A 34 year old primigravida in spontaneous labour has been actively

pushing for one hour. She has epidural anaesthesia, the cervix is
fully dilated and the vertex is 1cm below the ischial spines in the
direct occipito-anterior position. Justify your intervention to effect
safe delivery.
Women having a vaginal delivery after one previous caesarean
section are at risk of uterine scar dehiscence. How can this risk be
reduced and how would you identify and manage this complication?
A 34 year old primigravida in spontaneous labour has been actively
pushing for one hour and is exhausted. She has epidural
anaesthesia, the cervix is fully dilated and the vertex is 1cm below
the ischial spines in the direct occipito-posterior position. Justify
your intervention to effect safe delivery.
You have just performed a Neville-Barnes forceps delivery on a
primigravida for delay in the second stage of labour and identified a
third degree tear. Justify your management of this laceration
Debate the use of cardiotocography in low risk uncomplicated
labours.
A 38 year old woman with an uncomplicated pregnancy requests
induction of labour at 40 weeks gestation for personal reasons. How
would you counsel her?
Justify your management of a woman who has retained her placenta
following a spontaneous vaginal delivery.
A 30 year old woman is found to have a fetus with a transverse lie
at 38 weeks gestation. Justify your management.
You have been called urgently to the delivery room because the
midwife has encountered difficulties with delivery of the fetal
shoulders. Justify your actions.
A 30 year old woman presents at 42 weeks gestation with
spontaneous rupture of the fetal membranes and meconium stained
liquor. Her pregnancy had been uncomplicated and she is not in
labour. Justify your management.
A 30 year old woman presents at 38 weeks gestation with
spontaneous rupture of the fetal membranes but no uterine activity.
Her pregnancy has been uncomplicated. Justify your management.
A 30 year old woman collapses during delivery of the placenta. On
assessment, you identify an inverted uterus with the placenta
attached at the fundus. Justify your management.
A 30 year old primigravida is referred at 40+3 weeks gestation
following spontaneous rupture of membranes 30 hours earlier. She
was booked for a home confinement and is reluctant to have
medical intervention. Justify your advice to her.
A 25 year old woman presents in labour at 5cm dilatation in the
39th week of her third pregnancy. Four hours later, she is 6cm
dilated on vaginal examination. How would you manage this
patient?

A 40 year old solicitor is referred to you by her independent midwife

38 weeks into her first pregnancy. She has read that fetal
monitoring in labour results in an increased risk of caesarean
section without benefit to the mother or baby. She therefore does
not want any intra-partum fetal monitoring whatsoever. Justify your
advice to her.
What are the adverse effects of vaginal delivery on the pelvic floor
and how can these be prevented?
A 30 year old multiparous woman collapses suddenly during labour
at 7cm dilatation. There is no vaginal bleeding and her uterus is
soft. List the possible diagnoses and outline your management.
Critically appraise the different methods of intra-partum fetal
monitoring.
Debate the premise that in all normal pregnancies that progress
beyond the expected date of delivery, induction of labour should be
recommended at or before 42 weeks gestation.
A 34 year old asylum seeker has been admitted in spontaneous
labour at term. Clinical examination reveals that she has been the
victim of infibulation. Outline the potential intra-partum and postpartum problems and your management strategies.
A 34 year old woman has been counselled and admitted for
induction of labour at 42 weeks gestation. She has one previous
caesarean section for placenta previa. (a) How would you minimise
the risk of uterine rupture during labour? (10 marks) (b) How would
you recognise and manage uterine rupture? (10 marks)
A healthy 28 year old primigravida with a normal pregnancy
presents in spontaneous labour at 39 weeks gestation. She is
exhausted after 1h of active pushing. The cervix is fully dilated with
a direct occipito-anterior position 1cm below the ischial spines. (a)
Justify your intervention to effect safe delivery [10 marks]. (b) She is
found to have a third degree tear ? justify your subsequent
management [10 marks].
You are asked to review a healthy 35 year old woman 30 minutes
after spontaneous vaginal delivery because she is suspected of
having a third degree tear. (a) Justify your initial assessment [5
marks]. (b) Which information would you give her in order to obtain
informed consent for repair of the third degree tear?[6 marks]. (c)
She has a 3C third degree tear. Logically outline your intraoperative interventions to ensure optimum outcome. [9 marks].