Gravida 3 with no Progress! - 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 11-15-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 618 Times in 234 Posts
Reputation: 628
ObGyn Gravida 3 with no Progress!

A 31-year-old G3P2 woman at 37 weeks’ gestation presents to the labor and delivery floor after after 2 hours of contractions of increasing frequency and intensity. An epidural anesthetic is requested on admission and placed. The patient continues to have contractions for the next 15 hours, during which time her membranes rupture spontaneously. Vaginal examination at that time reveals a cervix which is soft, 3 cm dilated, in an anterior position, and 80% effaced. The fetal head is at the −1 station. Fetal heart tracings reveal a baseline heart rate of 156/min, with variable accelerations and no significant decelerations. What would be the next appropriate step in management?

(A) Apply intravaginal prostaglandin E2
(B) Attempt forceps-facilitated delivery
(C) Begin an infusion of oxytocin
(D) Increase the rate of intravenous fluids to hydrate the patient
(E) Proceed to cesarean section
Reply With Quote Quick reply to this message
The above post was thanked by:
dr.tasneem (11-15-2012)



  #2  
Old 11-15-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

(C) Begin an infusion of oxytocin

Some information regarding her previous deliveries could have helped.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (11-15-2012)
  #3  
Old 11-15-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 791
Threads: 76
Thanked 673 Times in 317 Posts
Reputation: 691
Default

yes agree....augment the labor with oxytocin.....
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (11-15-2012)
 
  #4  
Old 11-15-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 618 Times in 234 Posts
Reputation: 628
Default

Why not answer D coz in the real clinical sitting there is precautions for giving oxytocin for multipara (risk of U.Rupture)
Reply With Quote Quick reply to this message
  #5  
Old 11-15-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

Quote:
Originally Posted by heartbeat View Post
Why not answer D coz in the real clinical sitting there is precautions for giving oxytocin for multipara (risk of U.Rupture)
There is no information in the stem to suggest dehydration. The only information which is there suggests that the prolonged labor is due to inadequate uterine contractions due to epidural. Also, there is no information regarding her previous deliveries which I assume as being normal vaginal deliveries. She should have gone to active stage of labor beyond 15 hours and the most obvious cause seems to be "power" then you need to give her more power especially in the presence of an epidural.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (11-16-2012)
  #6  
Old 11-15-2012
dr.tasneem's Avatar
USMLE Forums Scout
 
Steps History: Not yet
Posts: 29
Threads: 0
Thanked 7 Times in 6 Posts
Reputation: 17
Default A

I think A is the answer (PGE2) ....infusion of oxytocin is dengerous in this case because the head is not engaged so there is a risk of uterine rupture..
if the head was engaged in this case oxytocin can be given.
__________________
doctor 88
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (11-16-2012)
  #7  
Old 11-16-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 618 Times in 234 Posts
Reputation: 628
Default

Quote:
Originally Posted by Novobiocin View Post
There is no information in the stem to suggest dehydration. The only information which is there suggests that the prolonged labor is due to inadequate uterine contractions due to epidural. Also, there is no information regarding her previous deliveries which I assume as being normal vaginal deliveries. She should have gone to active stage of labor beyond 15 hours and the most obvious cause seems to be "power" then you need to give her more power especially in the presence of an epidural.
Now it's clear thanks Novo
Reply With Quote Quick reply to this message
  #8  
Old 11-16-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 618 Times in 234 Posts
Reputation: 628
Default

Quote:
Originally Posted by dr.tasneem View Post
I think A is the answer (PGE2) ....infusion of oxytocin is dengerous in this case because the head is not engaged so there is a risk of uterine rupture..
if the head was engaged in this case oxytocin can be given.
Intravaginal prostaglandin E2 is used to induce labor when the patient has a cervix that is unfavorable for oxytocin induction. Prostaglandin E2 is not used once labor is in progress, and also carries a risk of uterine hyperstimulation, placental insufficiency, and uterine rupture.
Reply With Quote Quick reply to this message
The above post was thanked by:
Novobiocin (11-16-2012), slamdunk (11-16-2012)



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
CCS - Progress of Antibiotic Course! dr_mhm USMLE Step 3 Forum 4 10-17-2012 07:25 AM
Dr. Laura's Ste 2 CK Progress Dr_Laura USMLE Step 2 CK Forum 6 10-16-2012 07:52 AM
gravida and para chienpolska USMLE Step 2 CK Forum 4 06-23-2012 09:18 AM
My progress is very slow, what should I do? michelle14 USMLE Step 1 Forum 2 06-02-2012 06:21 AM
TPAL System for Gravida Para Notation! omarmhm USMLE Step 2 CK Forum 3 07-02-2011 09:24 AM

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)