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INSTRUCTION TO
CANDIDATE
She attends the postnatal clinic with
her partner
She wants to know more as to why a
caesarean section was done
She wants further clarification as to
why her surgical wound had become
infected
Counsel the patient appropriately
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Professionalism
Greet patient and partner
Sits at consultation table at a reasonable
distance from clients
Invites both partner and patient and makes
them comfortable
Has all documents and Bed Head ticket of
patient regarding the Obstetric Emergency
(cord presentation) and abnormal lie
Also has details of intrapartum and course of
postnatal care
States purpose of consultation and reviews her
obstetric problem and complication
ITEM
MARK
ALLOT
ED
ITEM
MARK
ALLOTE
D
ITEM
MARK
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INSTRUCTION TO
CANDIDATE
The cardiotocography done on the
patient after artificial ruptere of
membrane is shown below.
Study the CTG and answer the
questions
QUESTIONS
1. What do the TWO graphs in the CTG indicate?
The upper graph is a record of the fetal heart
rate and this is obtained using an ultrasound
(transducer placed over the point where the feta
heart is best heard)
The lower graph is obtained using a tranducer
which records the contractions of the uterus. It is
an indirect indication of intrauterine pressure
QUESTIONS
2. Describe the abnormality seen in CTG
Baseline fetal HR is about 150 bpm
The variability is <5 bpm
Variable decelerations from the baseline
are seen with variable recovery
Shouldering is clearly seen
Uterine contractions are occuring 1:3 in a
10 minute interval
QUESTIONS
3. What is the probable diagnosis
Considering the history of ARM in
patient where the fetal head is not
engaged, the most probable diagnosis
is PROLAPSE OF THE UMBILICAL CORD
QUESTIONS
4. How would you manage this patient?
i. Alert senior members of the team and keep patient nil
orally
ii. Set up iv access line and sent off blood for FBC and group
and X-match for possible urgent caesarean delivery
iii. Since the fetal heart is present one is assured the fetal is
alive
iv. Perform a pelvic examination taking aseptic measures
and confirm if the cord has prolapse
Also feel for cord pulsation and reassess the dilatation of
the cervical os
THANK YOU