 43 of 50

43. Question

A woman has an emergency Caesarean section at full dilatation complicated by postpartum haemorrhage. Post-operatively she complains of significant nausea, abdominal pain and distension which worsens over the subsequent 48 hours, becoming increasingly localised to the right iliac fossa. On examination, the abdomen is significantly distended with sparse bowel sounds and there is maternal tachycardia. What is the most likely diagnosis?

Bowel injury

Correct Incorrect Correct answer

Intra-abdominal collection

Correct Incorrect Correct answer

Ogilvie syndrome

Correct Incorrect Correct answer

Postoperative ileus

Correct Incorrect Correct answer

Ureteric injury

Correct Incorrect Correct answer

Question 44 of 50

44. Question

A woman has an emergency Caesarean section. Which of the following is associated with an increased risk with Caesarean section at full dilatation compared with operative vaginal delivery?

Admission to neonatal intensive care unit

Correct Incorrect Correct answer

Dyspareunia

Correct Incorrect Correct answer

Neonatal trauma

Correct Incorrect Correct answer

Relative subfertility

Correct Incorrect Correct answer

Urinary incontinence

Correct Incorrect Correct answer

Question 45 of 50

45. Question

A woman has a successful Ventouse birth for prolonged second stage of labour. On examination, there are 0/5ths of the fetal head palpable per abdomen and vaginal examination shows that the presenting part is +1 to the ischial spines in an LOT position. What classification of assisted vaginal birth should this be described as?

Low non-rotational

Correct Incorrect Correct answer

Low rotational

Correct Incorrect Correct answer

Mid-cavity non-rotational

Correct Incorrect Correct answer

Mid-cavity rotational

Correct Incorrect Correct answer

Outlet

Correct Incorrect Correct answer

Question 46 of 50

46. Question

Umbilical cord blood haematopoietic stem cells have been used clinically for haematological malignancy in children. Which of the following is a disadvantage of cord blood transplantation?

Extension of the donor pool

Correct Incorrect Correct answer

Lack of donor attrition

Correct Incorrect Correct answer

Low numbers of haemopoietic progenitor cells causing delayed engraftment

Correct Incorrect Correct answer

Lower incidence and severity of graft versus host disease

Correct Incorrect Correct answer

Lower incidence of viral transmission

Correct Incorrect Correct answer

Question 47 of 50

47. Question

A woman has a successful forceps birth for prolonged second stage of labour. On examination, there are 0/5ths of the fetal head palpable per abdomen and vaginal examination shows that the presenting part is +2 to the ischial spines in a direct OP position. The obstetrician applies direct traction forceps and the baby is delivered in an OP position. What classification of assisted vaginal birth should this be described as?

Low non-rotational

Correct Incorrect Correct answer

Low rotational

Correct Incorrect Correct answer

Mid-cavity non-rotational

Correct Incorrect Correct answer

Mid-cavity rotational

Correct Incorrect Correct answer

Outlet

Correct Incorrect Correct answer

Question 48 of 50

48. Question

A woman presents in spontaneous labour at 40 weeks gestation in her second pregnancy, having had a previous vaginal birth. The baby is normally grown with cephalic presentation and she progresses rapidly to full dilatation. She commences active pushing and the CTG becomes abnormal with rising baseline rate to 165bpm, reduced variability <5bpm and late decelerations with >50% of contractions for 30 minutes. On examination, there are 0/5^ths of the fetal head palpable per abdomen and vaginal examination shows that the presenting part is +1 to the ischial spines with LOA position <45°. What is the most appropriate management?

Caesarean section

Correct Incorrect Correct answer

Forceps birth with pudendal block

Correct Incorrect Correct answer

Forceps birth with regional analgesia

Correct Incorrect Correct answer

Ventouse birth with pudendal block

Correct Incorrect Correct answer

Ventouse birth with regional analgesia

Correct Incorrect Correct answer

Question 49 of 50

49. Question

A woman presents in spontaneous labour at 33 weeks gestation in her second pregnancy, having had a previous vaginal birth at term. The baby is normally grown with cephalic presentation and she progresses rapidly to full dilatation. She commences active pushing and the CTG becomes abnormal with rising baseline rate to 165bpm, reduced variability <5bpm and late decelerations with >50% of contractions for 30 minutes. On examination, there are 0/5^ths of the fetal head palpable per abdomen and vaginal examination shows that the presenting part is +1 to the ischial spines with LOA position <45°. What is the most appropriate management?

Caesarean section

Correct Incorrect Correct answer

Forceps birth with pudendal block

Correct Incorrect Correct answer

Forceps birth with regional analgesia

Correct Incorrect Correct answer

Ventouse birth with pudendal block

Correct Incorrect Correct answer

Ventouse birth with regional analgesia

Correct Incorrect Correct answer

Question 50 of 50

50. Question

A woman presents in spontaneous labour at 40 weeks gestation in her second pregnancy, having had a previous vaginal birth. The baby is normally grown with cephalic presentation and she progresses rapidly to full dilatation. She commences active pushing and the CTG becomes abnormal with rising baseline rate to 165bpm, reduced variability <5bpm and late decelerations with >50% of contractions for 30 minutes. On examination, there are 0/5^ths of the fetal head palpable per abdomen and vaginal examination shows that the presenting part is +1 to the ischial spines with mento-posterior face presentation. What is the most appropriate management?

Caesarean section

Correct Incorrect Correct answer

Forceps birth with pudendal block

Correct Incorrect Correct answer

Forceps birth with regional analgesia

Correct Incorrect Correct answer

Ventouse birth with pudendal block

Correct Incorrect Correct answer

Ventouse birth with regional analgesia

Correct Incorrect Correct answer

MRCOG Part 2 – Management of Delivery SBAs

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