Title OB Breech with OASI JULY 2025 (for distribution).pdf ✅

20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 1 University of the Philippines-Manila, College of Medicine Philippine General Hospital Department of Obstetrics and Gynecology ORAL SIMULATION EXAM JULY 2025 EXAMINER’S COPY (BREECH) Name of Examinee: Name of Examiner: A 32 year old G3P2 (2002), PU 37 weeks and 4 days AOG, consulted at the OB ER for labor pains. Her previous pregnancies were carried to term, delivered vaginally, weighing 3050 and 2980 grams respectively. She had her prenatal check-ups at a local health center with normal prenatal laboratory results. She has no history of hypertension, diabetes, bronchial asthma, thyroid disease, and no history of previous surgeries. On examination, she had stable vital signs, afebrile, BMI: 24 kg/m2, normal chest findings, with the following abdominal findings: Fundic height = 30 cm, Leopold 1 = hard, ballotable mass, Leopold 2 = hard, resistant mass on right side, Leopold 3 = nodular mass, Leopold 4 = fingers easily inserted, good fetal heart tones at the paraumbilical area, estimated fetal weight = 2.6-2.8 kgs. Internal examination revealed a normal external genitalia, smooth & parous vagina, cervix is 3 cm dilated, 50% effaced, presenting part is floating, intact BOW. ANSWER/ POINT SCORE What is your diagnosis? (1 POINT/S) (0.33 point each) ● Pregnancy uterine 37 weeks and 4 days age of gestation, breech in labor ● Overweight ● G3P2 (2002) Give at least 4 risk factors for breech presentation (in general): GIVE FOUR (4) (0.25 point each) ● Early gestational age
20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 2 (1 POINT/S) ● Extremes of amniotic fluid volume ● Multifetal gestation ● Hydrocephaly ● Anencephaly ● Structural uterine abnormalities ● Placenta previa ● Pelvic tumors ● Prior breech delivery What fetal well-being studies will you request for? (0.5 POINT/S) (0.25 point each) ● Biometry ● Biophysical profile with baseline intrapartal trace Result of biometry, biophysical profile and trace: (PICTURE OF TRACE) BIOMETRY AND BPP RESULT Single live intrauterine pregnancy, in frank breech presentation, with good cardiac and somatic activities. 36 2/7 weeks by composite sonar aging. Adequate amniotic fluid volume. Sonographic estimated fetal weight: 2710 + 120 grams. SCORE Please interpret the trace using the FIGO classification: (1 POINT/S) ANSWER: ● Baseline fetal heart rate: 135 bpm (0.15) ● Variability: normal (0.15) ● Accelerations: present (0.15) ● Decelerations: absent (0.15) ● Contractions: every 5-6 minutes, moderate, lasting for 60 seconds (0.15) ● Impression: NORMAL IPM (0.25) What is your plan of delivery? (0.5 POINT) (0.25 POINT EACH) ● Partial breech extraction

20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 4 view. During delivery of the arm, fingers and hand are aligned parallel to the humerus and act as a splint. (Perpendicular force risks humeral fracture). The body of the fetus is then rotated 180 degrees in the reverse direction to bring the other shoulder and arm into position for delivery. (0.5) ASK: What will you do when trunk rotation is unsuccessful and you may need to deliver the posterior shoulder first? ◻ The feet are grasped in one hand and drawn upward over the inner thigh of the mother. The operator’s hand enters over the fetal shoulder, fingers are aligned parallel to the long axis of the fetal humerus, and the fetal arm is swept upward. The posterior shoulder slides out over the perineal margin and is usually followed by the arm and hand. Then, by depressing the body of the fetus, the anterior shoulder emerges beneath the pubic arch, and the arm and hand usually follow spontaneously. (0.5)