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O&G CasesIntrapartum care — operative birth

O&G Cases · Intrapartum care — operative birth

Category 1 caesarean at 02:40 — emergency decision and escalation station

Emergency decision and escalation station: a category 1 caesarean when the only theatre is occupied. Tests category assignment under pressure, intrauterine resuscitation, parallel workflow, resource conflict between two women, closed-loop communication and the audit conversation afterwards. Includes assessor key and marking domains.

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Target exams

FRANZCOGMRCOGABOG
Prompt
A 26-year-old G1 at 41+0 weeks is being induced with oxytocin at 8 cm. At 02:40 the cardiotocograph shows a fetal heart rate of 60 beats per minute lasting three minutes and not recovering. The birth suite has one obstetric theatre, currently occupied by a category 2 caesarean that started ten minutes ago. The consultant is at home, twenty minutes away. You are the registrar.

Station brief

Format. Emergency management and communication station, approximately 12 minutes. A midwife and an anaesthetist are with you. The assessor runs the clock and feeds new information. Verbalise everything: your category, your reasoning, your orders and your escalation. [1]

Candidate instruction. Lead the response to a prolonged fetal bradycardia when the only obstetric theatre is occupied by another woman's caesarean. State your urgency category and defend it, direct intrauterine resuscitation, resolve the resource conflict explicitly, and hand over to the consultant. [1][4]

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References5ShowHide
  1. [1]Lucas DN, Yentis SM, Kinsella SM, et al. Urgency of caesarean section: a new classification. J R Soc Med, 2000.PMID 10928020
  2. [2]Thomas J, Paranjothy S, James D National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section. BMJ, 2004.PMID 15023829
  3. [3]Tuffnell DJ, Wilkinson K, Beresford N Interval between decision and delivery by caesarean section-are current standards achievable? Observational case series. BMJ, 2001.PMID 11387177
  4. [4]Bloom SL, Leveno KJ, Spong CY, et al. Decision-to-incision times and maternal and infant outcomes. Obstet Gynecol, 2006.PMID 16816049
  5. [5]Tolcher MC, Johnson RL, El-Nashar SA, et al. Decision-to-incision time and neonatal outcomes: a systematic review and meta-analysis. Obstet Gynecol, 2014.PMID 24499762
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