Obsgyn Osce

Question 1

What are contraindications to oxytocin use?

Answer 1

Prior classic c section
Prior transmural ex on the uterus eg removal of fibroid
Prior uterine rupture
Genital herpes
Placenta praevia/vasa praevia
Umbilical cord prolapse 
Transverse lie
Invasive cervical ca
Category 3 fh trace?!

Question 2

Name category 3 FHR tracings

Answer 2

Absent baseline fhr and any of:

Bradycardia, recurrent variable or late decels, sinusoidal

Question 3

What are category 3 fhr trace ass/ w/ ?

Answer 3

Higher risk of fetal hypoxic Acidemia

Question 4

What should you do if there is a category 3 fhr?

Answer 4

Help! mPrepare for delivery while initiating resuscitation measures:
Want to improve uteroplacental perfusion so –>
Place mum in lateral position
Give her O2 8-10l/min of O2 through non rebreather mask
Give iv fluid bolus 500ml of ns
Reduce uterine contraction freq

Then do fetal scalp stim to see if there’s acceleration - if there is no accel - sign of acidemia!

No improvement? Need to do expedited delivery taking into account mother and fetus health

Question 5

Define uterine tachysystole

Answer 5

> 5 contractions in 10m

Question 6

Causes of recurrent late decels

Answer 6

Uterine tachysystole, maternal hypotension (hem, anaesthesia), mat hypoxia. (Resp problems), mat vasculopathies (antiphospholipid syn), placental disorders (abruptio)

–> fetal hypoxia and acidemia –> reflex cns response, myocardial depression

Question 7

Variable decels sign of

Answer 7

Cord compression

Question 8

Explain tubal ligation

Answer 8

What is it - permanent contraceptive technique, no more children
Big decision
Must want it self
Good idea to look at all forms of contraception
Explain what Fallopian tubes are
In this op they are separated or sealed shut so…
A few diff ways- laparoscopy, mini laparotomy, hysteroscopic
Explain each..
Laparoscopy - bellybutton, tubes sealed with rings, anaesthetic, any time not after giving birth
Mini laparotomy - small incision, tubes partially taken out.. Often 2 d after giving birth
Hysteroscopic - through the vagina.. No anaesthetic needed .. Coil is placed in tube.. Not immediate

Regret 3-25%, 1-2 try reversal
Before coming in must use condoms or some form of contraception
Stis

Complications
With the laps - 1/1000, bowel perf, infection, bleeding, bladder inj, anaesthetic problems
With the hysteroscopic - perforation

Menstrual irregularity, lighter bleeding
No change to sexual desire
Pregnancy 1% ?? More likely to be ectopic

Question 9

Pop counselling

Answer 9

Contraceptive
Hx detail
Bp
Progesterone - mucus and perhaps ov
Desorgestral - ov
More than 99%effective if taken right
How to take it is imp
Same time every day
If miss by 3h take straight away and next pill at normal time, abstain or condoms for 48h 
Desorgestral allows for 12 hrs 
If vomit within 2h
Can start it day 1-5 of menses with immediate contraception
Up to day 21 pp immediate action 
Bleeding 2/10 none, 4/10 reg 4/10 irreg
Ses of progesterone
Meds
Stis
No delay in return to fertility!

Question 10

Explain cervical ca to pt

Answer 10

The central cause of cervical cancer is human papillomavirus or HPV:
§HPV is transmitted through sexual contact
§The HPV detected today could have been acquired years ago
§There are many different types of HPV that can infect the cervix, vagina and vulva
•‘Low-risk’ types may cause genital warts
•‘High-risk’ types may cause precancer and cancer of the cervix
§Most women who are infected with HPV will never have any symptoms
•In most cases HPV infection will go away

• Only women with persistent HPV (where the virus does not go away) are at risk for cervical cancer
• Most men and women who have had sex have been exposed to HPV
• More than 75% of sexually active women have been exposed to HPV by age 18-22

Who is at risk?
•Women who have ever had sex

• Women who have had more than one partner
• Women whose partner (s) has had more than one sexual partner
• Women who have had a sexually-transmitted disease
• Women who do not have Pap tests

•Women with immune problems including those who:
–Use steroid medications on a regular basis
–Have organ transplant
How do I lower my risk?
•Delay onset of sexual activity or remain abstinent
•Know your sexual partner
•Do not smoke
•Maintain a healthy diet and lifestyle
•Practice safe sex. Condoms decrease the chance of HPV exposure.
•If eligible, consider getting the vaccine that prevents most cervical cancers.
•Get your Pap test and HPV testing as recommended by your health care provider.