fandarast
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A 20-year-old primigravid woman at 37 weeks of gestation (confirmed by a first trimester ultrasound) presents to the clinic for routine prenatal care. She reports active fetal movement and abdominal pain. Her blood pressure is 162/103 initially and she has 2+ protein on the urine dipstick. Her physical examination is unremarkable except for diffuse tenderness on the abdomen; however, there is no rebound tenderness. Her fundus measures 36 cm above the symphysis pubis. You send her to labor and delivery where a complete blood cell count, liver enzymes, electrolytes, uric acid, urinalysis, and coagulation profile are drawn. On L&D, her blood pressure is 166/104 and there is 3+ proteinuria on urine dipstick. Her cervix is closed, long, firm, and posterior, and fetal vertex is high. What is the best next step in management?
A. Oxytocin and magnesium sulfate
B. Prostaglandin analogue and magnesium sulfate
C. Magnesium sulfate
D. Methyldopa
E. Hydralazine
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| guangyu
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B
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| titly
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A
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| fandarast
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In the management of preeclampsia, magnesium sulfate is used for seizure prophylaxis, and another agent such as a prostaglandin analogue or oxytocin (if cervix is favorable) is used to achieve delivery. But using oxytocin to induce this patient would be unsuccessful because her cervix is unfavorable.
So, B is a correct answer.
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| docofthebigapple
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since she is complaining of abdominal tenderness, i think of it as severe preeclampsia. She definitely needs Mgso4. Prostaglandin can be used for cervical ripening.
I would have picked B in the exam.
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| inkspot
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when does the favobral stars?
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| fandarast
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A cervix is determined to be favorable by its Bishop's score. Induction is usually successful with a score of 9 or greater.
(see the Bishop's score on p156, table 14-2, NMS ObGyn, 5th edition, 2005)
Edited by fandarast on 03/15/08 - 12:55 AM
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| Novak75
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hi, ok, I haven't read obgyn, but wouldn't the first next step be to lower blood pressure with choice D?, and do a C section not induce labor?
So what was the right answer fandarast?
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| motorola
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B. prostaglandin to dilate the cx and MgSO4 for eclamsia prophylaxis
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| shakespeare
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I'd go for MgS04 + corticosteroids to prepare baby's lung maturation. Instant cervical ripening with prostaglandins without corticosteroids before... if it were HTN+complications I'd go for MGSO4 + C section.
So C.
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| motorola
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baby is at term, 37 weeks. lungs fully mature.
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| nany
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B
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