ST3 Obstetrics and Gynaecology Interview
A 32-year-old primigravida was admitted into the delivery suite with a history of regular contractions and watery vaginal discharge. Outline your initial management.
History suggestive of preterm labour / rupture of membranes. Do not forget to discuss diagnosis with the couple and involve the neonatal team in the counselling process. This is a practical question and the candidate is expected to be methodological and very practical in their response
- take full history, including time fluid first noticed, colour of fluid, odour, discharge, bleeding, frequency of contractions and foetal movements.
- Perform abdominal exam
- Speculum exam – pool of fluid confirms SROM
- Assess dilatation. Avoid digital exam to minimise risk of infection.
- Tocolysis to allow administration of steroids (Bethamethsaone 12mg x 2 doses, 12hrs apart) and for in-utero transfer
- Antibiotics to prevent infection
- Inform Neonatal team to counsel patient and ensure cot available.
- Once steroid administered (48hrs), allow labour to progress if labours