| View previous topic :: View next topic |
| Author |
Message |
juliprakash
Joined: 08 May 2008
Posts: 30
|
 Posted: Thu Sep 04, 2008 3:44 am Post subject: CTG and delivery decisions |
 |
|
A junior SHO calls u in casualty and inform about a case in maternity unit. Select the most appropriate option from the following:
A Admit for monitoring
B Discharge
C Repeat CTG
D Urgent caesarean under GA
E Immediate caesarean under RA
F Urgent caesarean
G Salbutalmol
H Stop syntocinon
I Change position and monitor CTG
J Monitor CTG for further 5 minutes
I Instrumental delivery
I Continue with current management
Question 1
Pregnant patient 36 weeks high mobile head with CTG showing decreased variability,and variable decelerations.
or ... 36 weeks pregnant, high mobile head, contracting 1:1, with CTG showing decreased variability and variable decelerations
Question 2
CTG-decreased variabilty and late deceleration, cervix 1cm long and 1cm dilation with meconium stained liquor.
or ... 40 yrs, multiparous, CTG decreased variabilty and late deceleration, cervix 1 cm long and 1 cm dilated with meconium stained liquor.
 |
|
| Back to top |
|
 |
salihabduallah
Century Club
Joined: 04 Sep 2007
Posts: 120
|
| Posted: Thu Sep 04, 2008 6:52 am Post subject: |
|
|
just to add as i remember:
the first have contraction 1:1
the second was about 40 years old, multipara |
|
| Back to top |
|
|
rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
Posts: 966
|
| Posted: Thu Sep 04, 2008 7:01 am Post subject: |
|
|
so to summarize the question -
the list of options was--
admit for monitoring
discharge
repeat CTG
caessarean under GA
immediate caessarean under RA
and the questions were
1. 36 weeks pregnant, high mobile head, contracting 1:1, with CTG showing decreased variability and variable decelerations
2. 40 yrs, multi p, CTG decrased variabilty and late deceleration, cervix 1cm long and i cm dilated with meconium stained liq.
do we know how many weeks preg this multip was?
r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region |
|
| Back to top |
|
|
juliprakash
Joined: 08 May 2008
Posts: 30
|
| Posted: Thu Sep 04, 2008 8:01 am Post subject: |
|
|
| no the options were immediate caessarean ,no mention about anaesthesiawas given and the contractions 1;1 was not for this qn. |
|
| Back to top |
|
|
mrcog2010
Joined: 08 Jul 2008
Posts: 32
|
| Posted: Fri Sep 05, 2008 11:32 am Post subject: |
|
|
| for question 1 urgent C.S under general anathesia is the answer |
|
| Back to top |
|
|
rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
Posts: 966
|
| Posted: Fri Sep 05, 2008 8:40 pm Post subject: |
|
|
mrcog2010, why do you want an urgent GA section for Q 1?? that's not what i'll go for. please justify.
r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region |
|
| Back to top |
|
|
Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1854
Location: Nottingham
|
| Posted: Sat Sep 06, 2008 7:42 am Post subject: |
|
|
Another from the recent (Sep-08) exam I presume?
The answer is in the question - can you try and recall what the 'key' one or two words were.
Also we need to understand the options in more detail - anyone?
N
Last edited by Nick Raine-Fenning on Sat Sep 06, 2008 3:28 pm; edited 1 time in total |
|
| Back to top |
|
|
mrcog2010
Joined: 08 Jul 2008
Posts: 32
|
| Posted: Sat Sep 06, 2008 2:53 pm Post subject: |
|
|
| rpwalavalkar wrote: | mrcog2010, why do you want an urgent GA section for Q 1?? that's not what i'll go for. please justify.
r |
...OH i think urgent is a word not included in the question so no urgency...but...the question was
. 36 weeks pregnant, high mobile head, contracting 1:1, with CTG showing decreased variability and variable decelerations
we have 36 weeks pegnent lady with high mobile head..with variable deceleration on CTG both make the dicison go with CS...but u know i think we need more detials ...like ...is this lady in labour or not |
|
| Back to top |
|
|
rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
Posts: 966
|
| Posted: Sat Sep 06, 2008 10:15 pm Post subject: |
|
|
| mrcog2010 wrote: | | rpwalavalkar wrote: | mrcog2010, why do you want an urgent GA section for Q 1?? that's not what i'll go for. please justify.
r |
...OH i think urgent is a word not included in the question so no urgency...but...the question was
. 36 weeks pregnant, high mobile head, contracting 1:1, with CTG showing decreased variability and variable decelerations
we have 36 weeks pegnent lady with high mobile head..with variable deceleration on CTG both make the dicison go with CS...but u know i think we need more detials ...like ...is this lady in labour or not |
i think the info available is enough to make a decision...
2 non reassuring features on the CTG, with contractions 1:1 and high head, means vaginal delivery is not imminent nor will an instrumental be possible, even if fully dilated due to the high head. --------- the answer therefore is -- category 2 lscs / lscs under regional anaesthesia.
if the option of FBS had been given, i may have been tempted to consider it.
guess, we need to have full list of options and exact wording of the questions.
r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region |
|
| Back to top |
|
|
docsubhi
Joined: 03 Sep 2007
Posts: 59
Location: london
|
| Posted: Sun Sep 07, 2008 5:10 am Post subject: |
|
|
Fbs was not an option
Salbutalmol
Stop syntinon
Change position
Were the other options |
|
| Back to top |
|
|
Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1854
Location: Nottingham
|
| Posted: Sun Sep 07, 2008 9:01 am Post subject: |
|
|
| Thanks - I've added these as well now. |
|
| Back to top |
|
|
Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1854
Location: Nottingham
|
| Posted: Sun Sep 07, 2008 9:13 am Post subject: |
|
|
| juliprakash wrote: | | no the options were immediate caessarean ,no mention about anaesthesia was given and the contractions 1;1 was not for this qn. |
[quote="docsubhi"]Fbs was not an option
Salbutalmol
Stop syntinon
Change position
Were the other options[/quote
These are the key points actually and for those of you who have been on our EMQ (now the EMCQ) or ABC Courses will know that the two most important things to do in an EMQ is to:
1. identify the one or two key words / phrases that change everything.
2. read / consider all the options (even if the answer seems logical and straightforward)
I have read this post a little more carefully now and it is interesting, indeed highly informative, that the contraction frequency and the age and parity were missed out of juliaprakash's first post - either she or the rest of you are wrong therefore: was it in this question or not? The additional options docsubhi has just provided suggests contraction frequency was there! You must look through the options.
I assume, and I have not heard it described like this before, but contracting 1:1 equates to 10:10 right? If this is the case, and I guess it is, the answer to question 1 is to stop the synto or to give salbutamol (terbutaline would be more correct but it does not seem that you had this option). So, my question to you guys is was she on synto or not?
The anaesthesia option seems unlikely as this is an anaesthetists decision. We cannot tell them what to do - we can only state the urgency of the situation and how long we feel we have to deliver the baby. I guess the best option would be urgent caesarean if all three were given and for that reason I will leave the three options as we have them - it encourages debate as well. |
|
| Back to top |
|
|
juliprakash
Joined: 08 May 2008
Posts: 30
|
| Posted: Mon Sep 08, 2008 4:53 pm Post subject: |
|
|
I would like to clarify , this was the not the first qn in exam paper which had details about contractions.
This was exactly another theme stating a querry of a SHO to a registrar in casualty about a patient in maternity unit at 22 hrs.THe other qn of this theme was a multi with breech at term CTG - normal .She had bruises and left orbital hge,I think both the themes are now confused .May anyone clarify |
|
| Back to top |
|
|
Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1854
Location: Nottingham
|
| Posted: Mon Sep 08, 2008 7:17 pm Post subject: |
|
|
Well I am certainly confused! 
What has the haemorrhage to do with any of this?? |
|
| Back to top |
|
|
docsubhi
Joined: 03 Sep 2007
Posts: 59
Location: london
|
| Posted: Mon Sep 08, 2008 8:23 pm Post subject: |
|
|
there were two themes both based on CTG juliaprakash
the one u are talking about bruising was the theme based on reduced fetal movement in 24 hrs and the woman comes with bruises and slight abdominal pain |
|
| Back to top |
|
|
salihabduallah
Century Club
Joined: 04 Sep 2007
Posts: 120
|
| Posted: Sat Sep 13, 2008 7:40 pm Post subject: |
|
|
I think the first Q was like that :
A lady admitted to labour word with 4 cm dilatation, after 4 hours she become 8 cm dilatation, she was contracting 1:1, but develop decrease variability, variable superficial deceleration and blood stained liquor.
Options:
-change position and monitor CTG
-monitor CTG for further 5 minutes
-Immediate CS under GA
-Immediate CS under regional anesthesia
-Instrumental delivery
-Salbutamol
-continue with current management.
Any correction please ? |
|
| Back to top |
|
|
Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1854
Location: Nottingham
|
| Posted: Sun Sep 14, 2008 8:10 am Post subject: |
|
|
I've updated the list with these options now.
I am still not sure I understand the question. There are no 'superficial' decelerations and what is 1:1??
Anyway it sounds as if there are 2 CTG issues which equates to the need for FBS. Was that an option? If not I would reassses the CTG so (at present) option I as this is more correct than option J which does not involve any action. |
|
| Back to top |
|
|
|
FAQ
Search
Memberlist
Usergroups
Register
Profile
Log in to check your private messages
Log in
