Instruments

Question 1

Prerequisite for forceps delivery/ vacuum

Answer 1

• F: Fully dilated os
• O: OA/ OP
• R: Ruptured membrane
• C: Consent, Contraction
• E: Empty bladder, Episiotomy
• P: Pain relief, Pediatrician standby
• S: Sterilization, Skillful operator

Question 2

Contraindication for vacuum delivery

Answer 2

• Premature <34 weeks
• Fetal malpresentation (eg: breech, face, brow)
• Membrane intact
• Unengaged head
• Suspected macrosomia

Question 3

Advice to patient prior to pap smear

Answer 3

• To come between 7-13th day after last menstruation
• No sexual intercourse for 24 hours prior
• No douching/ use of vaginal suppository for 24 hours prior

Question 4

Indication for Pap smear

Answer 4

• As a method of screening programme for early cervical Ca
• Sexually active at the age of 20-65
• History of STD
• Abnormal PV bleeding/ discharge
• As a follow up following treatment of CIN

Question 5

When to do pap smear

Answer 5

• Start at the age of 20/ within 3 years of first coitus
• First smear should be repeated ideally a year later to guard against false negative result
• After that every 3 years is adequate if result normal
• In age 35-45 a one year interval is advisable
• Stop at age >65

Question 6

Step of ARM

Answer 6

• Clean the hand and wear the sterilized glove
• Clean the perianal region and vagina
• Perform vaginal examination and assess the condition of cervix, dilatation of os, presentation of fetus, station, and membrane
• Index and middle finger are placed between the vaginal wall and presenting part of the fetal head
• Rupture the membrane using hook with guidance of another hand
• Assess the liquor volume and color

Question 7

Complication of ARM

Answer 7

• Cord prolapses
• Placenta abruption
• Injury to maternal vaginal wall
• Injury to foetal presenting part
• Antepartum haemorrhage in case of vasa praevia

Question 8

Advantages of mechanical induction of labour

Answer 8

• Effective
• Safe
• Cheaper
• Low incidence of uterine hyperstimulation

Question 9

Maximum duration for mechanical induction to be inserted

Answer 9

12 hours

Question 10

Complication of IUD

Answer 10

• Expulsion
• Migration of IUD
• Ectopic pregnancy
• Uterine perforation
• Pelvic infection

Question 11

MOA of IUD

Answer 11

• Copper-releasing: copper ion interferes with sperm mobility and incite a foreign-body reaction that results in a spermicidal environment
• Mirena: thicken cervical mucus, stop ovulation, and thin the uterus lining

Question 12

Benefits of IUD

Answer 12

• Highly effective pregnancy prevention
• Does not require regular adherence to maintain high effectiveness
• Rapidly reversible

Question 13

Indication of Cusco Speculum

Answer 13

> Obs

• PROM
• PPROM
• APH
• Vaginal discharge during pregnancy

> Gynae

• Vaginal infection
• Bleeding per vagina
• Pap smear procedure
• Pipelle endometrial sampling
• IUD insertion
• Cervix ca (examination and biopsy)

Question 14

Step for pap smear

Answer 14

• Position the patient – usually dorsal
• Inspect the vulva (eg: masses, discharge)
• Insert the speculum
• Ayre spatulas rotate 360” for scraping vaginal lesion
• Push cytobrush into the canal, rotate 180”
• Smear the samples on slide
• Fixed with fixative immediately

Question 15

Define pap smear

Answer 15

• It’s a screening method
• Its cytological study
• It is the study of cells from the transformation zone of the cervix to detect the premalignant lesion of the cervix

Question 16

Contraindication of IUD insertion

Answer 16

• Severe distortion of uterine cavity (eg: bicornuate uterus, fibroid)
• Active pelvic infection
• Known or suspected pregnancy
• Unexplained abnormal uterine bleeding

Question 17

Side effect of IUD

Answer 17

• Post-insertion bleeding
• Uterine cramping
• PID
• Expulsion of IUD