Junior Clerkship in Reproductive Health II CAT — October 2022

Mount Kenya University Medical School Obstetrics and Gynaecology Junior Clerkship in Reproductive Health II CAT: 9 short-answer questions with an exam-oriented answer key.

Mount Kenya University · Medical School · Department of Obstetrics and Gynaecology

Assessment details

  • Assessment: Junior Clerkship in Reproductive Health II CAT
  • Source date: October 2022
  • Time allowed: 1½ hours
  • Section: Short Answer Questions
  • Questions: 9
  • Total marks: 50
  • Published on OmpathStudy: 5 October 2026, 10:02 EAT
  • Source: User-supplied scan of the original CAT
  • Answer status: OmpathStudy study answer key; not an official MKU marking scheme

> Question wording: The questions below are reproduced from the supplied scan. Answers are structured as an exam-oriented answer key and may contain more detail than the marks require.

Question 1 — 5 marks

> Differentiate normal and abnormal labour (5 marks)

Answer

Normal labour

  1. Spontaneous onset in a low-risk pregnancy at 37–42 weeks.
  2. Singleton fetus in vertex presentation.
  3. Regular, coordinated uterine contractions produce progressive cervical effacement and dilatation.
  4. Progressive descent of the presenting part occurs.
  5. Ends in spontaneous vaginal birth with no significant maternal or fetal complication.

Abnormal labour

  • Labour deviates from the normal pattern because of abnormal uterine activity, abnormal cervical dilatation/descent, or maternal/fetal mechanical problems.
  • Examples include prolonged/arrested labour, obstructed labour, malpresentation/malposition and fetal compromise.

Question 2 — 5 marks

> List 5 complications of cesarean section (5 marks)

Answer

Any five:

  1. Haemorrhage — including intraoperative or postpartum haemorrhage.
  2. Infection — wound infection, endometritis or pelvic infection.
  3. Venous thromboembolism — DVT or pulmonary embolism.
  4. Injury to adjacent organs — especially bladder, ureter or bowel.
  5. Anaesthetic complications — e.g. aspiration, hypotension or drug-related complications.

Other acceptable complications include wound dehiscence, ileus, adhesions, transfusion-related complications and complications in subsequent pregnancies such as placenta praevia/accreta or uterine scar complications.

Question 3 — 5 marks

> List 5 prerequisites for vacuum delivery (5 marks)

Answer

Before vacuum-assisted vaginal delivery, ensure:

  1. Cervix is fully dilated.
  2. Membranes are ruptured.
  3. Fetal head is engaged and sufficiently low in the pelvis.
  4. Fetal head position is known and is compatible with vacuum delivery.
  5. Pelvis is clinically adequate and there is no significant cephalopelvic disproportion (CPD).

Also required in practice: informed consent, adequate analgesia/anaesthesia, an empty bladder, appropriate equipment and personnel, and readiness to perform caesarean section if the procedure fails. Vacuum extraction is generally avoided before 34 weeks because of increased neonatal intracranial injury risk.

Question 4 — 6 marks

> Outline the normal mechanisms of labour (6 marks)

Answer

  1. Engagement and descent — the biparietal diameter passes through the pelvic inlet and the head descends.
  2. Flexion — the fetal chin moves towards the chest, presenting the smaller suboccipitobregmatic diameter.
  3. Internal rotation — the occiput rotates anteriorly to align with the maternal pelvic outlet.
  4. Extension — the head extends beneath the pubic symphysis and is delivered.
  5. Restitution and external rotation — the head returns to its relationship with the shoulders, then rotates as the shoulders rotate internally.
  6. Expulsion — the anterior and posterior shoulders are delivered, followed by the rest of the body.

Question 5 — 5 marks

> List 5 risk factors for breech presentation (5 marks)

Answer

Any five:

  1. Prematurity.
  2. Multiple pregnancy.
  3. Uterine abnormalities — e.g. fibroids or congenital uterine anomalies.
  4. Placenta praevia/low-lying placenta.
  5. Abnormal amniotic fluid volume — oligohydramnios or polyhydramnios.

Other risk factors include fetal congenital abnormalities, previous breech presentation and some maternal pelvic factors.

Question 6 — 5 marks

> Outline 5 contraindications for external cephalic version (5 marks)

Answer

Any five important contraindications/conditions in which ECV should not be attempted include:

  1. Placenta praevia or another condition in which vaginal delivery is contraindicated.
  2. Significant antepartum haemorrhage.
  3. Current fetal compromise/abnormal fetal heart-rate pattern.
  4. Severe oligohydramnios.
  5. Significant fetal growth restriction, particularly when associated with fetal compromise/abnormal Doppler findings.

Other situations requiring avoidance or specialist assessment include major uterine abnormalities/scars and multiple pregnancy, depending on the clinical circumstances.

Question 7 — 10 marks

> Define obstructed labour and briefly outline its management (10 marks)

Answer

Definition

Obstructed labour is failure of the fetus to descend through the birth canal despite adequate/strong uterine contractions because of a mechanical obstruction.

Management

  1. Recognise and assess the obstruction — assess maternal condition, uterine contractions, cervical dilatation, fetal station/position, moulding and caput.
  2. Assess fetal wellbeing — monitor the fetal heart rate and identify fetal compromise.
  3. Call for senior obstetric help and arrange theatre/neonatal support where required.
  4. Stop oxytocin if it is being used.
  5. Establish large-bore IV access and correct dehydration/electrolyte abnormalities with appropriate IV fluids.
  6. Insert a urinary catheter and monitor urine output.
  7. Take appropriate blood investigations and cross-match blood, anticipating haemorrhage.
  8. Give broad-spectrum antibiotics when indicated, particularly with prolonged labour, infection or operative delivery.
  9. Expedite delivery according to the cause and fetal/maternal condition:
    • Caesarean section for a live fetus when vaginal delivery is not safely possible.
    • Operative vaginal delivery only when the prerequisites are fulfilled and the obstruction has been excluded.
    • Destructive operation may be considered for a dead fetus when appropriate and by a skilled clinician.
  10. After delivery, actively manage and look for complications such as postpartum haemorrhage, uterine rupture, genital tract trauma and sepsis, and assess the newborn for hypoxia/trauma.

High-yield causes: CPD, fetal macrosomia, malpresentation/malposition, fetal anomalies such as hydrocephalus, pelvic masses and an abnormal/contracted pelvis.

Question 8 — 5 marks

> Outline 5 reasons why a partogram is important in obstetrics (5 marks)

Answer

  1. Monitors progress of labour — particularly cervical dilatation and fetal descent.
  2. Detects abnormal or prolonged labour early.
  3. Monitors maternal and fetal wellbeing through recorded observations.
  4. Guides timely clinical decisions, including referral, augmentation or operative delivery when indicated.
  5. Provides a written record for communication, continuity of care, audit and medico-legal documentation.

Question 9 — 4 marks

> Define precipitate labour and list 3 complications of the same (4 mark)

Answer

Definition

Precipitate labour is labour in which the fetus is delivered within less than 3 hours from the onset of regular painful uterine contractions.

Complications

  1. Maternal genital tract trauma — cervical, vaginal or perineal lacerations.
  2. Postpartum haemorrhage — commonly related to genital tract trauma and/or uterine atony.
  3. Fetal/neonatal complications — including birth trauma, intracranial haemorrhage or fetal hypoxia/asphyxia.

Rapid revision — answers at a glance

  1. Normal vs abnormal labour: normal = spontaneous, term, vertex, progressive, uncomplicated; abnormal = deviation from normal progress/condition.
  2. CS complications: haemorrhage, infection, VTE, organ injury, anaesthetic complications.
  3. Vacuum prerequisites: fully dilated cervix, ruptured membranes, engaged/low head, known position, adequate pelvis/no CPD.
  4. Mechanisms: engagement/descent → flexion → internal rotation → extension → restitution/external rotation → expulsion.
  5. Breech risks: prematurity, multiple pregnancy, uterine abnormality, placenta praevia, abnormal liquor.
  6. ECV contraindications: placenta praevia, significant APH, fetal compromise, severe oligohydramnios, significant FGR/fetal compromise.
  7. Obstructed labour: mechanical failure of descent despite adequate contractions; stabilize, assess, correct dehydration/infection, and expedite appropriate delivery.
  8. Partogram: monitors progress/wellbeing, detects delay, guides intervention, improves communication/documentation.
  9. Precipitate labour: delivery <3 hours; trauma, PPH, fetal trauma/hypoxia.

Source note

This page was created from the Mount Kenya University Medical School, Department of Obstetrics and Gynaecology, Junior Clerkship in Reproductive Health II CAT, October 2022 scan supplied for publication on OmpathStudy. The question wording is preserved; the answer key is an educational synthesis for revision and should not be represented as the university's official marking scheme.

Compiled by Abongo Davis · Ompath Study · shared for MBChB students at Mount Kenya University and other universities.