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OBSTETRICS OSCE REVIEWER

OBSTETRICS OSCE REVIEWER. egpt2010. Internal Examination. Dilatation Effacement. Clinical Pelvimetry. Adequate Pelvis. Pelvic Inlet. Midpelvis. Pelvic Outlet. Partograph. Arrested by sedation and conduction analgesia. Cardinal movements of labor. Dystocia. Electronic Fetal Monitoring.

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OBSTETRICS OSCE REVIEWER

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  1. OBSTETRICS OSCE REVIEWER egpt2010

  2. Internal Examination Dilatation Effacement

  3. Clinical Pelvimetry

  4. Adequate Pelvis

  5. Pelvic Inlet

  6. Midpelvis Pelvic Outlet

  7. Partograph

  8. Arrested by sedation and conduction analgesia Cardinal movements of labor

  9. Dystocia

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

  14. Montevideo Units 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.

  15. Cardinal Movements of Labor

  16. Cardinal Movements of Labor • 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

  17. Cardinal Movements of Labor • Internalrotation • 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

  18. Cardinal Movements of Labor • External rotation • delivered head undergoes restitution • if the occiput was originally directed toward the left, it rotates toward the left ischialtuberosity; 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

  19. Asynclitism

  20. Asynclitism

  21. Active Management of the Third Stage of Labor

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

  23. Instrument Identification

  24. Rampley dressing forceps Foerster sponge holding forceps

  25. Pederson vaginal speculum Grave vaginal speculum

  26. Halsted Mosquito Micro ForcepsStraight / Curved Kelly ForcepsStraight / Curved Crile ForcepsStraight / Curved

  27. Simpson Obstetrical Forceps Kielland Obstetrical Forceps Piper Obstetrical Forceps

  28. Backhaus towel forceps Pestalozza Obstetrical Curette

  29. Pudendal Nerve Block

  30. Pudendal Nerve • 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 obturatorinternus muscle within the pudendal canal (Alcock canal), which is formed by splitting of the obturator fascia

  31. Pudendal Nerve • 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

  32. Knot Tying Two-hand One-hand Instrument

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