fandarast
Forum Junior
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You are an attending obstetrician in charge of a busy hospital. You are monitoring the progress of a woman (gravida 2, para 0) who has been in labor for the past 24 hours; her membranes have been ruptured for 17 hours. Her cervix is 9 cm dilated and 100% effaced, and fetal vertex has reached pelvic floor and is in left occiput anterior position. She has an epidural. The fetal heart rate tracing is reassuring, and an intrauterine pressure catheter shows contractions every 2 to 3 minutes, 50 seconds in duration, and producing 45 mmHg of pressure. Four hours ago, the patient's cervix was dilated 9 cm, was 100% effaced, and fetal station was the same. What is the best next step in management?
A. Outlet vacuum delivery
B. Low forceps delivery
C. Low transverse cesarean section
D. Oxytocin augmentation
E. Penicillin
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| ganesha123
Forum Senior
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Posts: 225
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lscs for arrest...
Edited by ganesha123 on 03/22/08 - 12:54 AM
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| dr9576
Forum Newbie
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Penicillin because of 17 hours membrane rupture is the first step.
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| jasmin
Forum Junior
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lscs
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| fandarast
Forum Junior
Topics: 15
Posts: 53
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The answer is C.
This clinical scenario describes labor dystocia. The patient is gravida 2 but
is nulliparous because she has never had a vaginal delivery. She has had arrest of dilation and descent. She does not meet one of the prerequisites for instrumental delivery (vacuum or forceps), which is a fully dilated cervix. Oxytocin is not necessary because she is having adequate labor contractions as measured by the IUPC. Penicillin would be appropriate if she had ruptured her membranes more than 18 hours and she did not have group b streptococcus vaginal-rectal cultures.
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| ricardoricardo
Forum Newbie
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Posts: 26
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a 25 year old primigravida was transfered form another hospital she had an eclamptic fit and was treated with diazepam and Mg sulphate she 30 wks gestation, BP=140\100 she is now concious and oriented, what is the next step in her managment?
a. c\s
b.induction of labour with PG gel
c.indution of labout by aminiotomy and oxytocin
d.antihypertensive
e.conservative managment till term
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| sfk
Forum Elite
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c. induction by amniotomy & oxytocin
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