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Old 05-24-2016
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25. A 25 year old primigravid woman is admitted in labor at 39 weeks gestation. The cervix is 6 cm dilated and 100% effaced. The presenting part is not palpable. Fetal heart rate is 140/min. The estimated fetal weight is 3200 g (7 lbs 1 oz). Which of the following is the most appropriate next step in management?
a) X ray pelvimetry
b)Ultrasonography
c) Oxytocin augmentation
d) Amniotomy
e) Cesarean delivery.

43. A 37 year old woman gravida 5 para 3 aborta 1 at 40 weeks of gestation is admitted in labor. Contractions began 2 hours ago. She has not had vaginal bleeding or loss of fluid. Her pregnancy has been uncomplicated. Her last child was delivered vaginally at term and weighed 4300 g (9 lb 8 oz). At her last prenatal visit 1 week ago, the cervix was 50% effaced and 1cm dilated, and vertex was at -2 station. Examinations now shows contractions every 5 min. The cervix is 50% effaced and 6cm dilated. No presenting part can be felt. A fetal heart tracing shows no abnormalities. Which of the following is the most appropriate next step in management?
a) Arterial Blood Gas analysis of the umbilical artery
b) Fetal scalp stimulation
c) Ultrasound of the pelvis
d) Amniotomy
e) Cesarean delivery
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Old 05-25-2016
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[QUOTE=JosepRiv;1139721]25. A 25 year old primigravid woman is admitted in labor at 39 weeks gestation. The cervix is 6 cm dilated and 100% effaced. The presenting part is not palpable. Fetal heart rate is 140/min. The estimated fetal weight is 3200 g (7 lbs 1 oz). Which of the following is the most appropriate next step in management?
a) X ray pelvimetry
b)Ultrasonography
c) Oxytocin augmentation
d) Amniotomy
e) Cesarean delivery.

43. A 37 year old woman gravida 5 para 3 aborta 1 at 40 weeks of gestation is admitted in labor. Contractions began 2 hours ago. She has not had vaginal bleeding or loss of fluid. Her pregnancy has been uncomplicated. Her last child was delivered vaginally at term and weighed 4300 g (9 lb 8 oz). At her last prenatal visit 1 week ago, the cervix was 50% effaced and 1cm dilated, and vertex was at -2 station. Examinations now shows contractions every 5 min. The cervix is 50% effaced and 6cm dilated. No presenting part can be felt. A fetal heart tracing shows no abnormalities. Which of the following is the most appropriate next step in management?
a) Arterial Blood Gas analysis of the umbilical artery
b) Fetal scalp stimulation
c) Ultrasound of the pelvis
d) Amniotomy
e) Cesarean delivery[/QUOTE

b & e

Both questions are from labor and delivery...both are tricky for me atleast.. None of the obgyn resources deal with labor problems..
First question.. No palpable presenting part... Could be transverse lie ? Or no descent .. Usg to confirm the cause...

Second one... Previous exam showed presenting part.. Now it doesn't .. There is mo fetal compromise so a& b may not be correct... Amniotomy is done to induce labor .. But here labor has begun.. So may be cpd so cesarean section
This is what i think ..
Thanks for posting
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Old 05-26-2016
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1) d
2) b
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Old 05-27-2016
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Quote:
Originally Posted by srisakhi View Post
1) d
2) b
Hey srisakhi..
Could you please elaborate the ideas here.. I'm really getting confused with these type of questions from labor..
I got both wrong
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Old 05-27-2016
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Quote:
Originally Posted by Aesculapius View Post
Hey srisakhi..
Could you please elaborate the ideas here.. I'm really getting confused with these type of questions from labor..
I got both wrong
Hello,

You're wrong because the effacement is @ 100% , and that usually takes place as soon as the baby's head touches the cervix .. Leading to Breakage of disulfide bonds . So no ultrasound is needed to asses fetal position.

It's Arrest/prolonged of active phase in stage 1 .

seems like some info is missing from the question, no mention of contraction quality, so My answer is OXY 1st .. you Can do an Amniotomy " membrane rupture along with Oxy if no improvemnt seen . AMNIOTOMY is not 1st step , you don't know how long she will be in labor and you increase risk of infection that way

Usually try Oxy for few hours , if it fails then C-section is next
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Old 05-27-2016
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here's what UptoDate has to say :

Oxytocin augmentation Oxytocin is the only medication approved by the US Food and Drug Administration for labor stimulation in the active phase. It is typically dosed to effect, as predicting a women's response to a particular dose is not possible [56]. We titrate the dose to obtain an adequate uterine contraction pattern and do not generally exceed a dose of 30 milliunits/minute. After four hours of adequate uterine contractions (or six hours without adequate uterine contractions) and no cervical change in the active phase of labor, we proceed with cesarean delivery. If labor is progressing, either slowly or normally, we continue oxytocin at the dosage required to maintain an adequate uterine contraction pattern.
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Old 05-27-2016
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Here's what UptoDate says ...


Other approaches — Oxytocin alone is the best approach for treatment of a protraction disorder. The body of evidence does not support using an alternative approach.

●Oxytocin and amniotomy – Amniotomy is often combined with oxytocin augmentation to increase the frequency and intensity of contractions in women with a protraction disorder, but the efficacy of this approach is unproven. For women in spontaneous labor who have developed a delay in the progress of the first stage, a 2013 systematic review of randomized trials found no convincing evidence that a policy of both early amniotomy and early oxytocin significantly shortened the first stage of labor compared with routine care (mean difference -1.58 hours; 95% CI -4.27 to 1.10 hours; two trials, 240 women), and there was no reduction in the rate of cesarean delivery (RR 1.47, 95% CI 0.73-2.96) [62].
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Old 05-27-2016
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Compaq1 .. Thanks a lot for clearing that out.. I had pv exam in mind .. And so i thought no palpable presenting part.. And got confused..vertex beyond station -2 will not be alpabke per abd i think.
Time frame could be missing i think.. The rate of cervical dilatation..
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  #9  
Old 05-27-2016
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Hey compaq1 thanks for that article on oxytocin and amniotomy..
In the first question time makes all the difference.. Time since onset of labor should be there and the quality pf contractions.. The answer could also be cesarean if it's a cpd.. But yes goven the info oxy seems to be the best answer
Could you give some explanation for the second one? Here it says fhr tracing is ok.. So why should there be fetal scalp stimulation
Thanks again
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