yw OCA What is partograph? It is a composite graphical record of the events of labor against time in labor on a single sheet of papers. Q. Component of partogram? Progress of labor Fetal record Maternal record Q. Aim of plotting partogram? + Early detection of abnormal progress of labor * Early detection of CPD ‘* Prevention of prolonged & obstructed labor ‘* To detect timing of augmentation of labor. * Facilitate handover procedure. Q. Whats alert line? It is the line which start 4 cm of cervical dilatation and ends at 10 cm of dilatation Q. What is action line? Aline drawn 4 hours right & parallel of alert line. Q. Important parameter & there interval? Half hourly- F.H.S, Pulse, Abdominal contraction 2 hourly- Blood pressure 232Fetal head is still 5/5 palpable, cervix is 4 cm dilated, membrane ruptured spontaneously & amniotic fluid is clear, uterine contraction is 1 in 10 minutes, lasting less than 20 seconds. ‘At pm: Her fetal heart sound was 110 b/min, Liquor clear fetal head is 5/5 palpable cervix is 6 cm dilated uterine contraction is 2 in 10 minutes, each lasting less than 20 seconds. Blood pressure 110/70 mm of Hg. At pm: Fetal heart rate is 80 b/min Amniotic fluid stained with meconium. No further progress in labour. Caesarean section was performed at 9.20 P.M due to fetal distress. Fill the supplied graph with the given data.shourly-dilatation, descent, amniotic fluid, moulding, acetone in urine, 2,Symbols of plotting & ways of plotting? ¢HS~dot in line & then make a line cervical dilation- first plotting must be on alert line & then give time.put all the recod on left side afline. Symbol is X. escent of head- will be on the line made by dilatation with time. Symbol is O. \pdominal contractions: 1f<20- then give (.) (20-40: oblique line £240: then give dark shed. If oxytocin is given- amount of dose 2ulse- half hourly, symbol ine dot (.) 4-2 hourly , symbol is two sided arrow in between the line Temp -write down. +h Acetone: +/- Urine- prot Volume: write down. SAMPLE QUESTION: 1. Mrs.S, primigravida, registration no-1248, admitted on 17 th May,2013 at 10.00 A.M. Her fetal heart sound was 140 b/min, - membrane intact fetal head is 5/5 palpable cervix is 4 cm dilated uterine contraction is 2 in 10 minutes, each lasting less than 20 seconds. Pulse is 90 b/min 7 B.P is 110/70 mm of Hg. At2 pm:Q. At 2 pm what was your diagnosis? ‘The diagnosis was unsatisfactory progress of labor. Q. Tell the reason behind your diagnosis? Cervical dilatation was right of the alert line on the partograph Q. How can you help the woman to progress her labor? Labor should have augmented with oxytocin at 2 p.m.(Ref- IMPAC-s 59) PIeVANHIIN SYA) 236gaMPLE QUESTION: 2 y ys. M, 4" gravida, registration no-6639, admitted on 20 th May,2013 at 10.00 A.M. 2 yerfetal heart sound was 140 b/min, . embrane ruptured at 9 a.m, clear amniotic fluid, G «gal head is 3/5 palpable anixis 4 cm dilated i terine contraction is 3 in 10 minutes, each lasting for go-4odeconts st degree moulding uise is 90 b/min & B.P is 110/70 mm of Hg, (2pm: : etal head is still 3/5 palpable, cervix is 6 cm dilated, membrane ruptured spontaneously & mniotic fluid is clear, uterine contraction is 3 in 10 minutes, lasting 40 seconds. scond degree moulding tS pm: er fetal heart sound was 92 b/min, quor meconium stained :tal head is3/5 palpable anvix is 6 cm dilated, third degree moulding terine contraction is 4 in 10 minutes, each lasting more than 40 seconds. lood pressure 110/70 mm of Hg. aesarean section was performed at 5.30 P.M illthe supplied graph with the given data. ARI SA) =Worksheet Part 3: Using the Partogniph fo monitor progress of labour and fetal heart surveillance temo Mtg. As aig ot agnszon 20: 5'1% 238 “Is ak S30 pryWorksheet Part 3: Using the Purtograph to monitor progcess of labour and fetal heart surveillace ‘What would you do? ‘tntinue to properly monitor the labour, fetal heart rate & maternal wellbeing. 241SAMPLE QUESTION: 3. A primigravida at term was assessed at 5 a.m. At that time her cervix was 2 cm dilated, with contractions every 3 minutes, lasting 20 seconds each. The woman's vital signs were stable. The fetal heart rate was 160 b/min. At 9A.m, the woman’s cervix is $ cm dilated , with 4 contractions every 10 minutes, each lasting 40 seconds. The fetal heart rate is 150 beats per minute. Q. Is the woman in labour? Yes, because contractions regular & frequent Dialatation > 4 cm. Q, What is your management plan? Admit the patient & start the partograph. Q, At 12 p.m. she was 8 cm dilated and having four contractions every 10 minutes, each lasting 0 seconds, The fetal heart rate was 140 beats per minutes. Is labour progressing normally? Plot the given data. SYA)ystify the cause of caesarean section? caesarean section was performed due to obstructed labour. sample partogram showed arrest of dilatation & descent in the active phase of labour. Fetal ess & third degree moulding together with arrest of dilatation and descent of the active stage gbour in the presence of adequate contractions indicates obstructed labour. what are the cause of this type of labour? shalo-pelvic disproportion Iposition Ipresentation if caesarean section was not performed what may happen to mother? sture of uterus tabolic acidosis vital’sepsis 4 ck ritor-urinary fistula, PRAIAWorksheet monitor progress of Inbour and fcinl heart surveillance Gems bo est Part 3: Using the Patograpl 244pie Que: nigravida at 38 weeks gestation is assessed at 10 a.m, with contractions every 2-5 minutes pe previous 3 hours. On arrival, her cervix is 2 cm dilated, 40% effaced and fetal head is not J shat is your management plan? quick assessment of the mother & fetus. sether there is any non-reassuring clinical signs like foul smelling vaginal discharge, ruptured mbrane, severe headaches, blurring of vision, any abnormality in fetal heart rate. How is labour diagnosed? sfequisite assessment mlractions: rate, duration, intensity :nix: effacement, dilatation & position us: presentation and engagement At 6 p.m (8 hours after arrival), cervical dilatation has not changed. It remains at 2 c.m. The ttal heart rate is 140 beats per minute. What would you do? ishe lives far away from health facility, keep the woman for observation, but do not admit her as eis not in active stage of labor. ‘the woman lives close to the health facility, discharge her & provide her with information on ‘ow to cope with pre-labour & when she would come back. Lifer cervix is still < 4cm after a period of observation, what could be happening? ‘ake labor or Prolonged latent phase. What actions will you take? ‘false ;labor- discharge her. {Prolonged latent phase, then if cervix does not change and there are no signs of fetal distress, eassess diagnosis. ‘there is progression, | will rupture the membrane & consider oxytocin {there is signs of infection- consider oxytocin augmentation and begin antibiotic therapy.SAMPLE QUESTION:4. Awoman at term presents at 10 a.m with contractions occurring every 5 minutes, each lasting 2¢ seconds. The fetal head is 4/5 palpable & cervix is at 4 cm. The woman vital signs are normal. Fet; heart rate is 148 beats per minute. Plot the data on partograph. Q. Is the woman in labor or not? Yes, woman is in labour. Cervix dilatation is >4 cm. Q. What is your management plan? Admit the woman & start partograph in order to monitor her labour Q. At 12 p.m feat! head remains still high, dilatation is still 4 cm and contractions are unchangec Fetal heart rate is 120 beats per minute. Plot the data on your partograph. Is labor progressing or not? 'No, alert line has been crossed; itis a prolonged active phase. Q. What is your management plan? Consider transfer to referral hospital in remote area, Measure to prevent dystocia : -Accurate diagnosis of labour -Support during labor -Aripulation -analgesia Artificial rupture of membranes . Oxytocin augmentation if records are close to action line on the partograph and contractions are insufficient. 242Worksheet (Li)Univer - NUTR Final Prvstioosinininl Hessrsinathons Duby & Mecvorntoes MELD Hubpoct) Caters bee @ Cpnaeeetiony Objective Rirnerined Hrwetiont B eilnetion (PE) Station No 4 Howl ie certain and mnworer the pientiorme wlven below Time 5 Minutes Instruction to the enadidate Scenario AM year multigravid Indy presents with H/O amenurrhaes for 3 mantis and introduction af sticks P/V 8 days hack. Now she develope foul eenalliong blood stained vaginal discharge, high fever and lower abdominal pain, 1. What is the most probable diagnosis? 2. What investigations will you suggest for her? 3. What complications will she develop? 4. Write down the treatment of this patient,University of Dhaka MBBS Final Professional Examination July & November 2023 Subject : Obstetrics & Gynaecology Objective Structured Practical Examination (OSPE) ‘Station No. Ol - Instruction for the candidate Look at the photograph & answer the following questions Time - 5 minutes 7 Q.No.1 Identify the photograph. Q.No.2 Mention two important presenting complaints of this patient. Q.No.3 What operation will be done if patient is multipara and 45 years old? Q.No.4 Why will this operation be done? Mention 3 points in favor. Q.No.5 Mention 3 complications of this condition if left untreated.University of Dhaka MBBS F inal Professional Examination July & November 2023 Subject: Obstetrics & Gynaecology Objective Structured Practical Examination (OSPE) [Station No 09 Instruction to | Identify the supplied photograph and answer the | the candidate following questions, | | Time 5 Minutes 1) Identify the supplied photograph, 2) Mention four diagnostic indications of its use. 3) Name fur procedures which can be performed by this instrument? 4) How this instrument can be sterile?University of Dhaka MBBS Final Professional Examination July & November 2023 Subject: Obstetrics & Gynaecology Objective Structured Practical Examination (OSPE) Station No- 0 _ : Read the scenario and answer the questions | lnstrection tothe eanditale given below __ _Time 5_ Minutes _! Scenario A multiparous lady delivered vaginally at home after prolonged labour 1 hour back. Now she has developed severe P/V bleeding and is brought to hospital. 1. What is your diagnosis? 2. Mention 6 parameters to assess her condition immediately, 3. Mention steps of ist line of management, 4. What uterotonic drugs will you use?682 | __ stirs representation on OSPE & WARD BOOK = Cordocentess Antenatal Care {CU-19M) ‘A primi gravida attended at GOPD for ANC. Her LMP was 7 October, 2018. (CU-19M) Q. What is your clinical dlagnosis? (CU-19M) Ans. ‘A case of primigravida 33 weeks of pregnancy. ‘A the level of junction of upper and middle third between umbilicns and xiphod proces Q. What wil be her EDD? (CU-I9¥9) Ans. 1ar72021 (Q. What are the essential investigations neded for her during antenatal period? (CU-19M) As. Routine investigations: 1 Blood: Hb%é, ABO grouping & Rh typing, VDRL + Random blood glucose (RBS) Urine RIM/E: Protein, saga & pus cells * Cervical eytology sty by Papanicolaou stain has become a routine in many clinic investigations: ‘Serological tests for rubella & HBV + Maternal serum a (alpha) feto protein (MSAFP) + Ultra sound examination: |* wimester sean ether ran.sbdominal (TAS) or tans. PARTOGRAPH Mrs. X, primigeavida, hospital reg. no. 1334 has been admitted in the labour ward on 25° of August 2021 at Sam with labour pain. On examination following findings were obtained at S am and 9 am. (DU21Aug20Nv) isa Pr 683 Ge pores ot rma Obstetrics & Gynaccology OURO ‘No, usalisactory progeset ibe, : (Q. What problem is identi os es 9m. DU2tAag2,) Inadequate suc were emrctin Partograph (SUING) stretlon: Please observe the Jnsructon:Pleae observe he pararaph and toner the following questions. Drop the answer script =‘584 | _arits representation on OSPE & WARD BOOK, Q. Identity the partograph, (SU:20N%, 16a) Ans. ‘This is WHO modified partograph. I isa composite graphical record of abtevation of a worn ia labour gaint time in hour Q. What are the components oft? (SU-20Nv,16tu/I) Ass 1 Patient's identineation 2. Fetal condition (fetal part): "FR + Amati uid 2 Clear uid (©) ~ Meconium strined (M) Absent (A) © tact) + Moulding f skull bone. ‘3. Progress of labour (abour part): + Cervical dilatation + Descend of head + Uterine contation = Number of conration per 10 min * Duration ofeach contraction 4. Maternal condition (maternal part): ‘+ Vierine contraction Drugs and TV Mids + Pulse rate Blood pressure ‘Temperature Oxytocin given ‘Urine examination (volume, protein, acetone), Q. When itis started? (SU-20N,618) Aas. ‘When te patent is in ative labour, cervical station 4 em. Write down the advantages of is use. (SU-20Nv,16Iu) (Q. Write down is importance. (SU-16!3) ‘A single sheet of paper ean provide detail necessary information at a glance. Early detection of abnormal progress of labour. Early detection of CPD. Prevents prolong labour, obstructed labour. ‘Assist in erly detection of decision of transfer, augmenttion and termination. Early detection of maternal and fetal complication. cee . How fetal distress can be diagnosed from here? (SU-I6) Aas. FHIR110 oF >160, Liquor Stained ‘Actin lini ava, ‘aanageneat i os made by doctor angen Allie. Tiss real line at which specific decision for x 2; RU 16a, Assessment S$37%) 8p the "Aree er rad the fooning scenario. Drop the answer script inthe “Mrs, Rabi, 32 yeas old iy, a3 4 come temic ward at term with lab in tS in ia cr oe em ih ew Instruction: bor. Puls eng + BPis [tomer Tempera oe (On per abdominal xniaaen: 58 fot ea pape Uren conan tin in + Exchoontnton ia fae Fetal beara (FR bea On PV examination: + Caninis em dass + Liguriscler + degre ong igre. On laboratory exami: = Urine vole 20a + roen and ecoe dat686 | _ srits reprosentaion on OSPE & WARD BOOK Obstetrics & Gynaccology_|| 687 Q hh Filling-2 tare Hes. ome gh oe 3 ae Dea ing asirucn: Red te fllovng earl nd pet te ndings in the supped blank partograph a8 eta 17. 86.(8 teeta fe Ai etree A a nover the geen scone Mente te inte pinned nen fr Rea he Fong Sirabatadate A eta ee apne gos iene Nestermng ope se] te saa FHV a Mutation eet ett | io | Ft o ‘rioai | se = [ewe [| » | wo [ou] wm [or | wo | s | | cm | == — Obstetrics & Gynaccology = Pattograph Interpretation da, CU, assessment S35") ware Andi et ye 3, tet Seem CG) teem 10.Q6m peewee SK Plotting: Pease do yourself630_| _ arirs representation on OSPE & WARD BOOK Instruction; Please observe the partograph and answer the following questions. Drop the answer script ithe box. Name the three components of partograph. (CU-16l) ans 1. Focal part 2. Labour prt ‘Matera part (tention 3 import fro 5 indings on admision ofthis patient at 10 AM, (DU-18181200) etal hea 35" palpable enix dem dilated 5 conzactions in 10 min, ach lating for 4045 soe. ‘tear amistad 1 degree mouling Foetal Hear Rate (FHR): 120 beatin ‘Menton 2 features that indicate tht the fetus isin distres at 2 PM. (DU- 28) "Foes art ate les than 100 beatin + Bolou of liquor: Mecenium tied the progress o labour satisactory? (DU-18I5) ‘ase Not saisfctory. (Q. Write the fetal condition? ‘Aas Fetus iin tess (Q. Write the maternal condition? As Mother is in dstes. . What wil be the fate ofthis case? Aas requires active management, QW As 1. IRD 2. PROM 55. Incombinaton wth surgical induction (ARM). the Indleatons of medial induction of labour? 0. What are the coatr-indcations of ARM? (Assessment $S-35%) Aas. 1. wD 2) Matera! AIDS 3, Genital active herpes infection, Obstetrics & Gynaccology_| 691 Sa ea pest TOE a Ae ane a aL Gran ae ten ene i Pon ce, Oe wer Noa lage Ne i Se ea Se Beet sie ammo So Men Ie ir pas ge gee eae oe ce Sw Cant ti ee Tm, 37, nt ak Preteen fotos Wont beret cotton coerce see Pleased yours ‘ insicustion: MisX 20 yearn oy ee ee cee ee ce pen needing fier eee ee? So ae aS gs Please do yourself. eee ee a ana eee as Paeony eG Cee Oe oe oe Ion 3 gin hy nn oy ih a i eee Se ct eas rei orm ce ae as eee ipa aaa ny a een as feaiene trad asada Sere gear aeeeaa = itted at 38 weeks of pregnancy with labour pain for last foe mee eae aro nana ena ear ee en ree et (ak tierce ote nr nate mints ated foe 2040 seconds, (CUS) Zpstetrics & Gynaecol : Please identify the instrument and answer the following questions. Drop the answer script in the box. Vaginal Speculum U-17/1 ssessment SS-34") ‘alve Self Ret: CU-1SJu; Cusco’s Bi (DU-16/14/10Ju; RU-21Ja,20Nv,19/16, Fig: Cusco’s bi-valve self retai ing Vaginal speculum. Q. Identify the instrument in the photograph. (DU-16/14/10Ju? RU-21Ja,20Nv,19/16Ja; CU-15Ju; SU- 17/15Ja; Assessment SS-34") Ans. Cusco’s bi-valve self retaining vaginal speculum, Q. What is its identifying point? Ans. Ithas two valves with an adjustable screw. Q. Mention 4 (four) fgynaccotogical] uses of this instrument. (DU-16/14/10Ju; RU-16Ja; CU-15Ju; Assessment SS-34") Q. Write down 5 (five) /3 (three) common uses of this instrument. (RU-21Ja,20Nv,19Ja; SU-17/15Ja) Ans. To visualize the cervix and vaginal fomices during pelvic examination a. b. To take high vaginal swab and cervical swab c. Cervical scraping for cytology @. Darnginsevion TUCO e. To take cervical biopsy — £ TTo-perform minor operations like- polypectomy, D & C, LEEP ete. Q. Mention twofobstetrical gonditions where it can be used. (DU-16/14/10Ju) Ans. a. Diagnosis of PROM b. APH to exclude local cause Diagnosis of cervical incompetence in pregnancy d. Diagnosis of Cervical tear. ° Q. Enumerate 5 common lesions in the cervix. (SU-17/15}a) Q. Name the cervical pathology which can be assessed by using it. (Assessment $S-34)Ans, aes WARD BOOK Cervicitis Cervical polyp Cervical erosion CIN Cervical malignaney Cervical tear. Q. What are the functions of the valves of this instrument? (SU-17/15Ja) Ans. Retraction of the anterior and posterior vaginal wall for good visualization of the cervix Q. Mention two advantages of this instrument over Sim's speculum. (DU-16/10Ju) Q. What are the advantages of using this instrument? (DU-16/10Ju, RU-19Ja) Ans. a. b. No assis Patient be examined in the middle of the bed c. Both anterior a valls of the vagina can be retracted. Q. Mention one (1) disadvantage of its use. Ans. The vaginal walls can not be inspected. Q. What is the mode of sterilization? (DU-16710) U-17/15Ja; Assessment SS-34") Q. How it can be sterilized? (RU-21Ja,20Nv,19Ja) Ans. a, Autoclaving b. Boiling Q. Write down the risk factors of cervical malignancy. (SU-17Ja) Ans. Early marriage Multiple sexual partners HPV infection ‘ow socioeconomic condition Smokers Husband's previous wife died due to cervical cancer STDs. Sim’s Double Bladed Posterior Vaginal Speculum (DU-18/13Ju,11Ja, SU-16Ju) Fig: Sim’s double bladed posterior vaginal speculum.Obstetrics & Gynaccology Q. Name the instrument, (DU-1 Ans. Sims double bladed posts u,1 a SU-16Ju) I speculum. Q. Write 2 ide Ans. . 1. One blade on either side with a handle in between them 2. There is a groove along the whole length of the instrument. ng points of this instrument, Q. What structures can be examined with this instrument? (DU-18)u)? Ans. Cervix and vaginal wall. pein A Q. Write 3 (three) faymaccal fogical ses of this instrument. (DU-13Ju,1 Ja) Ans. ‘a. During operations like E & C, anterior colporthaphy, vaginal hysterectomy, VVF repair b. _ Insertion & removal of IUCD —_—_— c. Totake cervical biopsy d. YWEexamination— e t Detection of rectocele, enterocele and Gartner's duct eyst etc. During MR Q. Write 3 (three) important, bstetrical] Ans. 5 ‘a. To visualize any injured site on cervix and vagina during PPH b. Repair of cervical tear —— c. For diagnosis of PROM d. To examine cervix and vagina after delivery | of this instrument. (DU-13Ju,! 1Ja) Q. Write down 6 indications of using this instrument, (SU-16Ju) Ans. Please write from above. Q. Ans. 1. VVE 2. “Enterocele and rectocele. {ame two pathological conditions that can be diagnosed by this instrument. (DU-18Ju)/ Q. Write down the name of 6 operations where this instrument is used. (SU-16Ju) Q. Name 3 (three) operative procedures that can be done with this instrument. (DU-18Ju) Ans. E&C Anterior colporthaphy Vaginal hysterectomy Coipotomy Local repair of VVF TUCD insertion & removal Fothergill’s operation’ Shirodkar’s operation AAYVaYNe Q. What are the disadvantages of this instrument? (DU-138u,1 Ja) Ans.arif’s representation on OSPE & WARD BOOK . ox yi Needs assistant to us a b. The patient mist be at the edge of the bed during examination by this instrument c. Both anterior and posterior walls of the vagina can not be retracted, Q. Write down the name of 3 other speculum. (SU-16Ju) Ans, 1. Single bladed vaginal speculum 2. Cusco’s speculum 3. Auvard’s speculum. Q. What are the different positions of the patient during gynaecological examination? Ans. 1, Dorsal position 2. Sim’s position 3. Lithotomy position \ 4, Knee-chest position 5, Trendelenburg position. Q. How will you sterilize the instrument? (DU-13Ju,1 1Ja, SU-16Ju) Ans. a. Autoclaving b. Boiling. 1 Obstetric Forceps : (DU-13Ju,12Ja,10Ju; SU-20Nv,17/16Ja,14Ju; RU-19Nv; Assessment SS-34") sO Jawa, Autociaving b. Boiling. Obstetric Forceps (DU-135u,12Ja,10Ju; SU-20Nv,17/16Ja,14Ju; RU-19Nv; Assessment SS-34") Fig: Obstetrical forceps — Left: Long curved; Right: Short curved. Q. Identify the instrument. (DU-13Ju,12Ja, 10Ju; SU-20Nv, 17/16Ja, 14Ju; RU-19Nv; Assessment SS-34") Ans. A pair of long/short curved obstetrical forceps. Q. What are the different parts of this instrument? (SU-20Nv, 17/16Ja,14Ju; RU-19Nv) Ans. 1. Blade 2. Shank 3. Lockte! 553 4. Handle S. Fixation screw (absent in short curved obstetrical forceps). Q. What are the types of this instrument? Ans, 1, Short curved obstetrical forceps (Wrigley's forceps) 2. Long curved obstetrical forceps 3. Kielland’s forceps. Q. Mention 3/4 important pre-requisites for its use. (DU-133u,72a,10Ju; SU-20Nv,17/16Ja,14Ju; RU- 19Nv; Assessment $S-34") Ans. 1, Presentation & position must be suitable ~ “Cervix must be fully dilated 3. “Membrane mst berptata 4, “Head must be engaged 5. Bladder must be evacuated 6. “Rotation of head must be completed 7. Pelvis must be adequate. Q. What are the indications of forceps delivery? (DU=13Ju,12Sa, 05u; Assessment SS-34") Q. Mention 4 indications of its use. (SU-20Nv,17/16Ja,14Ju; RU-19Nv) Ans. Eclampsia & pre-eclampsia Foetal distress at 2™ stage of labour After coming head of breech race delivery rolong 2” stag Cord prolapse with live bat Prematurity. Write important fetal complications ofits use, (DU-131u,12Ja, 10Ju) Birth asphyxia f yortate) Ngee 5C hoad. Pasa eaenee factad 14COS'2" f soft -Hss for: Intracranial hemorrhage "577 ‘ephalohaematoma 1 2. 3 4. 5. Cerebral palsy 6. wi ‘Skull fracture. Q. What are the maternal complications of using it? Ans. Injury to the genital tract, PPH Hematoma Puerperal sepsis Foot drop and obstetric palsy Dislocation of symphysis pubis and coceyx. PAR Pe Q. Mention the maternal and fetal complications that may develop with this instrument. (SU- 20Nv,17Ja,14Ju; RU-19Nv) Ans.554 arif’s representation on OSPE & WARD BOOK Please write from above. Q. Mention 3 advantages of this instrument over ventouse. (DU-13Ju) Ans. 1. Can be used in case of premature baby 2. Can be used in acute foetal distress 3. Can be used in mento-anterior face. Q. Write 4 contraindications of using this instrument. Ans. Malpresentation Obstructed labour Contracted pelvis IUD. eee Se Q. How will you sterilize this instrument? (SU-20Nv,17/16Ja,14Ju) Ans, 1, Autoclaving 2. Boiling.hemical sterilization. a can be sterilized? (DU-21 Aug,20Nv, RU-19/18Ja) Ventouse (DU-17Ja,14Ju/Ja,11Ju, CU-20M,16Ja, SU-16Ja, Assessment SS-36") Fig: Vacuum extraction with cup.Obstetrics & Gynaecology !-16Ja, Assessment SS-36") Q Wdentify Ans. This is the photograph of suction cup of ventouse. the instrument. (DU-175aj14Ju/Ja,1 Ju, CU-203 Q, Mention 3 common indications for its use. (DU-17H8,14JwJa,11Ju, CU-16Ja, Assessment SS-36°) Q. In which conditions it is indicated? (CU-20M, SU-16Ja) Ans. As an alternative to forceps operation Maternal exhaustion Prolonged 2" stage Pre-eclampsia, eclampsia, maternal heart disease — PrevioushistoryofC/S ~ Delay in the delivery of the 2™ twin. - : Q. In which stage of labour it is used? (CU-16Ja) aye Ams. First stage of labour, Q. Mention 4 important conditions to be fulfilled before its application. (DU-17Ja,14JwJa, SU-16Ja, Assessment SS-36") Q. What are the pre-requisites of its application? (CU-20M) Ans. . F VAC Vertex presentation d.cervix musk be ab least Fem dilate F Bidder mutteeaeg — SE Tate should not be Significant 4. Uterine contraction must be present Capul- rmahon . 3 Membrane must be ruptured 6. Pelvis must be adequate, Q. Mention 3 contra-indications of using this instrument. (DU-11Ju, SU-16Ja) Ans. Cephalopelvic disproportion Fetal distress ‘Mal-presentation Prematurity Non-engaged head Suspected fetal coagulation disorder. yay Q. Mention 3 complications of using this instrument. (DU-14JwJa,11Ju, CU-16Ja, SU-16Ja, Assessment SS-36") Q. Mention 3 fetal complications of it. (CU-20M) Ans, Fetal complications: Immediate: 1. Cephalhaematoma 2. Intracranfar haernorrhage 3. Scalp abrasion 4. Asphyxia Late: Cerebral pal 2. Mental retardationarif’s representation on OSPE & WARD BOOK Maternal complications: 1. Cervical tear and vaginal laceration 2. Perineal tear 3. Puerperal sepsis. Q. Write down 4 advantages of using this instrument. (DU-17/14Ja,11Ju, Assessment SS-36") Q. Write down 4 advantages of its use over forceps. (SU-16Ja) Less space occupying device used in mal-rotated head Can be used even if the cervix is not fully dilated Less maternal genital tract inj . Simple to use, so less expertise is required. Doyen’s Abdominal Retractor (RU-20Ju/M,18Ja, CU-18/17/16Ju, SU-16Ja) »¥ . anwne?Obstetries & Gynaecology — | 595 [Rise of BP specially in hypertensive patients 3. Hourglass contraction af the uterus and retained placenta 4, Gangrene of the limbs. gq. Name the other ergot derivatives, ws gethongin. gq. Write down the name of other uterotonic drugs. (DU-18hu) Ans 1 Oxytos 2 Pro 1. misoprosto}) Tocol (U-22NWFu.200eUSWMy Agent - MgSO, (Mag Sulph) Y12Ja,10Ju, RU-21. A2ONv, CU-20M, 16Ja, SU-16Ja, Assessment SS-34" & 365) Fig: Inj. Mgso4. Instruction: Please examine the ampoule and answer the following questions. Q. Identify the content of the ampoule / photograph, (DU-200ct/JwM,15/12Ja,10Ju, RU-215a,20Nv, SU- léla, CU-16Ja; Assessment $S-34" & 36%) Q. Identify the drug. (DU-22NviJu, CU-20M) Ans. an ampoule contajni ml. Tl Q. Mention 2 (two)/ 3 (three) important uses of this drug. (DU-22Ny/Ju,200cUJwM,15/12Ja,10Ju, RU- 21Ja,20Nv, SU-16Ja, CU-16Ja; Assessment $S-34" & 36") Q. Write down the indication of this drug, (CU-20M) Ans. 8. Control of convulsion in eclampsia b. Prevention of convulsion in severe PE ¢. “Asa tocolytic. ~ Q. Name 2 tocolytic drugs. 2. Salbutamol. Q. Mention the mechanism of action of this drug. (RU-212,20Ny, Assessment $S-34" & 36") Ans.& WARD BOO! Decrease sensitivity to acetylcholine and thus reduces neuromuscular Magnesium blocks the neuronal influx of Ca"* Increased production of endothelial prostaglandin Induces cerebral vasodilatation Dilates uterine artery Inhibits platelet activation, 90 arif's representation on meense Q. What are the other anti-convulsants? (SU-16Ja) Ans. 1, Diazepam 2. Phenytoin 3. Lytic cocktail Q. What are the different routes of use of this drug? (CU-20M) Ans. 1. Intramuscular (IM) 2. Intravenous (IV) Q. What are the three parameters / signs to be observed before and during administration of this drug? (DU-22Nw/u,200cUwM,15/12Ja, 10u, CU-16)a; Assessment SS-34") Q. What are the pre-requisite conditions for its administration? (RU-21Ja,20Nv) Q. Write down the three pre-requisite. (SU-1633) Ans, a. Knee jerk: Must_be present, b. Urine oytput: > 30 ml/fhour. c. Respiratory rate: > |6/min, Q. Mention its dose schedule. (DU-15/12Ja,10Ju; Assessment $S-34" & 36”) Q. Mention the loading dose with route of administration. (RU-21Ja,20Nv) Q. Mention the dase schedule that is used for managing eclampsia. (DU-22Nv/Ju,200cvJwM, CU-16Ja) Ans. A. Loading dose; 4 gm MgSO, diluted with 12 ml of distilled water(VV_slowly over followed immediately by 6 gm MgSO, 1/M inj. (3 gm in each buttock), B. Maintenance dose: 2.5 gm (1 ampoule drug) deep VM every 4 hourly using altemate buttocks continued for 24 hours afer the last convulsion or delivery. — Q. Mention 2 complications / side effects of its use. (CU-16la) Ans. a. Flushing b. Respiratory depression ¢. Hypotension 4. Renal failure ¢. Diminished or absent patellar reflex. 5. mins Q. What are the contraindications of this drug (any 4)? (DU-10Ju, CU-20M) Ans. In patiemts with myasthenia gravis If patellar reflexes “knee jerks are absent Respiratory rate < 16 breaths/min Urine output < 30 ml/ hour. eeseObstetrics & rug? (DUSAQa, 1M)u, SU>) ment SS-34" de V6") ‘ye Saletan gluconate -20M) . Weite down the steps of AMTSL, (Cl w 1. Palpate the mother's abdomen to exclude 2" baby (twin) 2 Give 10 1U oxytocin IM within | minute of delivery, Wait 2-3 minutes for strong uterine contraction and deliver placenta by controtled cord traction: 4 5. Feel if uterus is well contrieted, 6. Give supportive care, nti-D Immunoglobu (DU-19Nv,17/13Ja, RU-19N) Fig: Anti-D immunoglobulin, Instruction: Please examine the ampoule and answer the following questions. Q. Identify the drug / vial, (DU-19N¥,17/13Ja, RU-I9Nv) An) containing anti-D / Rh immunoglobulin, Q. Mention the indication of its use. (DU-19Ny,17/13Ja, RU-I9Nv) Q. What is the purpose of using the drug? (DU-17/138) immunization of Rh negative unimmunized mother, Inj. anti-D / Rh immunoglobulin (IgG) 1s administered intra-muscularly to the mother following: “Child birth & abortion topic pregnancy — Molar pregnancy Chorionic villus sampling (CVS). Q. When it is used? (DU-19Ny, RU-I9Nv) Q. What is the optimum time to give this drug? (DU-17/13Ja) Ans. Within 72 hours or preferably earlier following delivery, ubortion, ectopic or molar pregnancy. Q. Who is the candidate of this drug?ISPE & WARD BOOK Ans. I should be given in an Rh negative mother with Rh positive baby & 1 iret Coombs’ text is negative, Q. Mention the dose and route of administration. (RU-19Nv) Ans Intramy scularly (300 jig) to mother following delivery Q. What complications may develop subsequently if this drug is not used? (DU-17Ja) Q. What complications the baby may develop if it is not used? (DU-19Nv), Ans 1, Fetal complication: + Hydrops fetalis + Icterus gravis neonatorum * Congenital anemia of the newborn These are also known as enthroblastosis fetalis. 2. Maternal complication: * Pre-eclampsia + Eclampsia * Rolyhydramnios * Big baby with its hazards Hypofibrinogennemia PPH. Q. What are the principals of prevention of Rh immunization in a Rh negative mother? (DU-13Ja, RU. 19Nv) Ans. 1. To prevent active immunization ~ by administering anti-D immunoglobulin 2. To'prevent or minimize Te1o-maternal bleed 3. Toavoid mismatched transfu Q. Mention the treatment of Rh iso-immunized baby. Ans, Exchange transfusion Phototherapy Photochemical renction Phenobarbitone Antibiotic. Hydralazine Fig: Inj. Hydralazine, tManual vacuum aspirg Syringe (MVA Syringe). a, entity the instrument, (DUD Aye.20N, inal scum aspirat 16/1499, CUI9Ns.18h4,17I0, RI Syringe (MVA plus syringe) /-19/18a) re its parts? g. What Ans. 1 Plunger 2 Connecting rubber tube & 3 Pinch valve (double valve) Write down 2 important uses of this instrument, (DU-2 a a 1-21 Aug.20Nv) Q. Mention the uses / indications oft, (DU-I6 lala, CU-loNe tale tyfa, RU-LOV1ANa) Ans. Incomplete abortion upto 12 weeks, Evacuation of molar pregnancy Missed abortion Endometrial biopsy Menstrual regulation Q. When ean MVA be used to terminate a pregnancy? wean be used to terminate pregnancy up to 12 weeks gestation. Q. How effective is MVA at terminating pregnancy? Ww successfully ends first trimester pregnan 0.01%, 99.5% of the time and carries minor complication rate of Q. Mention the mechanism of aspiration. (RU-19J3) Ans. Aspiration of the uterine content or product of conception with the help of a cannula fitted with a suction apparatus, . Mention 3 important advantages of using this instrument, (DU-21Aug.20Nv) use? (DU-14Ja) * Quick procedure / shorter time Less bleeding . ‘No need Tor prior cervical dilatation Less pain Tess complications Tow cost.Q. What are the different treatment op Ans, * Hospitalization and bed re * Blood grouping and Rh typi © UV fluid © Evacuation & curett Q. Mention 6 complica Ans Hemorrhage 1 2. Shock 3. Pelvic peritonitis 4. Pelvic abscess 5. Generalized peritonitis Q. Mention 3 complications following its use. (DU d chronic complications of this instrume! Q. What are the acute an Ans. [Tmmediate fomplications: T. Haemorrhage Injury / perforation infection 5 ovagal artack. Delayed|complications: ——T~ Cervical incompetence 4 2, MD 3. Chronic pelvic pain 4. Infertility 5. Ectopic pregnancy 6. Septic abortion. & WARD BOOK < of septic abortion. (CU-19Nv) 6. Sepsis 7. Septicaem 8. Endotoxic shock 9. DIC 10. Renal failure. J-21Aug,20Nv,14Ja, CU-17Ja) nt? (RU-19/18Ja) can can be sterilized? (DU-21 Aug,20Nv, RU-19/18Ja) r mical sterilization. Ventouse (DU-17Ja,14Ju/Ja,11Ju, CU-20M,16Ja, SU-16Ja, Assessment SS-36%) wy Fig: Vacgum evrea-.y J supplementation (beginning 1 month before conception up to 12 weeks of preynaney) Hydrocephal (DUG eVIWM. CU-16/ 180) Q. Identify the photograph. (DU-200evJw/M) Ans. Picture showing » congenitally. malfomed fetus showing the hea is enlarged and glob. the ice tively small, Q. What is your diagnosis? (CU-16Ja,15Ju) Ans. Hydrocephalus. Q. What kind of abnormality it is? (CU-15Ju) Ans. Congenital abnormality. Q. What is the incidence of this disease? Ans. 1 in 2,000 deliveries. Q. Name 2 associated discases of this clinical condition. Ans. 1. Aneuploidy 2. Neural tube defects. Q. What are the causes / mechanism of this condition? (DU-200cU)wM) Ans. mal increase in the formation.of CSF culation of CSF A Timinished absorption of CSF. 2. What will be the abnormal findings at term? (CU-15Ju) 3. How will you diagnose this condition clinically in late pregnancy? (DU-200cUJwM) Ans. I 2. 3, ‘The head is felt larger, globular & softer 1 ter than the normalhead 2. Theheadis high up and impossible to push down into the pelvis 3. FHS is situated high up above the umbilicus. ). How this condition can be confirmed? (CU-15Ju) \ns,& WARD BOOK 1 Neray skull 2. Ultrasonography Q. How will you manage the conditio Q. What treatment will be done in severe eases? (DU-200ev)wM) Ans ete 1. Induction of labour by low ruprure membrane or oxytocin. = C7 5 2. Decompression of the head by a sharp pointed seissor or with a wide bore long needle. Aborted Fetus Q. Identify the specimen? Ans, Jar containing specimen of aborted fetus Or, (if photograph is given) picture showing specimen of an aborted fetus. 1, Threatened abortion 2. Inevitable abortion 3. Incomplete abortion 4, Complete abortion 5. Missed abortion 6. Septic abortion 7. Habitual/ recurrent abortion. Q. Mention two causes of mid-trimester abortion, 1. Anatomical abnormalities e.g. cervical incompetence, congenital malformation of uterus 2. Maternal medical illness e.g. cyanotic heart disease 3. Unexplained - Q. Write the complications of septic abortion. Ans. 1. Hemorrhage 6. Sepsis 2. Shock 7. Septicaemia 3. Pelvie peritonitis - a 8. Endotoxic shock 4. Pelvic abscess - ———9— pie - — 5. Generalized peritonitis 10, Renal failure. — Q. What investigations are done in septic abortion?Pre-Eclampsi: (DU-20Ju/M,16/11Ju, RU-205W/M) Scenario: A 22 years old primigravida at her 36 weeks of pregnancy was admitted with the complaints of severe headache, vomiting and blurring of vision. On examination, BP was found 150/110 mmHg, urine albumin +++, (DU-20JWM), A 28-year old primi-gravida at her 37 weeks of pregnancy has come with complaints of headache & blurring of vision, On examination BP is 200/120 mm of Hy. (DU-16Ju) Scenario: A 20 years old primi-gravida come at her 38 weeks pregnan js 200/120 mm of Hg, Proteinuria ++. (DU-11Ju) y. On examination, her B.P A 20 years old primigravida come at her 32 weeks pregnancy. On examination, her BP is 20 mm of Hg, proteinuria ++, (RU-20JWM) Scenario: A 26 years old lady primigravida of 34 weeks pregnancy present to you with following investigations report: Serum uric acid- 5 mg/dl, Urine for protein- 10 g/l (+++), Platelet count- <100,000/mm. (RU-18Nv) gin is your diagnosis? (DU-16/1 1Ju, RU-20JWM, 18Nv) ns. Primi-gravida with 36 weeks pregnancy with severe pre-eclampsia. Q. Mention 2 clinical signs you look for manage the patient. (RU-18Nv) Ans. * Hypertension = Oedema. 1. Headache 2. Blurring of vision 3. Epigastric pain 4, Oliguria (decreased urinary output). gran three (3)/six (6) important investigations of this patient that should be done. (DU- fu/M,16/1 Ju) Ans, Bed side & 24 hours urinary protein S.creatinine— Blood urea SGPT Platelet count Coagulation profile (BT & CT) USG of pres Q. Mention four (4) maternal complications if left untreated. (DU-205W/M, 16/1 1Ju, RU-I8Nv) Ans. NMAWSYNEarif's representation on OSPE & WARD BOOK Eelampsia = - Hors. Heart failure Pulmonary edema’ 6. DIC Cerebral edema 7. Abuptio placentae Renal failure 8. HELLP syndrome. Q. Mention four (4) foetal complications. (RU-20JwM) Ans. 1 WGR > 1UFD 3. Asphyxia 4, Prematurity Q Outline the principals of general management. (DU-20Jw/M,16/1 Ju) ns. 1. Control of hypertension 2. Termination of pregnancy 3. Prevention of convulsion (by prophylactic MgSOy). Q. Name 4 anti-hypertensive drugs used to control hypertension, (RU-20Jw/M) Ans a-methyldopa Nifedipine Hydralazine Labetalol, Q. How to prevent impending eclampsin? (RU-20Ju/M) Ans. Prophylactic Inj. MgSO, Q. Mention mechanism of action of MgSO,. (RU-20JwM) Ans ‘a. Decrease sensitivity to acetylcholine and thus reduces neuromuscular irretability b. Magnesium blocks the neuronal influx of Ca c. Increased production of endothelial prostaglandin 4. Induces cerebral vasodilatation ¢. Dilates uterine artery f Inhibits platelet activation. 1 is the obstetric management of this case? (DU-16Ju) © If the maternal condition and response to the treatment is satisfactory: Pregnancy may be continued up to term and then termination of pregnancy will be done accordingly. Z 2, [f maternal condition and response to the treatment is not satisfactory: * Induction of labour (medical or sur = Caesarean section,arif's representation on OSPE & WARD BOOK Eelampsia = - Hors. Heart failure Pulmonary edema’ 6. DIC Cerebral edema 7. Abuptio placentae Renal failure 8. HELLP syndrome. Q. Mention four (4) foetal complications. (RU-20JwM) Ans. 1 WGR > 1UFD 3. Asphyxia 4, Prematurity Q Outline the principals of general management. (DU-20Jw/M,16/1 Ju) ns. 1. Control of hypertension 2. Termination of pregnancy 3. Prevention of convulsion (by prophylactic MgSOy). Q. Name 4 anti-hypertensive drugs used to control hypertension, (RU-20Jw/M) Ans a-methyldopa Nifedipine Hydralazine Labetalol, Q. How to prevent impending eclampsin? (RU-20Ju/M) Ans. Prophylactic Inj. MgSO, Q. Mention mechanism of action of MgSO,. (RU-20JwM) Ans ‘a. Decrease sensitivity to acetylcholine and thus reduces neuromuscular irretability b. Magnesium blocks the neuronal influx of Ca c. Increased production of endothelial prostaglandin 4. Induces cerebral vasodilatation ¢. Dilates uterine artery f Inhibits platelet activation. 1 is the obstetric management of this case? (DU-16Ju) © If the maternal condition and response to the treatment is satisfactory: Pregnancy may be continued up to term and then termination of pregnancy will be done accordingly. Z 2, [f maternal condition and response to the treatment is not satisfactory: * Induction of labour (medical or sur = Caesarean section,Sunny Amir's Obstetr 446 3. Write down the indications of episiotomy. [DU-20NOV, 18/08JU, l4Ja, CU-18/17/145a, RU-02 M, SU-19yV I8JU, 18/12Ja] Ans. Indications of episiotomy 1. When the perineum threatens to tear Forceps delivery Assisted breech delivery Rigid perineum Face to pubis delivery Face presentation delivery . Delivery of the premature baby History of repair of third degree perineal tears and posterior colpoperineorrhaphy [Ref : Prof. Nurjah FN NwWe YY What is the timing of episiotomy?|SU-16JU] When episiotomy is done? (SU-19May,18JU] e What instrument is used in episiotomy? |SU-19May] Ans. Timing of episiotomy: 4,