late decelerations and baby at +1 station !! next step? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-29-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 588 Times in 354 Posts
Reputation: 598
ObGyn late decelerations and baby at +1 station !! next step?

A 16-year-old G1P0 woman at 39 weeks’ gestation presents in active labor. Upon admission, her cervix is 3 cm dilated and 90% effaced. The fetal heart trace is initially reassuring. The labor progresses at a normal rate. However, the fetal heart trace reveals repetitive late decelerations with decreased beat-to-beat variability for approximately 40 minutes. Her cervix is completely dilated, with vertex at + 1 station.
Which of the following is the most appropriate next step in patient care?

A. Cesarean section
B. Epidural anesthesia
C. Forceps delivery
D. Oxytocin augmentation
E. Vacuum delivery

guys, i dont have expln to this q....
Reply With Quote Quick reply to this message



  #2  
Old 05-29-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

A C-section
i think c-section is indicated in Fetal/maternal jeopardy, though her cervix is completely dilated but the head is still at +1 station, and we can't infuse oxytocin in this case, so i will go with immediate c-section

to use forceps, we need +2 i think
Reply With Quote Quick reply to this message
  #3  
Old 05-29-2012
shyangel18's Avatar
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 388
Threads: 48
Thanked 237 Times in 128 Posts
Reputation: 247
Send a message via MSN to shyangel18
Default

its D. Oxytocin stimulation

the mother is totaly dilated, she can deliver the baby thru SVD. the baby is at higher station, so cant use vaccum or foceps. best way is to augment the contractions! also these deceleration are not specifically nonreassuring i think
__________________
Ppl come here to study n ponder
I am here to Excell like Thunder!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
 
  #4  
Old 05-29-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 761 Times in 256 Posts
Reputation: 772
Default

next step is oxytocin..
Reply With Quote Quick reply to this message
  #5  
Old 05-29-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,104 Times in 1,049 Posts
Reputation: 2124
Default

A. Cesarean section
She is Primi ----Can't wait for vaginal delivery
Oxytocin is contraindicated. In fact, if she was on Oxytocin then stop it and give terbutalin.

Quote:
Late Decelerations
• These are gradual decreases in FHR below the baseline with onset to nadir of >30 s.
The deceleration onset and end is delayed in relation to contractions. They are medi-
ated by either vagal stimulation or myocardial depression and occur in response to
uteroplacental insufficiency.
• All late decelerations are non reassuring and may be associated with fetal acidosis.
Quote:
Variability
These describe baseline FHR fluctuations in amplitude and frequency of >2 cycles/min.
Variability is a reflection of normal healthy autonomic interplay between the sympathetic and
parasympathetic nervous systems. Classification criteria include the following:
• Absent: variability is undetectable. This finding is nonreassuring.
• Minimal: $;5 beats/min.
• Moderate: 6-25 beats/min. This is considered normal variability.
• Marked: >25 beats/min.
Quote:
Turn off any IV oxytocin infusion or administer terbutaline
0.25 mg subcutaneously to enhance intervillous placental blood flow.
Quote:
Criteria for Nonreassuring FHR tracing
• Baseline rate shows tachycardia or bradycardia without explanation.
Accelerations are absent.
• Repetitive variable decelerations, if severe, are seen.
• There are repetitive late decelerations of any magnitude.
Variability is absent.
Quote:
Specific Interventions if Immediate Delivery Is Indicated
In stage one of labor, the only option is emergency cesarean section.
In stage two of labor, an operative vaginal delivery (e.g., vacuum extractor assisted or
obstetrical forceps) may be appropriate, or an emergency cesarean section must be
performed.

Last edited by Novobiocin; 05-29-2012 at 06:04 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
bisho (05-30-2012), chriledi (04-08-2013), mbbs2010 (05-29-2012), samajade (09-14-2016), tyagee (05-29-2012)
  #6  
Old 05-29-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 456 Times in 289 Posts
Reputation: 466
Default

Quote:
Originally Posted by tyagee View Post
A 16-year-old G1P0 woman at 39 weeks’ gestation presents in active labor. Upon admission, her cervix is 3 cm dilated and 90% effaced. The fetal heart trace is initially reassuring. The labor progresses at a normal rate. However, the fetal heart trace reveals repetitive late decelerations with decreased beat-to-beat variability for approximately 40 minutes. Her cervix is completely dilated, with vertex at + 1 station.
Which of the following is the most appropriate next step in patient care?

A. Cesarean section
B. Epidural anesthesia
C. Forceps delivery
D. Oxytocin augmentation
E. Vacuum delivery

guys, i dont have expln to this q....

guess is A......
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message



Reply

Tags
ObGyn-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Is July too late to take step 2 CS? jasonb123 USMLE Step 2 CS Forum 4 05-19-2012 09:05 PM
Third Trimester Late Fetal Heart Decelerations after Motor Vehicle Accident? tyagee USMLE Step 2 CK Forum 3 05-16-2012 05:35 PM
Got 213/90 and a New baby (My Step 1 Experience) Dr_Laura USMLE Step 1 Forum 48 08-17-2011 03:00 PM
is it too late to apply for step 1 TAAOM USMLE Step 1 Forum 5 12-23-2010 01:23 PM
Early Decelerations; What to do? RRMadukha USMLE Step 2 CK Forum 1 05-19-2010 04:10 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)