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Old 11-16-2012
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ObGyn Indication of cesarean delivery

A 27 Year-old primigravid women at 39 weeks’ gestation comes in labor and delivery ward with a gush of fluid and regular contractions. Examination show that she is grossly ruptured, contracting every 2 minutes, and that her cervix is dilated to 4 cm. the fetal heart rate tracing is in the 140s and reactive. She is admitted to labor and delivery, and over the following 4 hours she progresses to 9 cm dilation. Over the past hour, the fetal heart rate has increase from a baseline of 140/min to a baseline of 160/ min. furthermore, moderate to sever variable deceleration are seen with each contraction. The fetal heart rate dose not responds to scalp stimulation. The decision is made to proceed with cesarean delivery. Which of the following is reason for cesarean delivery and the preoperative diagnosis?


A- Fetal academia
B- Fetal distress
C- Fetal hypoxic encephalopathy
D- Low neonatal APGAR scores
E- Non-reassuring fetal heart rate tracing
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Old 11-16-2012
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Variable Decelerations = Umbilical Cord Compression leading to Fetal Acidosis. I'd go with A. Fetal Academia.
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Old 11-17-2012
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A- Fetal academia
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Old 11-19-2012
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The correct answer is E- Non-reassuring fetal heart rate tracing
With each uterine contraction blood flow to the placenta decrease and the fetus is exposed to transient hypoxia. As labor progresses and more contraction occur this hypoxia can eventually lead to a change from aerobic to anaerobic metabolism leading to build up of acid in the fetus or “fetal acidemia”. However most fetus tolerates the stress of labor and delivered just fine. Electronic fetal monitoring is used to determine whether the fetus is becoming dangerously acidemic or “stressed” during delivery so that delivery can occur prior to hypoxic damage to organ. Unfortunately, electronic fetal monitoring is not very specific tool for identifying the fetal acidemia. Many fetuses with a non-reassuring fetal heart rate tracing do not have acidemia and are not in distress. However it can be difficult to distinguish non-acidemic fetuses with non-reassuring fetal heart rate tracing from academic fetuses with non-reassuring fetal heart rate tracing. Thus the delivery of many fetuses is expedited cuz of concern for fetal acidemia when, in fact, the fetus is not academic at all. So it is most accurate to state, as is in this case, that fetus was delivered cuz of the non-reassuring fetal heart rate tracing
Fetal acidemia is not the reason for delivery. In fact, there is strong likelihood that this fetus is not academic at all.
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