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  #1  
Old 03-07-2012
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ObGyn No fetal movements and no fetal heart beats!

At a routine prenatal visit, a 28-year-old woman, gravida 5, para 4, at 28 weeks’ gestation, reports that she has not felt the baby move for 2 days. She first felt fetal movement at 17 weeks’ gestation. She denies any vaginal bleeding or fluid leakage. Her pregnancy has been complicated by chronic hypertension, for which she is being treated with twice-daily tablets of methyldopa. She is afebrile and her vital signs are stable. On physical examination, you measure the fundal height at an appropriate 30 cm. Four weeks ago, the fundus measured 26 cm. Leopold’s maneuvers reveal the fetus to be in transverse lie. Her blood pressure is 145/85 mm Hg. A urine dipstick test result is negative for albumin. You are unable to obtain fetal heart tones with a Doppler fetoscope.
Which of the following is the most appropriate next step in the management of this patient?
(A) Perform a non-stress test.
(B) Perform an amniocentesis.
(C) Obtain a real-time ultrasound assessment for cardiac motion.
(D) Obtain a maternal abdominal x-ray assessment of the fetus.
(E) Perform a quantitative human chorionic gonadotropin (hCG) assay.

please give reason too

Last edited by tyagee; 03-07-2012 at 04:23 AM.
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  #2  
Old 03-07-2012
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this is intrauterine fetal demise after 20weeks, do real time ultrasonography C, if therez no any fetal movement of dead fetus then we will induce labor, then we have to do autopsy of baby to evalute cause of fetal death
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Old 03-07-2012
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Question

ya even i was confused with this stuff
...NST or USG ??

similar to UW question
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Old 03-07-2012
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Quote:
Originally Posted by dr.dhruvdesai View Post
ya even i was confused with this stuff
...NST or USG ??

similar to UW question
yes its similar to uw qs so u/s is rite
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Old 03-07-2012
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ya i referrred it again

so remember this guys,

IF "NO" fetal movt- suspect demise ---go fOr USG

IF "decreased" fetal movt - suspect distress --- Go For NST

Quote:
Is that correct?
usmlepak?
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Old 03-07-2012
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Correct Answer Real-time ultrasound

Answer is real time U/S.
Protocols in OBS are-
1.Decreased Fetal movement-Next best step is NST(it shall tell if there is any stress)
2.Absent fetal movement-Next best step is Sonogram(it sees the fetal heart movements)
Usually vignettes mention that fetal hrt sounds were not audible,confirming that it is something more than distress,most likely fetal demise and thus needs best evaluation of status which obviously is U/S.
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  #7  
Old 03-07-2012
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Quote:
Originally Posted by Aussie Guy View Post
Answer is real time U/S.
Protocols in OBS are-
1.Decreased Fetal movement-Next best step is NST(it shall tell if there is any stress)
2.Absent fetal movement-Next best step is Sonogram(it sees the fetal heart movements)
Usually vignettes mention that fetal hrt sounds were not audible,confirming that it is something more than distress,most likely fetal demise and thus needs best evaluation of status which obviously is U/S.
can u mention the source of this info...i doubt its in kaplan.
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Old 03-07-2012
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answer is C...real time sono
ans is C.
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  #9  
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source is UW... i observed a few questions in UW to make the inference
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Old 03-08-2012
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Ans is C. u world said do real -time U/S and if there is no fetal heart sound and fetus is confirmed dead ie fetal demise , then do induction of labor after discussing with the patient to see if she approves of induction of labor or whether she wants to wait for spontaneous labor which u have to discuss the risk of waiting which is DIC. WHILE SHE WAITS MONITOR FIBRINOGEN LEVEL AND PLATELETS COUNT. otherwise do induction of labor WHICH IS SAFER.
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