Case Scenario: 1

A 23-year-old primigravida presents to labour ward at 39 weeks of gestation, in labour.

1. Discuss the parturition cascade responsible for the timely and spontaneous onset of labour at
term.

A vaginal examination reveals she is 5-6cm dilated, station at spines and she spontaneously ruptured
membranes during the examination, liquor was clear, vertex presentation at left occiput anterior (LOA)
position.

Plan was to monitor her in first stage, start her partogram, 2 hourly CTG with repeat VE in four hours.

2. Describe how you will assess whether she is a low or high-risk pregnancy/labour.
3. Discuss the role of admission CTG in labour ward for low risk pregnancies.
4. Describe how you would conduct, appropriate fetal heart monitoring in the different stages of
labour.

Below is her admission CTG:

5. Describe the above CTG using the DR C BRAVADO mnemonic, explain why this pattern occurs in
labour & its physiological significance.

The patient is anxious and seems very concerned about labour pains. She asks if her sister could be
present during her labour.

6. Compare and contrast the different options available for pain relief in labour.
7. Discuss the role of a support person during labour.
Four hours later a repeat vaginal examination reveals she is 8cm dilated, station at +1, still draining
liquor clear, no caput, no moulding with LOA position. Her contractions are 3 in 10 mins lasting 35s. Plan
was to continue monitoring with partogram, repeat her CTG in the next 1 hour.

Below is the trace of her CTG:

8. Describe the above CTG using the DR C BRAVADO mnemonic, explain why this pattern occurs in
labour & its physiological significance.

An hour later a CTG was repeated for her.

Below is her 3rd CTG.

 9. Describe the above 3rd CTG using the DR C BRAVADO mnemonic, explain why this pattern occurs
in labour & its physiological significance.

On examination, the patient has the urge to push. She is fully dilated, station +2, clear liquor, DOA, mild
caput, no moulding. The patient is taken to second stage.

10. Describe the mechanism/cardinal movements of normal labour in a vertex presentation

11. Describe how you would conduct a vaginal delivery.

(Your answer should include the management of the 3 rd stage of labour so that the risk of PPH can be
reduced)

Approximately 20 minutes later she delivered a live, female baby who cried well with apgars of 7,8 & 9

12. Explain what you understand by the following statement “CTGs have high false positive rates”
13. Recommend strategies to validate possible false positive CTG traces.

The student nurse who was present for the delivery is assisting the mother with breastfeeding.

14. Outline the monitoring plan for this woman’s fourth stage care.

Case Scenario:

You accompany the registrar who was called by the midwife attending to a 28-year-old at 38 weeks of
gestation. The woman has been pushing in second stage for an hour now.

15. Evaluate this woman’s second stage of labour.

(Your answer should include the clinical parameters that would determine whether the second stage is
normal or abnormal eg length of the second stage of labour)
After reviewing the patient, the registrar decided to perform an episiotomy.

16. Discuss the indications for performing an episiotomy.

17. Justify the type of episiotomy the registrar should perform.
18. Identify the structures incised during the procedure.
19. Outline the steps in assessing the perineum after the repair of the episiotomy.