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Obg practical examination preparation - give case sheet, presentation with "why" of every history and cause and differential diagnosis, summary with positive history and examination findings, examination procedure ,diagnosis  with explanation, case discussion, investigation and management and possible viva questions and answers for the following obstetrics topics( refer  hepsibah kirubamani practical obg book)  postdated delivery.

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Your complete OBG Practical Examination Preparation on Post-Dated Delivery is ready!

PostDated Delivery OBG Practical

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What's Inside - 31 Slides Covering Everything

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SECTION 1 - Case Sheet

Mrs. Meena R., 26 yrs, G1P0L0A0, at 42 weeks gestation
  • Chief complaint: Amenorrhoea × 10 months, no onset of labour
  • Reduced fetal movements × 48 hours, no PROM, no bleeding PV
  • Bishop score 3-4 (unfavourable cervix)

SECTION 2 - History with "WHY" of Every Question

History ItemWHY You Ask It
LMP (certain/uncertain?)Most common cause of apparent post-datism is incorrect dating
Cycle regularity & lengthIrregular cycles or long cycles → ovulation after day 14 → add days to EDD
Previous post-term delivery2-3× recurrence risk in subsequent pregnancies
Family historyMaternal genes control fetal HPA axis that triggers labour
PrimiparityPrimiparity is an independent risk factor for post-term
Male fetusMale fetuses carry slightly higher post-term risk
No fetal movementsReduced movements = uteroplacental insufficiency warning

SECTION 3 - Differential Diagnosis

DiagnosisDistinguishing Feature
Incorrect dating (Most common)No early USG, uncertain LMP, irregular cycles
True post-term (>42 wks)Confirmed by early USG + LMP
Fetal anencephalyNo HPA axis → polyhydramnios, absent fetal skull on USG
Placental sulphatase deficiencyX-linked recessive, male fetus, low estriol, resistant to induction
Post-term + IUGRReduced fundal height, oligohydramnios

SECTION 4 - Summary of Positive Findings

Positive History: G1P0, 42 weeks by dates + USG, no labour, reduced FM, unfavourable cervix
Positive Examination: Fundal height 38-40 cm, cephalic presentation, 3/5 head palpable, FHS 136 bpm, AFI reduced, Bishop score 3-4

SECTION 5 - Examination Procedure

Abdominal Exam sequence: Inspection → Fundal height → Fundal grip → Lateral grips → Pawlik's grip → 5th rule (engagement) → FHS auscultation
P/V Examination (Bishop Score):
ParameterScore 0Score 1Score 2Score 3
DilationClosed1-2 cm3-4 cm5+ cm
Effacement0-30%40-50%60-70%80%
Station-3-2-1/0+1
ConsistencyFirmMediumSoft—
PositionPosteriorMidAnterior—
Score <6 = Unfavourable → Cervical ripening required first

SECTION 6 - Diagnosis (Examination Format)

"Mrs. Meena R., 26 years, G1P0L0A0 at 42 weeks gestation (Post-Dated Pregnancy) with unfavourable cervix (Bishop score 4), presenting for induction of labour."

SECTION 7 - Case Discussion (Pathophysiology)

Why does labour not start? Fetal hypothalamus → CRH → ACTH → DHEA-S → Placenta aromatizes → Oestradiol surge → Oxytocin receptors↑ + Gap junctions↑ + PGF2α → Labour
In post-term, this cascade FAILS due to: defective fetal HPA axis, placental sulphatase deficiency, or fetal anencephaly.
Perinatal Mortality (Creasy & Resnik MFM):
  • 42 weeks = 2× term rate
  • 43 weeks = 4× term rate
  • 44 weeks = 5-7× term rate
Dysmaturity Syndrome (Clifford): SGA infant (NOT macrosomic) - affects 10-20% of post-term pregnancies - caused by chronic intrauterine malnutrition

SECTION 8 - Investigations

  1. Gestational age confirmation - First trimester USG (±7 days, 9-16 wks) - gold standard
  2. NST - Reactive = 2 accelerations ≥15 bpm × 15 sec within 20 min
  3. BPP - 5 parameters (NST + movements + tone + breathing + AFI); score ≤4 = deliver
  4. Modified BPP - NST + AFI only (acceptable alternative)
  5. Doppler - Not routine; use if IUGR suspected
  6. Routine labs - CBC, blood group, urine R/E, blood glucose, coagulation

SECTION 9 - Management

Algorithm:
  • 41 weeks → Offer induction; if expectant: twice weekly NST + BPP + daily kick chart
  • 42+ weeks → Mandatory induction
  • AFI <5 cm or non-reactive NST → Deliver immediately
Cervical Ripening (Bishop <6):
  • Misoprostol (PGE1) 25 mcg vaginal q4-6h (NOT in previous CS)
  • Dinoprostone (PGE2) 0.5 mg gel q6h ×3 or 10 mg slow-release insert
  • Foley balloon / Laminaria (mechanical)
  • Membrane sweeping
Oxytocin Induction: Start 0.5-2 mU/min → titrate up every 30 min → target 3 contractions/10 min lasting 40-60 sec → continuous CTG monitoring

SECTION 10 - Viva Q&A (23 Questions with Model Answers)

Covers: Definition, terminology, risk factors, dysmaturity syndrome, perinatal mortality statistics, Naegele's rule, Bishop score, NST/BPP interpretation, HPA axis pathophysiology, placental sulphatase deficiency, oligohydramnios, meconium management, shoulder dystocia, and complete management algorithm.
References: Creasy & Resnik's Maternal-Fetal Medicine, Swanson's Family Medicine Review, ACOG Guidelines - aligned with principles from Hepsibah Kirubamani's Practical OBG approach

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PostDated Delivery OBG Practical

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