Clinical Placement

Question 1

You are monitoring the CTG of a mother in labour. You have given them 1L of NaCl with 10 IU of Syntocinon 2 hours ago at a rate of 45 ml/hr. You notice the variability has reduced since 5 minutes ago.
What is the normal range of variability on a CTG?
What is the likely cause of this reduced variability?
What should you do to address this?

Answer 1

Normal range is 5-25
The likely cause may be Syntocinon but it cannot be confirmed as it was given 2 hours ago => not that likely.

Reduce flow (to 30ml/hr)

Question 2

A woman on the antenatal ward is diagnosed with Antiphospholipid syndrome. Briefly describe what that is/pathogenesis.

What are the main concerns with it in pregnancy (5).

Answer 2

Antibodies against lipids leading to a hyper coagulable state => attack atherosclerotic plaque => inflammation and narrowing => thrombosis => increased risk of DVT, Stroke, MI, ALI
If you add this to pregnancy’s increased VTE risk AND imagine it happening to the placenta => placental insufficiency, IUGR, Pre-eclampsia, oligohydramnios, early delivery, and miscarriage.

Question 3

Define Vertex in ObGyn
In what context is it typically described? How is it’s position graded?

Answer 3

Crown of the head of the foetus

The station is typically calculated during labour to determine how close the vertex is to the ischial spine. This is done as part of the Vaginal exam. Fatal station describes how far down the foetus’s head has descended into the pelvis.

Question 4

What is Syntocinon?

Answer 4

Synthetic Oxytocin

Question 5

What is the preferred lie and presentation in OBGYN?

Answer 5

Longitudinal lie with a Cephalic presentation

Question 6

A patient is experiencing decelerations and you are confused as some appear early, some are concurrent and some are late. What is your first like management of this in a patient in labour?

Answer 6

Changing positions/lying on a side helps ease deceleration due to there being less pressure on arteries => relieving the physiological cause of decelerations (early decelerations)

Question 7

You are reading the chart of a lady presenting to the emergency department with intense contractions. The midwife notes Pain = 5:1:1. What does this mean?

Answer 7

contractions every 5 minutes that last 1 minute every 5 minutes

Question 8

You are with a patient in labor. The midwife sprays the patient with cold water on their abdomen and chest. Why is she doing that?

Answer 8

This is to test the “block” of the individual who is on an epidural. If they only feel sensation/pressure then that area is blocked. If they feel that it is cold then it is not blocked. That’s how you will find the block. Typically this occurs at T6/T7 for labour (based on my experience so far)

Question 9

The midwife is taking a swab of the patient’s vagina after artificially rupturing her membrane. What is the reason behind that?

Answer 9

That is typically performed to test for the presence of GBS.

Question 10

What is meant by Effacement?

Answer 10

Thinning and softening of the cervix

Question 11

What is the max dilation of the cervix?

Answer 11

10cm

Question 12

What is Labetalol?
give 1 contraindication

Answer 12

Beta blocker used in the tx of hypertension in pregnancy

Asthmatics, bradycardia, hypotension (shock)

Question 13

While taking a hx in OBGYN, what malignancies are we most concerned about?

Answer 13

Colon
Breast
Ovarian
Endometrial
Cervical

Question 14

How does a foetus present hypoxia on a CTG?

Answer 14

Decelerations (of all types)
Opposite to after birth which would be tachycardia