1. OBSTETRICS OSCE REVIEWER egpt2010

2. Internal Examination Dilatation Effacement

3. Clinical Pelvimetry

4. InletDiagonal conjugate: sacral promontory not accessible >11.5 cm MidpelvisIschial spines not prominent Pelvic sidewalls not convergent Sacrum curved OutletIntertuberous diameter >8 cm Subpubic arch >90° Adequate Pelvis

5. Pelvic Inlet

6. Midpelvis Pelvic Outlet

7. Partograph

8. Arrested by sedation and conduction analgesia Cardinal movement s of labor

9. Dystocia ProblemNULLIPARAMULTIPARAManagement Prolonged latent phase> 20 h> 14 hRest Protracted active phase dilation< 1.2 cm/hr< 1.5 cm/hrExpectant and support (2°) arrest of dilationNo Δ in >2 h (4 cm dilated, 180 MVU, no cervical change) Same as nulliIf with CPD, CS If no CPD, oxy Protracted descent<1 cm/hr<2 cm/hrExpectant and support Arrest in descentNo Δ in >1 hSame as arrest Failure of descent>1 h with no descent in deceln. phase or 2 nd stage Same as nulliSame as arrest Prolonged deceleration phase>3 h>1 hSame as arrest

10. Electronic Fetal Monitoring BFHR Variability Accelerations Decelerations

11. Electronic Fetal Monitoring Normal BFHR = 110-160 Variability – Minimal: fluctuations of 5 bpm – Moderate: 6-25 bpm – Marked/Saltatory: > 25bpm Accelerations (2 or more) – At least 15 bpm x 15 sec-2 min in term (20 min strip) – At least 10 bpm x 10 sec in preterm (20-30 min strip)

12. Electronic Fetal Monitoring Decelerations (decrease 15 bpm, > 30 sec) – Early: head compression – Variable: cord compression (abrupt decrease) – Late: uteroplacental insufficiency – Prolonged: >2 but <10 min

13. 3 cm/min. 1 minute 1cm/min.

14. Montevideo units are calculated by subtracting the baseline uterine pressure from the peak contraction pressure for each contraction in a 10-minute window and adding the pressures generated by each contraction. In the example shown, there were five contractions, producing pressure changes of 52, 50, 47, 44, and 49 mm Hg, respectively. The sum of these five contractions is 242 Montevideo units. Montevideo Units

15. Cardinal Movements of Labor

16. Engagement – biparietal diameter passes through the pelvic inlet Descent Flexion – results from descending head meeting resistance (cervix, walls of pelvis, pelvic floor) – chin is brought closer to the fetal thorax – shorter suboccipitobregmatic diameter is substituted for the longer occipitofrontal diameter Cardinal Movements of Labor

17. Internal rotation – occiput gradually moves anteriorly toward the symphysis pubis (or less commonly, posteriorly toward the hollow of the sacrum) Extension – base of the occiput in direct contact with inferior margin of the symphysis pubis – progressive distension of the perineum and vaginal opening  increasingly larger portion of the occiput gradually appears – head is born as the occiput, bregma, forehead, nose, mouth, and finally the chin pass successively over the anterior margin of the perineum Cardinal Movements of Labor

18. External rotation – delivered head undergoes restitution if the occiput was originally directed toward the left, it rotates toward the left ischial tuberosity; if it was originally directed toward the right, the occiput rotates to the right – followed by completion of external rotation to the transverse position – rotation of the fetal body – one shoulder is anterior behind the symphysis and the other is posterior Expulsion – anterior shoulder appears under the symphysis pubis, and the perineum soon becomes distended by the posterior shoulder – after delivery of the shoulders, the rest of the body quickly passes Cardinal Movements of Labor

21. Asynclitism

22. TypeAnterior asynclitismPosterior asynclitism Parietal boneAnteriorPosterior Sagittal suturePosteriorAnterior Asynclitism

23. Active Management of the Third Stage of Labor

24. AMTSL 1.As soon as baby is out and you are sure there is no second baby, infuse oxytocin. 2.Apply controlled cord traction and suprapubic countertraction. 3.When placenta is at introitus, slowly rotate 360°. 4.Inspect placenta and membranes. 5.Massage the uterus.

25. Instrument Identification

26. Rampley dressing forcepsFoerster sponge holding forceps

27. Grave vaginal speculum Pederson vaginal speculum

28. Halsted Mosquito Micro Forceps Straight / Curved Kelly Forceps Straight / Curved Crile Forceps Straight / Curved

29. Simpson Obstetrical ForcepsKielland Obstetrical Forceps Piper Obstetrical Forceps

30. Pestalozza Obstetrical Curette Backhaus towel forceps

31. Pudendal Nerve Block

32. sensory innervation to the perineum, anus, and the more medial and inferior parts of the vulva and clitoris derived from ventral branches S2-S4 passes beneath the posterior surface of the sacrospinous ligament just as the ligament attaches to the ischial spine – courses between the piriformis and coccygeus muscles – exits through the greater sciatic foramen in a location posteromedial to the ischial spine – courses along obturator internus muscle within the pudendal canal (Alcock canal), which is formed by splitting of the obturator fascia Pudendal Nerve

33. three terminal branches in the perineum: – dorsal nerve of the clitoris supplies the skin of the clitoris – perineal nerve serves the muscles of the anterior triangle and labial skin – inferior rectal branch supplies the external anal sphincter, the mucous membrane of the anal canal, and the perianal skin Pudendal Nerve

34. Knot Tying Two-hand One-hand Instrument