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EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

May I insert this SAQs that has been given by the college as an example for factual knowladge...
<<< Critically appraise your management of slow progress of the second stage of labour>>>

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

obviously emak recieved the paper work for the exams, didn't you EMAK? Laughing

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

What you mean by paper work pls Confused

???

Abik · Posted: Mon Feb 19, 2007 10:09 am Post subject:

Good question, we've done the first stage so let's see how we all manage the second stage.
Shouldn't be too hard - we do it every day!! Laughing

A 32 yr old nullip who is low risk, has been pushing for over an hour. The midwife asks you to review her.

a. How would you assess her? (6 marks)
b. What are your management options? (6 marks)
c. What are the principles of instrumental delivery? (8 marks)

Piece of cake, eh Wolverine?

Abik · Posted: Mon Feb 19, 2007 2:31 pm Post subject:

I have worked out a marking scheme - and only got 12/20 myself!! The bubbles have it all but it's the translation into full sentences which looses detail. I would encourage evryone to bubble but then do the essay in the 15 or so mins left and see what I mean.
If you want the bubbles marked, I will tell you what I've got Cool

Nick Raine-Fenning · Posted: Mon Feb 19, 2007 5:11 pm Post subject:

Great division of marks Abi - this is exactly what you will be asked aka the 'retained placenta' question.

Excellent work.

When asked to discuss "the principles" of anything I advise a surgical like approach outlining:

consent (where necessary)

procedure
- what it involves
- intended benefits
- risks (common and nasty)

alternate options (including no treatment) (NB these will be discussed in section 2 here)

the ideal patient

anaesthesia

longterm impilcations

Try it ... it works Wink

_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

A..
Such a situation not an uncommon thing and needs proper assessment.Majority will deliver vaginally.

History

Ask about progress earlier ie in I st as if slow there, might be slow here as well. slow progress & early rupture of membranes might be due to OP.

Epidural analgesia might be reason for slow prog

CTG trace(if avail), may help in Mx decision

Exam
contractions: how good? frequency?
VE:
whether vertex or not
station higher might be due to CPD,
sagittal sutures ? stuck in OP/OT
caput/moulding : CPD
presence of meconium?

B
Conservative:
can wait n watch with adequate hydration n analgesia if no abn in FHR. esp if epidural.

Medical :Oxytocin:if contractions not good, start with low dose,gradually increasing, max of 32mu/min.use Cont elec monitoring. Beware of hypertonic ut / FHR abn

Surgical:
vaccum / forcep:
dependng on operators skill, experience and the assessment in VE( station, rotation, )( more failure and cepahlhematoma , retinal h'age with vaccum; more perineal trauma with forceps)

C
Consent for procedure
membranes ruptured
fully dilated
No CPD
<1/5 th palpable per abd
analgesia ( pudendal or epidural)
asepsis
skilled n experienced operator
Pediatrician avail

cant rem more, though there are a lot more i guess
Mad

Abik · Posted: Tue Feb 20, 2007 11:03 am Post subject:

Great bubbling again Vani
I hope you are practising writing them out in full - it is VERY different (don't you agree Wolverine!!)

You seemed to start well and then run out of steam!!
What about LSCS as an option??

For the third section think your way through what you would actually do.

Bound to be marks for;

Consent (written , with risks and alternatives)
Calling the peads
Pre-requisites on examination (station, vertex etc) but this is probably only 1 mark as we all should know it.
Need a back-up plan - what if it fails? - think SAFETY, SAFETY, SAFETY!!
Cord blood samples (for those gold medallists!!)
24 hr fluid balance afterwards to detect retention (it's in the guideline before you all groan)
Operator experience
Follow-up with discussion and woolly caringness....!

I also think it's worth mentioning that there must be an indication - not just registrar distress!!

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

hey I obviously thought of LSCS,
guess forgot putting it down in black n white Crying or Very sad

you are right,
I need to write...... Laughing

not really practising that..

Nick Raine-Fenning · Posted: Tue Feb 20, 2007 8:56 pm Post subject:

You all need to elaborate in your histories and examination as well.

What about fetal growth and symmetry? Pain - how is she coping?

Examination should include a general assessment of hydration and then it is essential to palpate the abdomen - size, lie, presentation, engagement etc.

Try and think clinically ... what do you do on labour ward?
_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997