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Old 10-26-2012
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Arrow Gyrus Daily Questions; Obstetrics & Gynecology #1

A 28-year-old woman, gravida 2, para 0, aborta 1, at 30 weeks' gestation comes to the physician because of a decrease in fetal movements. She has felt no fetal movements the past 18-hours. Her prenatal course, prenatal tests, and fetal growth have been normal up to this point.Triple test was performed at 14-weeks and showed no abnormalities. Her first pregnancy was terminated because her fetus was diagnosed with Down's syndrome_ She does not use tobacco, alcohol, or drugs. Fetal heart tones are heard by Doppler. Non-stress test is non-reactive; therefore, biophysical profile is performed and shows a score of 8_ Which of the following is the most appropriate next step in management?

A. Reassurance and repeat biophysical profile in one week
B. Perform contraction stress test
C. Give steroids and repeat biophysical profile with in 24 his
D. Advise continuous home fetal monitoring
E. Deliver the baby immediately
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A Reassurance and repeat biophysical profile in one week since the BPP is 8

B. Perform contraction stress test is done when the BPP is 4-6

C. Give steroids and repeat biophysical profile with in 24 hrs is done when BPP is 4-6 and the fetus is less than 36 weeks

D. Advise continuous home fetal monitoring ?????????? don't know the indications

E. Deliver the baby immediately done when BPP is 0-2
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A) Reassurance and repeat BPP in a week.

The score in the BPP is a good score (good being 8-10 score) moderate is from 4 to 7 and bad is less than 4

If you have a moderalte BPP result and the baby is less than 34 weeks gestation you have to give steroids and repeat in 24 hours (letter C) and then act accordingly.

If you have a bad BPP regardless of the baby age you have to deliver the baby ASAP regardless of the age (Option E)

Source: Bad a lot of mistakes and Kaplan Obs GYN notes
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Recommended management based on the biophysical profile

This is what UW mentions too.
Quote:
BPP............ Recommended management

<2..............Labor induction

4................Labor induction if gestational age >32 weeks
..................Repeating test same day if <32 weeks, then delivery if BPP <6

6................ Labor induction if >36 weeks if favorable cervix and normal AFI
...................Repeating test in 24 hours if <36 weeks and cervix unfavorable; then delivery if BPP <6, and follow-up if >6

8................. Labor induction if presence of oligohydramnios
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Last edited by Novobiocin; 10-26-2012 at 02:03 PM.
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Answer is A Reassurance and repeat biophysical profile in one week.


Biophysical profile (BPP) is a scoring system designed to evaluate fetal well being. It is indicated in high risk pregnancies, or in case of maternal or physician concern, decreased fetal movements, or a non-reactive NST. It includes the NST in addition to four parameters assessed by

ultrasonography:
Fetal tone;
fetal movements (3/10min);
fetal breathing (30/10 min);
amniotic fluid index, (5-20).

Each of these five variables is given a score of two when present, and a score of zero when absent or abnormal. A total score of 8-10 is considered normal, and should only be repeated once or twice weekly until term for high risk pregnancies.

1. In the presence of oligohydramnios (AFI <5) delivery is to be considered since it can result in umbilical cord compression and therefore fetal compromise.

2. If the score is 6 without oligohydramnios, contraction stress test should be ordered.

If this latter gives non-reassuring results, delivery is usually indicated; if it gives suspicious results, repeat the next day.

If the score is 4 without oligohydramnios and fetal lungs are mature, delivery should be considered. If fetal lungs have not yet reached their maturity, steroids injection should be administered and BPP assessed within 24 hours. 4 If the score is <4, the fetus should be delivered.

(Choice B) Contraction stress test is indicated when the BPP score is 6.

(Choice C) BPP is reassuring in this patient and repeat in one week is enough.

(Choice E) Delivery is indicated when BPP score is <4.
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