VBAC -ANS module part2

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A 27 yr old asian woman in her first pregnancy is known to have thalassemia major .she is
28wks pregnant.she comes to ER with SOB that has rapidly detriorated .despite resuscitation
she died within 20 mints.what is most common cause of death


A 39-year-old woman in her first pregnancy is being induced for symphysis
pubis dysfunction at 38 weeks. During the first stage of labour she was noted to
have uterine hyperstimulation, which was corrected by reducing the oxytocin

infusion. She was delivered later by lower-segment caesarean section for a suboptimal
cardiotocogram (CTG). Two hours post delivery she complained of
shortness of breath. On examination she was noted to be cyanotic and her pulse
was 100 beats/minute. A chest X-ray was performed that demonstrated a bilateral
ground-glass appearance with an impaired coagulation profile.

3) . Incidence of major obstetric haemorrhage in UK

A 40-year-old woman gave birth to her fifth child 15 minutes ago. She suddenly complains of
shortness of breath, and in the next few minutes after delivery she collapses. The blood
pressure is 70/30 mmHg, oxygen saturation is 88% on air and pulse is 75 bpm. Her arms have
started to twitch, and there is heavy bleeding vaginally

4) What is the likely cause of the collapse?A Amniotic fluid embolism


A 42-year-old woman is 39 weeks gestation in her second pregnancy having had a prior
emergency caesarean section for fetal distress three years earlier. She is keen to give birth
vaginally but is requesting induction of labour because of concerns regarding the increased risk
of perinatal mortality associated with her age. What is the most appropriate method of induction
to minimise the risk of uterine rupture in labour?

6) What is the most common cause of maternal collapse?


Ms XY is 38/40 weeks pregnant with one previous CS. She presents in spontaneous labour and
has an agreed plan for a VBAC. She now complains of pain in the site of the CS scar. Which of
the following is most consistently associated with a uterine rupture?


A pregnant woman walks into the A&E department and collapses; the collapse is witnessed by
the receptionist. The patient is unresponsive and has no breathing or pulse. CPR is commenced
immediately, and an emergency call goes out. The obstetric registrar arrives 3 minutes and CPR
is commenced. Medical and anaesthetic teams are already performing the necessary advanced
adult life support, including lateral uterine displacement. There is pulseless electrical activity,
and adrenaline has been given. There are no notes or relatives with the woman, but there is a
letter with an antenatal clinic appointment. This confirms she is 25 years old and pregnant. Her
uterine fundus is above the maternal umbilicus. There is an ultrasound machine in the A&E. The
team asks the obstetric registrar what additional measures should occur. What important course
of action should be taken in addition? Options


A 27 yrs old, second gravida at 35 weeks is brought to you in a collapsed state. Bp 60/50, pulse
110, breathless. What to do next?


A 28 year old G2P1 who had an emergency C.S in her last pregnancy in considering a VBAC .
While counselling about the risk and benefits ,you must explain about the risk of uterine rapture.
By what proportion does this risk increase


A 30-year-old woman, 28 weeks of gestation in her sixth pregnancy, presents to A&E with
breathlessness and displays severe anxiety. She had complained of left-sided pelvic pain for a
week. While being assessed she collapsed and it was not possible to resuscitate her


. Convulsions and cardiovascular collapse can occur with systemic absorption of local
anaesthetic drugs


A 38-year old woman who had an emergency caesarean section at 5 cm for fetal distress in her
previous labour is contemplating her subsequent mode of delivery. She would like to know the
best available evidence regarding the risks associated with VBAC.
Which one of the following statements is NOT true regarding the risk of VBAC?

14) True rate of maternal collapse in UK


A multiparous patient presents with severe abdominal pain at 36 weeks gestation, preceded by
mild uterine tightening following a clear gush of fluid passed per vaginam 2 days before, which
she thought was urine. She hasn’t vomited, but feels sick and has noticed shoulder tip pain. She
has a history of biliary colic, a previous caesarean section and moderate asthma. She is
apyrexial but tachycardic on examination, with a blood pressure of 85/45. She has rebound
tenderness, guarding and rigidity and absent bowel sounds. Speculum examination reveals a
closed cervix, but blood stained liquor. The CTG shows a fetal tachycardia with poor variability
and unprovoked decelerations. Her Hb is 87 g/l and her white cell count is 13.7 ×109/l.
Which is the most likely diagnosis?


A healthy 35-year-old woman attends the antenatal clinic at 37 weeks gestation in her third
pregnancy. She has had two previous caesarean sections for breech presentation, but the
current preg- nancy has a cephalic presentation and she would like to have a vaginal birth after
caesarean (VBAC).
What would be the risk of uterine rupture if she labours with such a history?


A 35-year-old woman with a previous history of one spontaneous vaginal delivery, followed by
two caesarean sections for breech babies attends the clinic to discuss delivery of her fourth
child. If the baby is cephalic at term she would like to try for a vaginal delivery. During your
counselling you mention the risk factors for uterine rupture during VBAC.
Which one of the following options does NOT increase the risk of uterine rupture?

18) Definative treatement for anaphylaxsis


A35-year-oldwoman had an elective Caesarean section 4 years ago for a breech
presentation. She is now 36 weeks pregnant in her second pregnancy. Shewould
like to try for a vaginal birth after Caesarean section (VBAC).Shewants to know
what risk her baby has of developing hypoxic ischaemic encephalopathy or brain
damage after a VBAC.
What isthe risk of the baby developing hypoxic ischaemic encephalopathy or brain
damage after a VBAC?


A 20-year-old primigravida presented with severe pruritus at week
32 of her pregnancy, and developed petechial haemorrhages 1 week
after her admission for obstetric cholestasis and severe liver enzyme
derangement. Following an induced vaginal delivery, she developed a
massive postpartum haemorrhage from which she died.


A previously healthy 18-year-old primigravida presents at 36 weeks feeling unwell and tired. Her
brother died unexpectedly aged 19 years. Her CXR showed an enlarged heart. While being
admitted she developed increasing shortness of breath and died despite intensive resuscitation.


Maternal collapse
Severe maternal morbidity rate in UK


45 A primigravida has been brought to the Accident and Emergency department following a
road traffic accident at 32 weeks gesta- tion. The obstetric registrar is summoned urgently. On
arrival she learns that CPR had been commenced 3 minutes earlier following a diagnosis of
cardiac arrest and pulseless electrical activity.What is the most appropriate initial action for an
ST5 trainee?


A 34-year-old woman presents in spontaneous labour at 38 weeks gestation in her second
pregnancy, having had a previous prelabour caesarean section for breech presentation. In the
first stage of labour, she develops continuous lower abdominal pain and a tachycardia. The fetal
heart rate becomes bradycardic. She is delivered by urgent (category1) caesarean section and
uterine rupture is confirmed. What is the risk of perinatal mortality?

25) Perinatal mortality rate in Amniotic fluid embolism is


In counselling women regarding the risks of vaginal delivery on the background of one previous
caesarean section, which one of the following would not generally be considered an absolute
contraindication to a VBAC attempt?

A 25-year-old woman, with a prosthetic heart valve for mitral
stenosis, on heparin presented at 35 weeks’ gestation in labour.
The heparin levels were monitored with factor Xa levels antenatally

27) Shortly after delivery, she collapses and resuscitation is unsuccessful.


A healthy 35-year-old woman attends the antenatal clinic at 37 weeks gestation in her third
pregnancy. She has had two previous caesarean sections for breech presentation, but the
current preg- nancy has a cephalic presentation and she would like to have a vaginal birth after
caesarean (VBAC).
What would be the risk of uterine rupture if she labours with such a history?


An anaesthetist is asked to assist with the insertion of an intra- venous cannula prior to the
commencement of a Syntocinon infu- sion in labour.The cannula is inserted successfully, but
shortly after it was flushed through as the woman starts to have convulsions and becomes
hypotensive and bradycardic.The syringes on the trolley are unlabeled and the anaesthetist suspects he may have flushed the cannula with a local anaesthetic solution.What is the appropriate
management of her collapse?


40 year old previous normal vaginal delivery at age of 17 years. One csection at age of 38 yrs.
Currently 28 weeks pregnant. She is not sure if she wants to try for vaginal delivery or elective c
section. She wants to know what her chance of death if she has csection.


A 22-year-old in her first pregnancy presents to Accident and Emergency at
14 weeks of gestation with severe sudden occipital headache. She had projectile
vomiting prior to arrival. After admission her score on the Glasgow Coma Scale
falls to 3.

32) Risk of OASIS in VBAC is

33) Incidence of primary cardiac arrest


A 26-year-old lady who had a spontaneous delivery 3 days ago is found collapsed
at home. In her history she had been noted to have had pre-eclampsia in
this pregnancy.


A 29-year-old para 0 at 40+4 weeks’ gestation presents to the labour ward with pyrexia, malaise
and shortness of breath. While transferring onto her labour room bed, she collapses. She is not
breathing and there is no pulse. Cardiopulmonary resuscitation (CPR) is commenced and an
emergency call is made. The anaesthetist and operating department practitioner arrive.What
would be the best airway protection during CPR in this patient?


Ms XY is a G3P2 at 30 weeks with a previous CS done 3 years ago for presumed fetal distress.
She would like to attempt a VBAC this time. What success rate would you quote for VBAC?


A 20-year-old woman is 36 weeks pregnant in her second pregnancy and is being reviewed in
the antenatal clinic. She has had a previous caesarean delivery. A recent obstetric growth scan

confirms cephalic presentation of a normally grown fetus. She has no other complicating
medical or obstetric disorders. She is deciding between planned vaginal birth after caesarean
(VBAC) and elective repeat caesarean section (ERCS) modes of delivery. Which ONE of the
following is correct in relation to the counselling she will receive?

38) Most common organisms responsible for sepsis in pregnancy

39) Features of amniotic fluid embolism

40) Most common cause of maternal collapse

41) Incidence of amniotic fluid embolism is


35-year-old primigravida with an unremarkable past medical and obstetric history was admitted
to the antenatal ward for investigation of a suspected lower limb DVT at 32 weeks of
gestation.She is found collapsed and unresponsive in the corridor. The midwife who found her,
has called for the emergency team. You are the next person to arrive on the scene.
What is the first most appropriate step in her care?


A 32-year-old woman in her second pregnancy collapses in the day assessment
unit at 34 weeks’ gestation. She is a known insulin-dependent diabetic. Her
insulin dose was increased a week ago because of persistently high blood sugar
readings. She complained of sweating and palpitations soon after arrival in the


History of previous vaginal birth in a woman with a caesarean section attempting to deliver
vaginally is associated with the planned VBAC success rate of:

45) What is the single best predictor for a successful VBAC?

Your score is