OSCE PY COMPILATION  Delivery s/b synchronous with uterine

1. Wrigley’s Forceps Contraction

 Fully Dilated cervix
 Engagement of fetal head <1/5 palpable above
pelvic brim
 Fontanelle m/b defined (position of head m/b
confirmed)
 Gentle traction can only be applied when there is
uterine contraction
a. Indication
 Apply traction to the Handle follow the axis
 Passenger (fetus)
of birth canal (downward → upward)
o presumed fetal compromise
 episiotomy Incision when indicated
o cord prolapsed in 2nd stage of labour
 Jaw seen (remove forceps)
o malposition (DT/OP → Kielland
c. Procedures
forceps)
d. What is failed forceps?
o delivery of the after coming head
 Fetal head does not advance with each pull
 Passage (mother)
 Fetus is undelivered after 3 pulls with no descent
o medical indications to avoid valsalva
e. What are the complications?
maneuver
Fetal Maternal
o HT crisis/ heart disease
o maternal fatigue/ exhaustion  Bruising, lacerations,  laceration to the
cephalohematomas cervix, vagina,
 Prolonged 2nd stage of labour
 Skull fractures, perineum, or bladder
o Inadequate uterine contraction/ poor
maternal voluntary effort intracranial hemorrhage  extension of
with falx, or tentorial tear episiotomies/ anal
o large fetus
o persistent OP/ deep transverse arrest of  Cerebral palsy, mental sphincter injuries
fetal head retardation  extensive bleeding
o malpresentation: face/ brow (PPH)
presentation  intrapartum rupture of
o contraction of pelvic outlet unscarred uterus
b. Prerequisites  urinary stress/ feacal
 Analgesia (epidural) incontinence
 Bladder must be emptied f. Indications for forceps instead of vacuum delivery
  face presentation with mento anterior position  incision is made during course of CONTRACTION
 bleeding from FBS site when the head distending the perineum
 delivery of the after coming head of breech (CROWNING)
presentation Repairing
 delivery before 34 weeks of gestation  place pad high in vaginal to prevent blood from
uterus obscuring the view
2. Episiotomy scissor  repair vaginal mucosa: start above the apex of cut,
a. Use in episiotomy (median/ medio-lateral) continuous stitch
b. Indication  muscle layer: closed by interrupted suture
 to protect fetus (tentorial tear – sudden release  close skin: continuous suture
of pressure) especially in premature baby
 perform VE to check any missed tear/
 to prevent perineal tear/ excessive stretching of inappropriate apposition of anatomy
muscle
 Remove pad
 to prevent damaged from abnormal presenting  PR examination to check for any inappropriate
part: OP & face presentation placed suture
 SD
 Instrumental delivery 3. Hegar’s cervical dilator
 Breech delivery
c. Complication
 Infection
 Excessive bleeding
 Urine/ feacal incontinence
 Extended tear
 dyspareunia/ vaginal narrowing
 psychological trauma
d. Procedures
Incision a. Indication: prior to operation on cervix/ uterus
 perineal is infiltrated with local Analgesia  preliminary to curettage & evacuation in case of
 Blunt end side of scissors put inside the perineum missed miscarriage, molar pregnancy ( os is
& presenting part protected by another hand closed)
 to explore uterine cavity for hysteroscopy,
remove polyps
  prior to operation on cervix (cervical amputation,
conization)
 other gynaecology procedure like HSG, drainage
of pyometra, hematometra
 prior to intracavity radiotherapy
b. Complication
 infection
 hemorrhage
 perforation of uterus
 cervical incompetence
 pain shock a. Describe pathogenesis
 if presenting part does not fit/ fill the internal
4. Mannequin – baby head is crowning cervical os, there is a room for the cord to
a. What is this stage of labour? descend/ prolapse
2nd stage b. Risk factors
b. Define labour.  Mother: multiparity, polyhydramnios, CPD, low
Regular painful uterine contraction bringing about lying placenta
progressive cervical change  Fetus: breech presentation, transverse/ oblique
c. What is prolonged labour? lie, prematurity, multiple pregnancy, long cord
 Prolonged latent phase >12h  Obstetric manipulation: ECV, Stabilizing induction,
 primary dysfunctional labour: <1cm/h cervical ARM, IPV, applying fetal electrodes
dilatation c. How to deliver if os = 5cm with cord prolpase?
 secondary arrest: progress in active phase of  Call for help, venous access s/b obtained
stage1 is initially good but then slows/ stops  Verbal consent is taken
altogether  Preparation made for immediate delivery in OT
 Prolonged 2nd stage of labour  To minimize the cord compression by elevating
o Multiparous >1 h w/o epidural; >2h w presenting part either manually/ by bladder filling
epidural method
o Primigravida >2h w/o epidural; >3h w  Minimal handling of loops of cords lying outside
epidural
the vagina which can be covered in surgical packs
soaked in warm saline
5. Mannequin – cord prolapsed
 Bladder filling quickly by inserting the cut end
of an IV giving set into a Foley catheter →
clamped
 once 700ml have been instilled (remember to on the presenting part s/b kept to a minimum in
empty the bladder again just before any delivery such women
attempt)
 cord compression can be further reduced by 6. UV prolapsed
mother adopting knee-chest position (in home
while waiting for hospital transfer)
 give terbutaline 0.25mg SC to reduce contraction
 give O2 by facemask
d. How to deliver when fully dilated os?
 Vaginal birth, in most cases operative, can be
attempted if it is anticipated that delivery would
be accomplished within 20 minutes from
diagnosis a. Findings/ signs
e. Complications  A pink/ red bulging through the vagina out into
 Cord compression preventing venous return to introitus and vulva
fetus  Can see the cervix and uterus
 umbilical arteries vasospasm secondary to b. Symptoms
exposure to vaginal fluids & /air  bulge/ lump in vagina
→ Birth asphyxia → HIE & CP/ perinatal  backache
death  vaginal discharge
f. How cord presentation be detected?  dragging discomfort
 Loop of cord in front of the presenting part can  urinary symptoms: incontinence, frequency,
be visualized by using colour Doppler studies to dysuria
serially examine women at high risk  difficulty defecation
 Loops of cord are palpated through the  dyspareunia
membrane by VE
 Bradycardia/ variable FHR decelerations 7. Male condom
g. How to prevent? a. Mechanism of action
 prompt VE is the most important aspect of  to prevent sperm deposition in the vagina by a
diagnosis barrier
 ROM s/b avoided if there is known cord  sperm and ovum cannot meet, so no fertilization
presentation → CS s/b performed b. Advantages
 ARM s/b avoided whenever possible if the  easy to use
presenting part is unengaged & mobile; pressure
  widely available o Hematinics: to correct anemia by supply
 cheap iron for RBC production
 can prevent STD o GnRH agonist can reduce the size of
c. Disadvantages fibroids & reduce blood loss during
 affect sensation operation if given pre-op 3months
 can burst/ slipping off during intercourse  Surgery
 latex-induced allergy o To remain fertility: hysterescopic/
laparoscopic resection of fibroids
8. Large UTERINE FIBROIDS with anemia o Myomectomy
a. Insepction: o Hysterectomy for those completed family
i. recognize anemia: conjunctiva pallor, palm pale, / heavy bleeding during operation
generally look pale
ii. suprapubic fullness: a visible mass/ swelling in 9. A 23 years old female underwent laparoscopic examination of
the SPA the pelvis as part of the investigations for her difficulty to
b. Palpation: conceive. These findings were noted in the Pouch of Douglas.
i. Size: 24 weeks of pregnancy size
ii. Shape: globular in shape
iii. Surface: smooth
iv. Consistency: Firm
v. Mobility: Freely move from side-to-side, but not
above downward
vi. Tenderness: NO unless there is complication a. What do you see & what is your diagnosis?
c. Investigation: Blood collected in POD (hemoperitoneum)
i. FBC: Hb level (anemia), polycythemia (pressure Dx: Endometriosis
symptoms on kidneys increase erythropoietin) b. What is the most probable hypothesis for the
ii. USS: TAS/ TVS (for obesity women) development of this condition?
iii. Endometrial biopsy to exclude malignancy Retrograde menstruation and implantation on POD
d. Treatment: correct anemia followed by surgery c. List 3 presenting symptoms apart from subfertility that
 Correct anemia/ stop bleeding may be associated with this condition.
o Anti-fibrinolytics: Tranexamic acid reduce  Pelvic/ abdominal pain during/ before menses
bleeding (Dysmenorrhea)
o NSAIDs: Mefenemic acid for reduce  Dyspareunia (Implants on POD)
bleeding & also dysmenorrheal  Low back pain
 d. Name 3 medical options for treatment of this condition & 11. Forceps
list one side-effect of each treatment. a. Name the forceps.
1- Combined estrogen + progestogen for 6-9m
→ produce pseudopregnancy state
(endometrial atrophy)
2- Danazol 200-800mg/ day for 6-9m →
weight gain & androgenic SE (hirsutism)
3- GnRH agonist SC injection for 6M →
pseudomenopausal state (menopausal
symptoms/ osteoporosis)
Barnes Neville
Forceps
10. Case with Obvious IUGR
a. Inspection: able to recognize small for gestation age
b. Palpation:
 measure SFH correctly from fundal height to
upper border of symphysis pubic
 easily palpable fetal parts
 deeply engaged presenting part Piper’s forceps
c. Investigations
 Fetal wellbeing: FKC, CTG
 Fetal growth: USS serial growth scan (biometry ,
AFI, placenta localization)
d. Complications of IUGR
 fetal distress Kielland’s
 risk of operative delivery forceps
 meconium aspiration
 respiratory distress syndrome
 necrotizing enterocolitis
 fetal death
 low birth weight

Simpson’s forceps
12. Malpresentation in late pregnancy
a. Inspection: Recognize abnormal shape of uterus (fundal
space look empty, flanks of abdomen look fullness)
b. Palpation: recognize the malpresentation
 SFH is smaller than date
 fundal grip is empty
 2 fetal poles on the lateral side of abdomen
c. Causes for this abnormality
i. Multiparous
ii. Polyhydramnios
iii. Placenta praevia
iv. fetal abnormality (anencephaly, hydrocephalus)
v. Contracted pelvis
vi. Uterine anomaly
vii. Fibroids in lower segment of uterus
d. Principles of treatment
i. Hospitalization at term
ii. Mode of delivery:
 if no spontaneous version of cephalic, opt
to ECV → stabilizing induction
 elective CS

13. A diagram of the uterus showing different types of fibroids.

 a. Identify each types a. What is this & what does it contain?
b. Describe the specimen (Multiple leiomyoma) Combined oral contraceptive pills (contain estrogen &
progesterone)
b. What is it used for usually?
Contraceptive (to prevent unwanted pregnancy)
c. What is the mode of action?
 inhibition of ovulation by prevent follicular
development within ovary
 endometrial modification to prevent implantation
 altering cervical mucus to prevent sperm
ascending
d. What are the other benefits of this medication?
 sharply circumscribed/ encapsulated but discrete  light, pain-free, regular bleeding
 round, firm and gray white masses  improve PMS
 characteristic whorled cut surface  reduce the risk of PID
c. What is the typical symptom associated with each type?  treat acne
i. Cervical fibroids: pressure on bladder  long term protection against both ovarian &
ii. Subserous: involve peritoneum endometrial cancers
iii. Intramural: HMB & dysmenorrhea e. Which patients should not be used this medication?
iv. submucous: HMB after PM  focal migraine
v. Pedunculated: torsion can cause acute abdomen/  CVA
calcification after PM  IHD
14. COCP  Significant HT
 Acute/ severe liver disease
 Breastfeeding

15. A 48 years old lady present with infrequent period & hot flushes.
She has been unable to sleep at night & is very irritable.
 d. List the type of abnormal findings that you might see
using this instrument.
Inflammatory, HPV infection
CIN I (mild dyskaryosis); CIN II (moderate dyskaryosis);
CIN III (severe dyskaryosis)
a. What is the possible diagnosis?
17. BISHOP score
Premenopausal syndrome
Dilatation of cervix (cm) 2cm 1
b. List the investigations you would like to do & state your
Consistency of cervix soft 2
reasons.
Length of cervical canal 2cm 1
Position of cervix central 1
c. What medications can you prescribe to her for her
Station of presenting part -2 1
condition? HRT
Total = 6/13
d. What are the benefits of the above medications?
a. Give the score based on the criteria given & comment on the
 relieve menopausal symptoms
total of the score.
 maintenance of quality of life 6/13. Favourable cervix and IOL is more likely to be successful.
 prevention of osteoporosis b. State different methods of IOL.
 Membrane sweeping & stretching twice a day offered
16. Pap smear to women prior to formal induction
 Prostin E2 (Dinoprostone) for those with intact
membrane and unfavourable cervix
 Artificial rupture of membrane +/- IV oxytocin
 Extra-amniotic foley catheter

a. What is this instrument called? 18. Given tablet of medication.

Ayre spatula, endocervical brush, cytobrush for liquid-
based cytology
b. What is this instrument used for?
Pap smear for cervical and vaginal cytology
c. Which patient will need to have the above procedure
done?
Sexual active woman who is asymptomatic and no clinical
findings of cervical cancer
a. What is this?
 Prostin E2, vaginal tablet, 3mg (Dinoprostone) a. Name this condition: Uterine inversion
b. Method of administration b. Predisposing factors
Insert into posterior fornix of vagina  Missed management of 3rd stage: traction on
c. What are the side effects? umbilical cord before placenta has separated
Hyperstimulation of uterus, fetal distress, uterine rupture,  CCT was not done properly
bronchospasm (CI in bronchial asthma)  short cord
19. Given an instrument  fundal placenta
 morbidly adherent placenta
c. Complications
 PPH
 PPC due to vasovagal shock and pain
 Chronic uterine inversion

a. Name: Green Armytage non-traumatic hemostatic tissue

forceps
b. When does it use? In cesarean section
c. Purpose: To get hemostatic at uterine edge
d. If it is unavailable, what is the instrument can be used to
replace it?
Sponge holding forceps
e. Benefits: non-traumatize & hemostatic function
d. Name the condition: Placenta circumvallate
e. Why you said so?
20. Pictures
i. separated cotyledons
ii. separated blood vessels
f. Normal condition: cotyledons & blood vessels are not
separated
21. Gross specimen on H.mole: A 21 years old lady come with BPV
after 1 months of amenorrhea

a. Name: Uterine sound

b. Usage
i. to determine the direction of uterus
ii. to measure the uterocervical length
iii. to detect foreign body (IUCD) & abnormal mass in
the uterine cavity (submucous fibroid)
iv. to differentiate between inversion of uterus &
polyp
v. to diagnose congenital elongation of the cervix
a. Explain the gross appearance vi. to diagnose congenital malformation of the cervix
Uterine cavity is filled with a delicate, friable mass of thin- & uterus
walled, translucent, cystic, grape-like structures vii. prior to most operation on the cervix & uterus
consisting of swollen edematous (hydropic) villi c. Complications
b. Diagnosis: Complete hydatidiform mole  perforation
c. Genetic etiology  bleeding
 Result from fertilization of an empty ovum (lost  infection
its chromosomes)  injury to nearby structures
 Genetic material is completely paternally derived 
d. Complications 23. 30 y/o, para 1, exclusive breast feeding, request IUCD
i. PV bleeding with the presence of ‘grape-like’
vesicles
ii. Uterine perforation
iii. Choriocarcinoma

22. Instruments
 a. Prerequisites for IUCD insertion 20mins, no decelerations, no uterine contractions seen. This is a
 No history of PID & ectopic pregnancy reactive-CTG.
 Do UPT to confirmed that she is not pregnant
 No valvular heart disease 29. Amniotomy hook
 No known malformation of uterus
 No copper allergy
b. Complications
 Increased menstrual blood loss
 Increased dysmenorrhea
 Increased risk of PID in the 1st few weeks
following insertion
c. Maximum time: Copper (10years)
d. Mode of action: all induce an inflammatory response in a. Indication
endometrium which prevents implantation. But, copper-  to enhance uterine contraction in the active
bearing IUD work by toxic effect on sperm which prevent phase of 1st stage of labour
fertilization; IUS prevents pregnancy by a local hormonal b. complication
effect on cervical mucus & endometrium  placenta abruption (especially in polyhydramnios
due to sudden release of pressure)
24. Demonstrate speculum examination  cord prolapse
25. Demonstrate episiotomy  infection
26. Demonstrate Pap smear  injury to fetal presenting part
27. Specimen: submucous leiomyoma  fetal distress
a. Clinical features: menorrhagia, mass over SPA,
constipation, urinary frequency, subfertility 30. Management of Delivery of after coming head
b. Complications: hyaline & cystic degeneration, recurrent a. Piper’s forceps
miscarriage, preterm labour, malpresentation,  assistant hold the rest of the baby body, operator
sarcomatous changes insert the forcep from below
b. Mauriceau-Smellie-Veit Maneuver
28. CTG – interpret normal CTG  jaw flexion & shoulder traction
This is a non-stress, antepartum CTG belonging to MrsA, G2P1,
 to maintain fetal head in flexed position so that
taken at 21/11/12 at 10am. The CTG shows a baseline HR of
to reduce the diameter of presenting part
140bpm, baseline variability of 10-15bpm, 2 accelerations in
c. Burn Marshall method
  use non-dominant hands to grasp the fetal leg/ c. Non-identical twins (fraternal twins)
ankle, & with gentle traction swept in a slow arc  result from implantation of 2 genetically different
over and put onto maternal abdomen embryo
 yolk sacs & fetal poles are seen in 2 completely
31. Interpret Twin Pregnancy USS
separate sacs
d. Signs of Dichorionic twins on USS
 twin peak sign/ lambda sign seen
 2 functionally separate placenta and 2 separate
amniotic cavities
 2 cavities are separated by a 3-layered
membrane
 fetus can same sex/ different sex
a. Identical twin  V-shaped extension of the placental tissue into
 monozygotic twins (1 gestational sac with 2 yolk the base of the inter-twin membrane “lambda/
sacs visible inside it ) twin peak sign”
 result from an early embryo dividing into 2 e. Complications of MC/MA
genetically identical embryo  miscarriage rate is higher
b. Signs of Monochorionic twin  perinatal mortality is higher
 single placenta/ two placenta  chromosomal defects, anatomical defect and
 majority have 2 amniotic cavities but 10% have pregnancy complications are more likely
same amniotic cavity  TTTS, cord accidents, conjoined twin
 dividing membrane is single-layered amnion
 always same sex pairing 32. Gross specimen
 thinner inter-twin membranes joins the uterine
wall in a T-shape “T-sign”

a. Describe the gross morphology

 Ovary filled with hairs and other germ cells  check placenta for any missing cotyledon
b. Name the gynaecology condition
 check blood clot inside uterus
Mature cystic teratoma (Dermoid cyst)
 check any local laceration: perineal tear – suture
c. Clinical features
 breastfeeding, mother & baby bonding, sucking
 mass on lower abdomen
milk stimulate oxytocin production for uterine
 pressure symptoms on bladder/ bowel
contraction
 amenorrhea
d. Mention 3 complications: Hemorrhage, Torsion, Rupture
34. Given a model of well-flexed breech baby, at 37 weeks of
gestation, mother is a multiparous, uncomplicated, no medical
33. A mannequin of a 3rd stage labour
condition case.
a. What are the signs of placental separation? a. What is the obstetric condition of this baby?
 lengthening of the cord from vulva Breech presentation
 small gush of blood from placenta bed b. What is your management?
 fundus rising up to umbilicus External cephalic version
 fundus become hard and globular c. How you prepare the management?
b. Demonstrate how you do CCT, you are given a clamp.  exclude the contraindication of ECV
Clamp the cord close to the perineum using sponge  ask for consent and explain the procedure to the
forceps. Hold the clamped cord with one hand and gentle mother
traction when pulling. Place the other hand just above  perform USS to the baby to confirm the
the woman’s pubic bone and stabilize the uterus by presentation, placental location, AFI
applying counter traction during controlled cord traction.  CTG done before started the procedures to
This helps prevent inversion of the uterus. Readjust the exclude fetal distress
clamped cord near to the perineum again when  apply gel/ talcum powder on the mother
lengthening of cord occurs. Twist while deliver the abdomen
membrane of placenta. Check for any missing lobe on the
 lift the breech up either by USS guidance
placental.
 rotate it in one direction
c. What should you do before CCT?
d. What are the complications of the management?
 Give IM syntocinon 10U, double clamp & cut the
 fetal distress
cord
 uterine rupture
d. What should you do after finishing active 3 rd stage
 rupture of membrane
management?
 cord accident
 palpate the fundus to check the tone of
contraction
35. Given 2 pictures.

a b

a. Describe the obstetric condition for a & b. a. Clinical manifestations

i. a= placenta praevia type III (cover the internal os i. Asymptomatic
asymmetrically) ii. Dysmenorrhea
ii. b= placenta praevia type IV (cover the internal os iii. Dyspareunia
symmetrically) iv. Cyclic pelvic pain
b. What are the general clinical features of these obstetric v. Subfertility
conditions?
b. Septate uterus: recurrent 1st trimester miscarriage
 painless BPV (antepartum hemorrhage) c. Unicornuate/ bicornuate uterus: 2nd trimester miscarriage,
 fetal part easily palpable malpresentation, preterm labour, uterine rupture
 fetal heart sound easily heard 37. Given an instrument
 abnormal lie
c. List 4 complications of these obstetric conditions.
 only can delivered by cesarean section
 increased risk of miscarriage
 fetal hypoxia → IUGR
 PPH

36. Given 5 pictures of abnormal uterus (embryology).

a. What is this?
Single-ended sharp uterine curette
b. State 2 diagnostic & 2 therapeutic purposes of this
instrument.
 Diagnostic Therapeutic  Augmentation of labour in hypotonic uterine
 abnormal uterine bleeding  miscarriage & molar inertia
(DUB/ PMB) pregnancy (for  during CS, after delivery of the baby ( to deliver
 secondary PPH & post- removal of RPOC) placenta)
abortal bleeding  Removal of  Prevention & treatment of postpartum uterine
endometrial CA (fractional endometrial polyp & atony (PPH)
curettes) IUCD (lost tail)  early stages of pregnancy as a adjunctive therapy
for the management of incomplete, inevitable/
c. List 4 immediate complications of this instrument. missed miscarriage
i. Perforation of uterus & injury to intra-abdominal d. State 2 complications of this drug.
structures due to vigorous handling of the curette  N&V, cardiac arrhythmias
ii. Hemorrhage  uterine hyperstimulation, uterine rupture
iii. Infection  fetal distress
iv. Asherman’s syndrome: overzealous curettage to
the basal layer of endometrium lead to uterine 39. Please plot the partogram
adhesions causing amenorrhea & infertility Mrs. P, at 6am, 3/5 head palpable, cervix dilatation 4cm, 3
contractions of 18s
38. Given a bottle: At 10am, 2/5 head palpable, cervix dilatation 8cm, 4 contraction
of 32s
At 12pm, cervix fully dilated, 4 contraction of 42s, baby is
delivered as SVD at 12.15pm
What is your comment on this partogram? NORMAL

40. Depo-Provera
a. Name the drug.
Synthetic oxytocin 10units in 1ml
b. Give 3 modes of this drug.
 IV drip infusion (never inject by IV bolus in case of
IOL & augmentation)
 IV bolus in case of PPH
 IM for active management of 3rd stage
c. List 4 indications of using this drug. a. What is the medication containing?
 IOL for medical reasons Medroxyprogesterone acetate
 b. Side effects:
 Weight gain
 delayed in return of fertility
 persistent menstrual irregularity
 risk of osteoporosis in long term use
c. Administration: every 12-13weeks given by deep IM
injection

41. A woman complained of dysmenorrhea and ultrasound is

performed. It shows multiple dense areas. a. Give the presentation and position of this baby.
a. Define endometriosis. Cephalic presentation, Right occiput-posterior
Presence of endometrial tissue other than uterine cavity b. What are the likely outcomes during labour?
b. Give the reason why endometriosis can cause During 2nd stage,
dysmenorrhea.  70%: occiput rotates spontaneously 3/8 of
 menstrual blood which contains endometrial circle anteriorly → OA → NSVD
glands & stroma retrogrades & implant on  10%: fails to rotate anteriorly due to
extrauterine sites deflexed head, weak uterine contraction, early
 the ectopic endometrial tissue is functional, thus ruptured of membranes → Persistent OP
they bleed with each menstrual cycle (termed  10%: rotate & arrests at ischial spine →
ectopic menses) Deep transverse arrest
 also contains prostaglandins thus causing pain  10%: rotate 1/8 of circle posteriorly → Direct OP
c. Why ultrasound finding shows dense areas? c. What are the complications?
 Blood is echogenic material (homogenous)  head is not well applied to cervix
 early rupture of the membrane
42. Malposition = relationship between the denominator of fetal  prolonged 1st & 2nd stage of labour
presenting part & the quadrant of maternal pelvis makes  backache & bearing down efforts before full
spontaneous delivery unfavorable dilation of the cervix
d. What are you going to do with this?
 Manual rotation (whole hand method)
 DOP: spontaneous face-to-pubes delivery
 If not favorable/ there are signs of obstruction/
FHR is abnormal at any stage, deliver by CS
43. Partogram: Describe what happen to uterine contraction and  singe silastic rod
cervix before and after giving syntocinon.
 inserted subdermally under LA into upper arm
44. X-ray (Uterus: Hysterosalpingogram): A 31 years old woman
 lasts for 3 years
came to fertility clinic and have a radiological investigation
 useful in women who
o difficulty in remembering to take pill
o want a highly effective long-term contraception
o rapid return of fertility once it is removed

46. USS – ectopic pregnancy (pain → bleeding)

47. Miscarriage (bleeding → pain)

a. Name the radiological investigation: Hysterosalpingogram

b. List 3 further investigation
i. Assessment of ovulation: mid-luteal progesterone
level at 21 days
ii. Assessment of the hypothalmo-pituitary ovarian
axis
c. What are the investigations for her partner?
 Semen analysis
 Post-coital test a. Definition: pregnancy loss before 24 weeks of gestation
b. Types: Threaten, Inevitable, Incomplete, Complete, Septic,
45. Implanon
Missed, Recurrent
c. Clinical features: Short period of amenorrhea, BPV,
abdominal pain/ contraction pain
d. Fetal causes: chromosomal abnormalities, congenital
anomaly, H mole, hydrops fetalis
e. Maternal causes: endocrine disease (DM, PCOS), uterine
anomaly, Asherman’s syndrome, infections (TORCH),
 psychological disorders, Immunological disorders (APS),  eight/ more subcapsular multiple follicles, <8mm
hormonal insufficiency, cervical incompetence diameter
f. Complications of septic miscarriage: localized/ spreading  increased prominent echo-dense stroma up to 80% of
endometritis, salpingitis, pelvic/ generalized peritonitis, anovulatory women
pelvic abscess, tubo-ovarian abscess, septicemia, septic
shock, ARF, DIC 50. USS – how to measure serial growth scan?
a. BPD: identify the midline echo of falx cerebri which
48. Endometrial carcinoma – gross between the cavum and sinciput, the leading edge to
leading edge perpendicular to midline; thalamus and 3 rd
ventricles will be present also
b. AC: a transverse image that consists of left portal vein
and stomach
c. FL: central end point of each metaphysic
51. Anencephaly

a. Clinical features
 asymptomatic
 irregular vaginal bleeding
 PMB
 excessive leucorrhea
 anemia

49. PCOS (picture)

Maternal complications:
 polyhydramnios (discomfort of abdomen due to
distension that accompanies this condition)
 pregnancy loss/ stillbirth
 Induction of abortion
Focused history taking on RIF pain (active station)
Normal diameter of well flexed head
POP pills  9.5cm suboccipitobregmatic diameter
Mechanism of action
 Local peripheral effect Fibroid – diagram given at the station
 Altering cervical mucus, becomes thick and hostile to ascending Condition Symptom Complication
sperm (A) Subserosa Pressure symptom hydronephrosis
 Altering endometrium, becomes thin and atrophic, thus prevent (A) Pedunculated subserosa Torsion expulsion
implantation necrosis
Advantages (B) Intramural Dysmenorrhea affecting QoL
 Safe for woman with cardiovascular risk and breastfeeding (C) Submucous HMB anaemia
 Can be used by people with CI for COCP
Disadvantages Erb’s palsy – shoulder dystocia
 Irregular menses Explain
 Functional ovarian cyst  Macrosomic baby
 Breast tenderness  Right arm – extended at elbow, pronated, flexed at wrist (waiter
 acne hip position)
 Diagnosis: Erb’s palsy
Given figure 12.11 (10 teachers) – Label fetal skull  Affected nerves
 C5, C6
 Brachial Plexus
3 causes
 Excessive traction of fetal head during delivery
 Severe oligohydramnios / anhydramnios
 Large infant size
 Using extraction tools during delivery
 Prolonged second stage
Predisposing factor
 Shoulder dystocia
 Difficult breech deliveries
Malignant ovarian tumour Prostin
4 features and diagnosis
 Enlarged ovary
 Multiloculated appearance
 Thick septa
 Cystic area
 Presence of solid nodule inside the ovary
 🡪 Mucinous cystadenocarcinoma
A. Give the name, content and dosage of this drug
Risk factors B. What is the indication of this drug?
 Nulliparous
C. What’s the route of administration of this drug?
 Family history
D. Give 3 complications
 Cigarette smoking
 Obesity
Uterine inversion
 BRCA 1 &2 gene mutation
 Lynch syndrome
 IUCD usage
 Pervious endometriosis
5 features f ultrasound image
 Bilateral
 Multiloculate
 Presence of solid mass
 Ascites
 Presence of papillary projection
 Increased vascularity by colour doppler A. Describe the picture given
 Thich capsule B. Propose a diagnosis
 Thick septa C. Give 3 predisposing factors
 Liver metastasis D. Give 3 relevant investigations
CIN and colposcopy E. Give 2 diagnosis of picture C
F. What is the primary and secondary prevention of above condition?

CTG

A. Give comment, interpret, and justify the above CTG

B. Give your diagnosis and justify

Cervical tear

A. What is picture A?
B. What is picture B?
A. What is the above condition?
C. Describe picture C
B. Give complications of the condition
D. Describe picture D
C. What causes the above condition?
D. What is the puerperal complication of the above condition?

Sponge forceps
A. Name the device
B. Give the uses of this device
C. Give 5 procedures that uses this device

PCOS

A. What is the condition above?

B. Give ultrasound findings of above condition
C. What are the clinical features of above condition?

9. Vulsellum forceps A. What is the embryology of above conditions?

A. Name the instrument above B. Name above conditions:
B. Describe the part of above instrument
C. Function? Anti-Hypertensive Drugs
D. Advantages?
E. Complications?

10. Uterine anomalies

 There are 6 in total. 1, 2, 5 and 6 clamp the upper and lower sides of the
uterine angles laterally; whereas 3 and 4 clamps respectively the upper
and lower edge of the uterine incision anteriorly.
e) Name the alternative instrument of Green Armitage.
Sponge holding forceps

Speculum
a) Name the instruments.
A – Sim’s speculum
B – Cusco’s bivalve self-retaining vaginal speculum
b) Identify and label the parts of the instruments.
A – Sim’s (Blades, Handle, Groove)
B – Cusco’s (Blades, Handle, Screw)

Green Armytage Focused History of Puerperium

a) Name the instrument given. a) Introduce yourself.
Green Armytage Hemostatic Non-Traumatic Uterine Clamp b) Name, Age, Gravida, Parity
b) Name the surgical procedure that uses this instrument. c) Medical issues during pregnancy
Lower segment Cesarean section (LSCS) c) Delivery history
c) What is the function of this instrument?  When was your baby born?
To help with hemostasis of uterine sinuses by holding the uterine  Gender of baby
incisional edges and angles in LSCS with its blunt ends without  Baby birth weight
traumatizing the uterine tissues  Timing of delivery (GA)
d) How many numbers of forceps are there? State the locations  Fetal presentation
that they are placed during the procedure.  Mode & onset of delivery
  Fetal & maternal complications (if any)  Secure the speculum but make sure it does not tightly
Fetal Condition surround the cervix to allow space for swab to get sample
Cry, Active movement , Alert or not, Skin color, Suckling & breastfeeding from high vaginal wall
(How many times already breastfed) PUBO  Sampling but avoid area that contact with speculum
 Take sample rotate 3600 every step from left lateral fornix
Maternal Condition to posterior fornix to right lateral fornix
Previously medical issues, is it controlled now?
Use of any medications
If C-section, how’s the wound? (pain score, bleeding, discharge, wound Immediate Management of Massive PPH
dehiscence/breakdown, healing, infection) a) Outline the first 4 steps in the resuscitation of women with
If episiotomy, how’s the wound? (pain score, bleeding, discharge, wound PPH >800mL following delivery.
dehiscence/breakdown, healing, infection)  Trigger the red alert
Does it affect PUBO?  ABC structured approach
Any offensive lochia (change in smell and color)?  Perform uterine massage, check placenta & evacuate
Any reduction in PV bleeding? blood clots
How many pads used? STRICT PAD CHART  Administer stat dose 10 units IM Syntometrine followed
General well-being such as vital signs, fever, chills, rigor, sleep, diet, mood, by 40 units Oxytocin in 500mL normal saline infusion over
PUBO 6 hours (uterotonics)
Use of contraception b) Identify the drugs and devices used in management of PPH
with justification.
High Vaginal Swab  2 large bore cannulas to set up lines for IV access for
 Introduce yourself blood taking and fluid resuscitation with crystalloid or
 Informed consent colloid
 Request for chaperon, lighting and privacy  Foley’s catheter or indwelling catheter to
 Ask patient to void first empty/evacuate the bladder as full bladder prevents
 Prepare equipment (sterile gloves, sterile KY gel, effective uterine contraction
speculum, partially open swab)  500mL normal saline to dilute 40 units of Oxytocin to be
 Position patient to dorsal-recumbent used as infusion over 6 hours to contract the uterus and
 Sufficient exposure control the bleeding
 Wash hands & wear sterile gloves Oxytocin , carboprost, syntmetrine are uterotonics to reduce bleeding
 Put on sterile lubricant gel on speculum Tranexamic acid is anti fibrinolytics to reduce bleeding
 Insert lubricated speculum Bakri balloon provide tampnade effect to the uterine cavity to reduce
bleeding
CBD There is bluish discoloration of membrane at the introitus. The
2 large bore cannulas membrane is bulging at the opening with the vulva distended. There is
also presence of hematocolpus at the introitus.
c) List 4 investigations can be done. b) What is the most likely diagnosis of this condition?
 FBC to check for presence of anemia Imperforate hymen
 GSH at least 2 units of blood are cross-matched and kept c) What are the 2 possible features of this condition?
in case of the need for blood transfusion Severe cyclical pelvic/abdominal pain (dysmenorrhea)
 Baseline coagulation profile to rule out coagulation Primary amenorrhea
defect d) State 3 complications of this condition.
 Ultrasound scan to rule out retained POC Urinary retention
Infertility
HPV Vaccination Primary amenorrhea
a) State the pharmacological name of these vaccines. e) State 1 management of this condition.
Gardasil – Quadrivalent Hymenectomy with surgical incision and drainage of the hymen to release
Cervarix – Bivalent the bleeding
b) State the contents of each vaccine.
Gardasil – 0.5cc IM injection HPV 6, 11, 16, 18 (20ug, 40ug, 40ug, 20ug) Trichomoniasis Vaginal Infection (STI)
Cervarix – 0.5cc IM injection HPV 16, 18 (40ug, 20ug) a) Describe the picture given.
c) What are the benefits of HPV vaccination? There are multiple red spots covering the cervix giving it strawberry-like
They are vaccines that contain live attenuated viruses of HPV, which appearance known as strawberry cervix. These red spots occur in the
stimulate host immune system to produce antibodies against them. With presence of punctuate hemorrhage. The cervix looks edematous.
the antibodies secreted, hosts are protected against HPV infection and b) What is the most likely diagnosis and causal organism of this
therefore reduces the risk of cervical cancer. condition.
d) Dosing Regimen Trichomoniasis infection caused by Trichomonas vaginalis
Gardasil 3 IM injections at 0, 2, 6 months from the first dose c) State 6 associated conditions with this disease.
Cervarix 3 IM injections at 0, 1, 6 months from the first dose  Pruritus vulva
e) In Malaysia, by what age (years) that the females are  Vulva erythema and sore
recommended to complete the HPV Vaccination Program?  Foul smelling vaginal discharge (yellowish green in
13 years old nature)
 Dysuria
 Abdominal discomfort
Imperforate Hymen d) Plan of treatment for this disease.
a) Describe the picture given. Give antibiotics (Metronidazole and Tinidazole)
Screen for the partner and treat along if infected, avoid sexual Women at 60 y/o experienced bleeding per vagina. Please take focused
intercourse until fully recovered. history.

ECV role play 7. Bleeding early in pregnancy

Please give this pregnant women at 36 weeks of pregnancy with breech Diagnosis Treatment
presentation regarding ECV with emphasis on the risk and complication. Picture Threatened
miscarriage
Kiwi cup given (real one) Incomplete miscarriage
(a) List Part A to F. (3m) Complete miscarriage
(b) Give the indication of the instrument above. (3m) GTD
(c) Give the contraindication of the instrument used (4m) Ectopic pregancy

Picture of endometriosis given

(a) What is the condition shown? (1m) 8. Contraception (copper IUD, Implanon and condom given)
(b) What are the symptoms (3m) (a) Identify Copper IUD (1m)
(c) Investigation to be done. (2m) (b) State one indication (1m)
(c) Outline the treatment (4m) (c) Identify Implanon (1m)
(d) State 3 indication (3m)
Pipelle given (real one) (e)Identify condom (1m)
(a) Name the instrument above. (1m) (f)State 3 uses (3m)
(b) List the condition requiring the procedure above. (4m)
(c) What is the advantage of the procedure above? (3m) 9. Partogram (normal progress)
(d) Complication (2m) (a) Interpret the partogram given (8m)
(b) State the diagnosis and justify. (2m)
Episiotomy (LA lidocaine 2%, episiotomies scissors and forceps are
labelled) 10. Picture of TAUSS and TVUSS given
(a) Identify the use of LA. (1m) (a) Name TAUSS. (1m)
(b) State its use other than epidurals (2m) (b) Disadvantage (2m)
(c) Explain how to use episiotomies scissors (3m) (c) State TVUSS. (1m)
(d) Name the instrument: forceps. (1m) (d) Uses of TVUSS (6m)
(e) State 3 use of forceps in O and G. (3m)
Mechanism of Labour- with patung
Focused history taking
Ultrasound Bakri Balloon
a. 4 fetal biometry (with pic so just label) a. Name
b. When can start scanning b. Mechanism
c. 3 clinical use for this ultrasound c. What clinical condition will use this
d. 2 other assessment d. What liquid inserted inside and what is the maximum
amount
Partogram e. 3 contraindication
a. Interpret and justification (normal, secondary arrest and
primary dysfunctional labour) Colposcopy
b. Mode of delivery in secondary arrest
c. Management of primary dysfunctional labour
1.

a. Name the lesion and describe

b. 3 step for colposcopy
c. Physiology of lesion form
2. CTG (something like this with uterine contraction) d. 2 further investigation
a. Interpret
b. Diagnosis 3. Genital Warts
c. Cause of condition

COCP
a. Name
b. 3 mechanism of action
c. 2 uses
d. 3 absolute contraindication
e. Failure rate
 a. Name b. State 3 clinical assessment before using this medication.
b. Describe the lesion (3)
c. Organism causing this and the subtypes c. State the route of administration. (1)
d. Investigation for diagnosis d. State 3 complications. (3)
e. Management
4. Vulsellum Growth chart
a. Parts of the instrument (4 charts using AC, HC, FL and EFW as parameters, AC and EFW are below
b. 2 advantages 5th centile)
c. 3 indication e. Name the chart. (1)
d. 3 maternal complication for this instrument f. Describe the chart. (3)
Single lady come with lower abdominal pain. Gyanecology history g. Interpret the chart. (4)
taking. h. State the diagnosis from chart. (1)
Focused history taking for a woman day 1 after delivery. (10) i. Which parameter is most accurate for estimating fetal
Bimanual digital vaginal examination. (10) weight? (1)

G1P0 lady admitted for IOL at 41 + 3 gestation Partogram (with only cervicogram plotted)
Cervical os = 1cm j. Describe the partogram and comment on the progress of
Cervical length = 2cm labour. (5)
Consistency = firm k. Describe the uterine contractions and comment. (5)
Position = Posterior
Station = -2 Fetal skull (coronal suture, anterior fontanelle, posterior fontanelle &
a. Calculate the Bishop score. (6) lambdoidal suture marked on the doll)
b. Comment with reasons. (2) l. Name the parts marked. (2)
c. State the method of choice with justification. (2) m. State the normal presentation and position of a vaginal
delivery. (2)
n. Describe the presentation in (b). (2)
o. Describe brow presentation. (2)
p. Describe face presentation. (2)

2.
Give the name and content of the medication. (2)
a. State one indication of this medication. (1)
 DepoPervera

3. Hydatidiform mole
a. State the diagnosis. (1)
b. State two types of the disease. (2)
a) 4 benefits
c. Give 3 investigations for this disease. (3)
•Highly effective method of contraception
d. Give 3 complications of this disease. (3)
•Improve PMS.
e. State the surgical treatment for this. (1)
•Can treat menstrual problems such as Dysmenorrhea or heavy periods.
4.
5. •More convenient for women can miss pills.
•Can be used with breastfeeding.
b) 4 side effects of Depo-Provera:
• weight gain of around 3 kg in the first year.
• Almost 6 months delay in return of fertility.
• Persistent menstrual irregularity.
• Very long-term use may slightly increase the risk of oesteopenia
osteoporosis (because of low oestrogen levels).
c) Route of administration
6. Instrument – sponge-holding forceps IM
a. Name the instrument. (1)
b. State the parts of the instrument. (3) Land mark on fetal scalp.
c. State advantages of this instrument. (3) a. Name the label site.
d. Give 5 uses of this instrument. (3) anterior fontanalle, lamboid suture, occiput and coronal suture
b. What is the safest mode of presentation and position.(2m)
Vertex presentation
Occipito anterior
c. Please describe it. (2m)
Suboccipito-bregmatic diameter, 9.5cm
 d. Describe face presentation. (2m) a. What is the diagnosis.
Submento-bregmatic diameter, 9.5cm Fetal tachycardia
e. Describe brow-presentation. (2m) b. Interpret the result
Occipito-mental diameter, 13.5cm c. State 3 causes
ARM
Injection form Syntocinon, 10IU in 1ml a. State 4 complications.
a. Describe the medication shown.(1m) i. Cord prolapsed
b. What are the three routes. (3m) ii. Cord compression lead to fetal distress
i. Intravenous drip infusioln iii. Rupture of vasa praevia
ii. Intramuscular injection iv. Infection – chorioamnionitis
iii. IV v. Fetal scalp injury
c. Give 4 uses of this drug.(4m) vi. Placenta abruption
i. Induction of labour vii. Amniotic fluid embolism
ii. Augmentation d. State 6 contraindication.
iii. Control of post partum hemorrhage
iv. 3rd third active management. Ruptured ectopic pregnancy.
d. Give 4 side effects. (2m)
i. Uterine hyperstimulation
ii. Uterine rupture
iii. Hyponatremia
iv. Fetal distress

1. CTG (question similar to this picture)

a. What is the diagnosis.

Ruptured ectopic pregnancy
b. State 4 symptoms.
i. Short period of amenorrhea
ii. Abdominal pain – aching pain of iliac fossa, sharp
stabbing pain, shoulder tips pain
iii. Bleeding per vagina – fresh in acute, brownish
iv. Fainting attack.
c. State 4 signs.
 i. pale, cold and clammy extremities iii. Asherman’s syndrome, amenorrhea, infertility
ii. vRapid pulse rate/Low blood pressure iv. Bleeding
iii. vAbdominal distension v. Infection
iv. vTenderness ± Rebound tenderness
v. vFree fluid on percussion Torsion ovarian cyst
vi. vSlightly enlarged uterus
vii. vCervical excitation
viii. vTender adnexal mass
ix. vFullness in pouch of Douglas
x. vArterial pulsation in the fornix of affected side
d. What is the surgical management. (1m)
i. Laparoscopic salpingectomy a. Describe the finding in picture. (3 marks)
ii. Laparoscopic salpingotomy b. State 2 predisposing factor
c. State 2 symptoms and 2 signs.
Instrument. Curette CTG
a. Name a. What is the diagnosis. Fetal tachycardia
Uterine curette b. Interpret the result
b. Give three diagnostic and three therapeutic functions of this c. What are the causes
instrument.
Diagnostic Amniotomy hook.
i. Abnormal uterine bleeding a. What is the instrument.
ii. Secondary PPH and post abortal bleeding b. What are the steps.
iii. Amenorrhea – PCOS, TB endometrium i. Assess the stage of labour, only perform ARM in
iv. Infertility – for hormonal function of ovary active phase of first stage
v. Endometrium carcinoma – fractional curettage ii. Sterile procedure with consent and chaperone
Therapeutic iii. Insert right fingers into vagina
i. Miscarriage and molar pregnancy – to remove iv. Palpate for membrane, and presenting part, exclude
RPOC cord, shoulde presentation
ii. Removal of endometrial polyp and IUCD(lost tail) v. Insert amniotomy hook between index and middle
iii. Secondary PPH fingers of right hands
c. Give four immediate complications of this instrument. vi. Penetrate membrane
i. Perforation of uterus vii. Expand hole with fingers
ii. Injury to nearby structure c. What you going to assess after the instrument had use. (3m)
 i. Liquor colour, amount a. Give three diagnostic and three therapeutic functions of this
ii. Cervix dilatation instrument.
iii. Fetal presenting parts Diagnostic
d. What are the complications. i. Abnormal uterine bleeding
i. Cord prolapsed ii. Secondary PPH and post abortal bleeding
ii. Cord compression lead to fetal distress iii. Amenorrhea – PCOS, TB endometrium
iii. Rupture of vasa praevia iv. Infertility – for hormonal function of ovary
iv. Infection – chorioamnionitis v. Endometrium carcinoma – fractional curettage
v. Fetal scalp injury Therapeutic
vi. Placenta abruption i. Miscarriage and molar pregnancy – to remove
RPOC
Ectopic pregnancy. Given a picture with tubal ectopic pregnancy. ii. Removal of endometrial polyp and IUCD(lost tail)
a. What is the diagnosis. iii. Secondary PPH
b. What are the symptoms. b. Give four immediate complications of this instrument.
i. Amenorrhea i. Perforation of uterus
ii. Abdominal pain – aching pain of iliac fossa, sharp ii. Injury to nearby structure
stabbing pain, shoulder tips pain iii. Asherman’s syndrome, amenorrhea, infertility
iii. Bleeding per vagina – fresh in acute, brownish iv. Bleeding
iv. Acute retention of urine due to large hematocele v. Infection
c. What are the signs.
i. Pale 2. Torsion ovarian cyst with laparoscopic view.
ii. Rapid pulse a. What is the diagnosis.
iii. Slight pyrexia b. What is the signs you will found.
iv. Distention i. Mass in iliac fossa
v. Tender ii. Cystic in consistency
vi. Guarding iii. Well defined margin and lower border palpable
vii. Cullen sign, grey turner sign iv. Freely mobile
viii. Cervical excitation pain v. Scoop sign positive
d. What is the surgical management. (1m) vi. Cleft sign positive
i. Laparoscopic salpingectomy vii. Presence of adnexa mass in VE
ii. Laparoscopic salpingotomy c. What is the management.
i. Complete oophorectomy
1. Instrument. Curette ii. Cystectomy
 In which trimesters to start to measure these parameters? [2]
Describe how to measure A? [2]
Femur length - How to measure femur length, uses In what obstetrics condition we need to measure? [3]

Op position- Name the position, complication of this position Contraception

MOA of COCP, Progesterone Implant, Depo-Provera, Copper IUCD, Male
Placenta praevia Condom [ 2m each]
a) Name the type of pp
b) Complication in labour

Ultrasound (multiple pregnancy)

Bartholin cyst
Cervical polyp
Symphysio-Fundal Height Chart
Interpret the chart [3]
In what condition we need to refer? [4]
Based on the result, plot [3]
24 weeks – SFH 28cm, 28 weeks – SFH 32cm, 32 Weeks – SFH 34cm Name the instrument. [1]
Ventouse vacuum extractor cups
H. Mole follow up after 1 week of D & C, take focus history taking. [10] Name the parts. [3]
Demonstrate Active management of 3rd stage and Control Cord Traction A: Hand pump
[10] B: Pressure indicator
C: KIWI cup
Pre-requisite. [3]
1. Confirm rupture of membrane and full dilatation of cervix.
2. Vertex presentation with confirmation of postion (OA, OT fetal head
must not be palpable intraabdominally; OP – 1/5 palpable; presenting
part - +1 station)
3. Adequate analgesia or anaesthesia; Bladder must be empty.
Indications. [3]
1. Prolonged delivery at second stage
2. Fetal compromise at second stage
3. Fetal head malpostion
State the important of measuring these 2 parameters? [3]
 iv) CBD catheterization (simple/ Foley)
v) Oxytocin/ Prostin

Double ended Uterine curette

i) 2 gynae condition
- Infertility
- Amenorrhea
- Endometrial carcinoma
- Abnormal uterine bleeding
- Miscarriage
ii) 3 treatment usage
Name the instrument. [1] 1. For removal for RPOC in miscarriage
Indications. [2] 2. For removal of endometrial polyp
Principal. [4] 3. For removal of lost tail of IUCD
Way to use. [3] 4. For removal of retained tissues or placenta tissues in secondary
PPH
iii) 4 complications
1. Bleeding
2. Infection
3. Asherman’s syndrome
4. Perforation of uterine walls
5. Injury to intra-abdominal structures

Name the lesion and the principal of colposcopy. [2] Given eclampsia situation.
What are the steps need to carry out in colposcopy? [3] i) Choose anti-hypertensive drug with mechanism of action
Why the lesion shows white in colour? [3] and route of administration.
What we need to proceed after this? [2]
CTG
PPH management with lecturer. Choose the choice of instruments given. i) Purpose
i) Cannula (pink/ green/ gray) ii) 4 normal features,
ii) How to transfuse blood/ fluid (blood transfusion set/ iii) 4 fetal distress features
usual IV drip) iv) Another 2 method to monitor fetal distress.
iii) IV fluid (NS/Dextrose)
Demonstrate high vaginal swab and endocervical swab.

1.

Progestogen Only Pills

Lichen sclerosis pic from ten teacher
i) Mechanism of action i) Clinical features
1. Thickening of cervical mucus. ii) Diagnosis
2. Thinning of endometrium to prevent implantation. iii) Differential diagnoses
iv) Investigation
ii) Advantages v) Treatment
1. Can be used in breast-feeding mothers.
2. No increased risk of ischemic heart disease and DVT Episiotomy with Dr May Zaw (interaction station) – name the instruments
3. Can be used in patients with contraindication to oestrogen (episiotomy scissors, lignocaine), the dosage of lignocaine, demonstrate
4. Immediate return of ovulation upon cessation. how to use the episiotomy scissors, name the toothed forceps, functions
iii) Disadvantages of toothed forceps
1. User dependant
2. No protection against STDs Partogram (interpret a partograph) State the risk factors for this lady
3. May have irregular bleeding according to her particulars (she is 36 years old, gravida 2, parity 1+0, 25
4. May have breast tenderness and mood swings hours since membrane rupture, baby is EDD+11 days), state the
abnormalities in first stage (prolonged latent phase), state abnormalities
in second stage (prolonged second stage), state intervention that should
be done in first stage (augmentation), state method of delivery and justify.

Magnesium sulphate vile. Identify the drug given, state 2 uses, give the
normal dosage and route of administration, give two side effects, give one
treatment for its side effect.
 Magnesium sulphate. To treat eclamptic seizures and for Describe the principle of its usage.
neuroprotection. Normal dosage: loading dose of 4g by infusion pump The principle of amnicator test is that:
over 5 – 10 minutes, then further infusion of 1g/hour maintain for 24 • Normal vaginal ph at term is 4.5 to 6.0
hours. Loss of deep tendon reflexes, respiratory depression, oliguria, • Amniotic fluid is usually 7.0 to 7.5
cardiac arrest. Calcium gluconate 1g over 10 minutes • By mean of simple ph change make nitrazine to turn yellow to
blue colour
Green armytage hemostatic non-traumatizing tissue forceps. Name the • It can easily detect amniotic fluid in vagina
instrument. State its function. State how it functions. State how many of Outline the steps of the procedure.
these instruments should be used in a c-section and the location of its • Insert the sterile speculum
placement. • Amnicator is introduced into the vagina,
• Fluid in the posterior fornix is sampled
Demonstrate bimanual examination. 20-week size uterus. • Withdraw the amnicator and examined for the colour change.

Fitz-Hugh-Curtis syndrome. Describe the laparoscopic picture (according

to lecture notes – the violin-string like appearance of adhesions blah blah)
State your diagnosis and the cause. State 3 other symptoms that may
accompany and explain why.

Pipelle biopsy sampling equipment. State the name and its function.
State its indication. List down the steps to use this instrument. State the
place you would like to do the procedure and justify.

Name and describe the chart given.

Name this given appliance.  Symphysio- Fundal height chart.
 Amnicator  SFH measurement (in cm) is plot on vertical axis against the
State the indication for this appliance. gestation (in week) on horizontal axis.
 To confirm the leakage of liquor in suspected case of PROM or  There are three lineal graphic lines which showed the percentile
PPROM. (95th /50th and 5th centile)
State the conditions which need to refer as soon as the graph sketch. Bleeding per vagina.
1. Below the 5th centile
2. Below the 50th centile
3. Crossing the centiles
4. Greater than 95th centile
Use the data given and plot on the chart.
• At 24 weeks (Date- XX/XX/XXXX) = SFH 24 cm
• At 28 weeks-(Date- XX/XX/XXXX) = SFH 30 cm
• At 32 weeks-(Date- XX/XX/XXXX) = SFH 34 cm

A 28 year-old woman is in her third stage of labour. Making use of Describe the ultrasound pictures.
mannequin demonstrate controlled cord traction for placenta delivery.  Fetal skull measurements
(Interactive)  Picture (A) measurement of BPD
When will you deliver the placenta?  Picture (B) measurement of HC
 Once placenta separation is identified. State the trimesters for these measurements to be taken.
How would you identify that placenta separation has occurred?  Second trimester
1. Rising of the fundus  Third trimester
2. Uterus becomes firm and globular and mobile from side to side State the correct method of measurement shown in picture (A).
3. Lengthening of the umbilical cord  BPD measures from upper surface of proximal skull bone to the
4. Gush of blood upper surface of distal, perpendicular to the midline.
Perform the steps of the procedure. List three indications for these measurements.
1. Clamp the cord close to the perineum and hold the clamp with  To assess gestational age
other hand.  To monitor fetal growth
2. Place one hand over the lower abdomen just above the
 To detect fetal congenital anomalies
symphysis pubis.
3. Wait for uterine contraction to start controlled cord traction
4. Gently exert traction of the cord to pull down and deliver the
placenta while abdominal hand applying counter-pressure to the uterus.
5. Delivery of the membranes by twisted motion.
What else would you like to do after delivery of the placenta?
1. Check placenta and membranes
2. Uterine tone
3. Any laceration or tears
Describe the findings in CTG.
 Base line heart rate – 150 beats/minute Male condoms
 Base line variability – 10 beats/minute  Acts as a barrier, so preventing fertilisation by
 Acceleration are present in 20 minutes preventing sperm deposition in the vagina
 No deceleration
 No Uterine contraction A 20-year-old primigravida at 36 weeks of gestation was admitted to
Interpret your findings. labour ward with severe headache, projectile vomiting, visual
 Base line heart rate – normal because it is within range of 110- disturbances and epigastric pain. On admission, her blood pressure was
150 beats/min 180/120 mmHg.
 Base line variability – normal because it is within range of 10-25 Study the given drugs and answer the following questions.
beats/min Choose the drugs suitable for this patient and give reasons.
 Acceleration – (+) 2 in 10 minutes indicates good fetal condition. 1. Labetalol (0.5 mark)
 Absence of deceleration indicates no fetal distress. Rapid onset action to lower blood pressure (1 mark)
Comment on the whole CTG. 2. Nifedipine (0.5 mark)
 Normal CTG Rapid onset action to lower blood pressure (1 mark)
3. Magnesium sulphate (0.5 mark)
Combined oral contraceptive pill To prevent eclamptic fits (1 mark)
 Inhibition of ovulation Describe briefly how you would administer and their mechanism of
 Thinning of the endometrium action in this patient.
 Thicken cervical mucus

Injection Depot medroxyprogesterone acetate

 Local action on cervical mucus (hostile to ascending sperm), on
endometrium ( Making thin and atrophic)

Subdermal implant
 Inhibition of ovulation
 Thinning of endometrium.

Copper-bearing intrauterine devices

 Toxic effect on both sperm and egg
 Hostile environment in the endometrium Study the given CTG report and answer the following questions
 Patient (A) Label the lie of the fetus and justify.
Answer – Oblique lie
Fetal head in one iliac fossa and absence of presenting part
at the pelvic brim.

Patient (B) Label the lie of the fetus and justify.

Answer –Longitudinal lie
Fetal head at the pelvic brim.
State purpose of this investigation. Fetal spine is parallel to the maternal spine.
 Fetal monitoring.
State four features that are normal.
• Base line fetal heart rate:110-150bpm
• Baseline variability>10 beats/min
• Presence of 2 or more acceleration in 20-30 min CTG
• No decelaration Patient (C) Label the lie of the fetus and justify.
Name four features that you expect if a fetus is distressed. Answer –Transverse lie
• Decelarations Absence of presenting part in the pelvic brim.
• Bradycardia Fetal spine cross the maternal spine.
• tachycardia
• Loss of variability
State two other measures to identify fetal distress.
• Thick meconium stained liquor colour
• Intermittent auscultation of fetal heart sound
• Fetal blood sampling List two abnormal lie shown in the above pictures.
1. Oblique Lie
The abdominal examination findings of three pregnant women are 2. Transverse Lie
shown in the pictures. Study the pictures and answer the following
questions.
Progestrogen only pills Patient: ln August only one day menstrual flow.
What is the mechanism of action? Candidate: Ask for intermenstrual bleeding and dysmenorrhoea.
 Thickens cervical mucus and prevent ascent of sperm Patient: No IMB and dysmenorrhoea
 Thinning of endometrium and prevent implantation Associated symptoms
List three advantages of using this medication. Candidate: Any other problem apart from your period?
 Do not interfere with breast milk production. Acne
 Can use in women with contraindication to combined oral Hirsutism
contraceptive pills Alopecia
 Can return to fertility without delay Weight gain
List three disadvantages of using this medication. Acanthosis nigrans
 Erratic or absent menstrual bleeding Psychological symptoms- mood swings, depression, anxiety, poor self-
 Functional ovarian cysts esteem
 Breast tenderness Sleep apnoea
 Acne
 Failure rate is greater than COC and if fail there is slightly A 63- year-old menopausal lady presented with a 6-month history of
increased risk of ectopic pregnancy. itchiness in vulval area. A photograph of her vulva is shown. (Dr Raihana)
picture from ten teacher -136
A 22-year-old single obese lady came to gynaecological clinic for
oligomenorrhea for one year. Please take focused history.
Introduce yourself with the patient, ask patient’s particulars ( name, age,
parity, marital status)
Complaint
Candidate: What problem brings you here?
Patient: I experienced less menstrual periods for one year.
Candidate: How is your period?
Patient: Not every month like other woman, my periods always late
around 8 weeks.
Candidate: How was the menstrual flow?
Patient: Just half pad sock for one day. Describe the appearance of vulva.
Detail on menstrual history • White parchment paper appearance
Candidate: When did you start menarche? • Papery thin atropic areas interspersed with reddened thick areas.
Patient: 16 years old
Candidate: When was your last menstrual flow (LMP)? State the likely diagnosis.
Lichen sclerosis High vaginal swab : Circle around the high vaginal wall once ( Lateral
State two associated conditions. fornix to posterior fornix to other lateral fornix) (2 marks)
• Thyroid disease Endo-cervical swab: Place in endo-cervical canal and do 3600 sweep (2
• Pernicious anaemia marks)
List two differential diagnoses. Put into the container and tighten the cap (0.25 mark)
 Vulva atrophy Close and withdraw the speculum (0.25 mark)
 Vulva intraepithelial neoplasia Send the sample (0.25 mark)
State the diagnostic investigation. Document in patient’s note (0.25 mark)
 Skin biopsy and histological examination
State the treatment for the condition. Study the ultrasound probes given and answer the following questions.
• Good skin care
• Steroid ointment, e.g. Dermovate

Demonstrate the procedure of taking high vaginal and endocervical

swabs on gynaecological mannequin.
Introduction
Introduce
Ask patients’ name
Explain the procedure Name the type of the probes. (1 MARK EACH)
Preparation A. Transvaginal ultrasound transducer probes
Why it’s necessary and get consent B. Transabdominal ultrasound transducer probes
Presence of chaperone List six advantages of using probe A.
Privacy should be ensured 1. reduced target distance and better image resolution
Put the patient in dorsal position 2. Does not require full bladder
Good Lighting 3. Earlier diagnosis of fetal viability and ectopic pregnancy
Check the instruments ( KY gel, Swabs in containers, speculum, sterile 4. Useful in early pregnancy in obese women
glove) 5. Accurately identify the lower edge of the placenta and posterior
Procedure placenta previa
Wash hands and apply gloves (0.25 mark) 6. Useful for examining cervix later in pregnancy
Lubricate speculum (0.25 mark) List two disadvantages of using probe B.
Insert the speculum (0.25 mark) 1. Require full bladder
Check the cervix and vagina wall (0.25 mark) 2. 1 week later than probe A for diagnosis of early pregnancy and its
complications
 A partogram is shown of a woman in her first labour
State the risk factors that you can identify from the mother’s particulars.
• Increased maternal age
• Post date
• Prolonged rupture of membrane
State the abnormality illustrated in the 1st stage of labour. Examiner: Name the instrument.
• Prolonged first stage Answer: Episiotomy scissors
• Inadequate uterine contraction. Examiner: Demonstrate the method of inserting this instrument.
State the intervention that has been applied at B. Answer: Place two fingers between fetal head and posterior vaginal wall
 Oxytocin infusion. Place blunt end of epsiotomy scissor between the fingers and posterior
State the abnormality illustrated in the 2nd stage of labour. vaginal wall
 prolonged 2nd stage Examiner: When will you cut the perineum?
Mention the mode of delivery and give two reasons. Answer: At Crowning (during the course of a contraction when the fetal
Instrumental delivery head is distending the perineum)
• Cevix fully dilated
• Per abdominally 0/5 th palpable
• Second stage 2 hours already
• Contraction adequate

Interrogate with the examiner regarding episiotomy procedure.

Examiner: Name the medication.
Answer: Injection Lignocaine Examiner: Name the instrument.
Examiner: State the correct dosage. Answer: Toothed forceps
Answer: 10 ml of 0.5% lignocaine solution. Examiner: How do you use this instrument?
Answer: To hold vaginal mucosa, perianal muscle and skin.
 Describe the laparoscopic picture.
 Typical "Violin-string" appearance.
 Adhesions between the liver and peritoneal surface.
State the diagnosis and underlying cause.
 Fitz-Hugh-Curtis syndrome (FHCS) refers to development of a
perihepatitis in association with pelvic inflammatory disease (PID).
State three possible symptoms for this condition and give the reason.
 Chronic pelvic pain due to PID
 Right Hypochondrium pain due to perihepatitis
Increased/unusual vaginal discharge, dyspareunia, dysuria and
intermenstrual bleeding due to chlamydial cervicitis.

Demonstrate bimanual examination on gynae mannequin.
Introd
uction
Introd
uce
yourse
lf
Explain
the
proced
ure
Prepar
ation
Why it’s necessary and get consent
Presence
of
chaperone
Privacy
should be
ensured
Put the patient in
dorsal position
Good Lighting
Wash hands and apply
gloves Procedure and
correct interpretation.
• Palpate the cervix with vaginal fingers
State size, position, os , surface, mobility , tenderness, other abnormality
• Examine the
uterus bimanually Size
(18 weeks pregnant
uterus size
firm consistency, smooth surface, no tenderness)
• Adnexa and POD – any mass, tenderness
• Move upwards the mass abdominally from SPA
and check whether the cervix is moving along with the
mass.