1. For the examination findings described, choose the most suitable mode of delivery. Each option may be used once, more than once or not at all.

Possible Answers

For each of the questions below, select the answer which is most appropriate. Each option can be used once, more than once or not at all.

a.) A nulliparous woman is exhausted. The cervix is fully dilated, the fetal head is at the level of the spines, and is in a direct occipito-anterior (DOA) position. The CTG is reassuring and the epidural anaesthesia is working well.

Choose from one of the following answersA Caesarean sectionB Attempt Kielland's forcepsC Attempt Neville–Barnes (non-rotational) forcepsD Attempt Ventouse deliveryE There is currently no need for instrumental delivery

b.) A woman is reviewed after pushing for 2 hours. This is her second baby. The first was delivered normally. The cervix is fully dilated, the station is −1 to spines and per abdomen there is 2/5 of the head palpable. The position is right occipito-transverse (ROT). The CTG is reassuring. No analgesia has been used in the second stage.

Choose from one of the following answersA Caesarean sectionB Attempt Kielland's forcepsC Attempt Neville–Barnes (non-rotational) forcepsD Attempt Ventouse deliveryE There is currently no need for instrumental delivery

c.) A nulliparous woman is reviewed for a pathological CTG in the second stage. The cervix is fully dilated, the head is at +2 to the spines, the position right occipito-anterior, and 0/5 of the head is palpable per abdomen. She has been pushing for 30 minutes and is making good progress, but the decelerations are becoming increasingly prolonged. She does not have an epidural.

Choose from one of the following answersA Caesarean sectionB Attempt Kielland's forcepsC Attempt Neville–Barnes (non-rotational) forcepsD Attempt Ventouse deliveryE There is currently no need for instrumental delivery

d.) A nulliparous woman is reviewed for a bradycardia. The cervix is 9 cm dilated. The head is direct OA, −1 station, the head is 2/5 palpable per abdomen, and she has a well-working epidural. The bradycardia is now continuing for approaching 10 minutes.

Choose from one of the following answersA Caesarean sectionB Attempt Kielland's forcepsC Attempt Neville–Barnes (non-rotational) forcepsD Attempt Ventouse deliveryE There is currently no need for instrumental delivery

e.) A nulliparous woman without an epidural is reviewed as she is requesting a caesarean section. She has been pushing intermittently for half an hour, but she is shouting and struggling when she is pushing. She is unsupported by her partner and is frightened. The cervix is fully dilated, the head is at +2 to the spines, direct occipito-anterior (DOA) position. The fetal heart rate is normal.

Choose from one of the following answersA Caesarean sectionB Attempt Kielland's forcepsC Attempt Neville–Barnes (non-rotational) forcepsD Attempt Ventouse deliveryE There is currently no need for instrumental delivery