DrVirgo
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11. A 30-year-old woman, gravida 4, para 3, is admitted to the hospital in labor at 38 weeks' gestation. The cervix is 4 cm dilated. Contractions occur every4 minutes. The fundal height is 40 cm. The membranes are intact. The fetal lie cannot be determined by abdominal examination, and no presenting part is palpable in the pelvis. Which of the following is the most appropriate next step in management?
O A) Ultrasonography
O B) Administration of oxytocin
O C) Administration of tocolytic drugs
O D) Amniotomy
O E) Cesarean delivery
38 weeks, 4cm dilated, contrac. Q4min, membranes intact, lie cannot be determined, no presenting part palpable in the pelvis…Next step???
A. U/S –to determine lie (do we have to do this?)
or
D. Amniotomy –AROM to get labor going since she is already dilating and contracting.
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| Aashi
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A) Ultrasonography --------->Its important to know the position of the fetus before attempting a vaginal delivery..coz if it s a breech, not all breech positions are delivered vaginally..
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| DrVirgo
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Good point... Thanks. 
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| Tuscani
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D!
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| DrVirgo
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No, its not D because as I just realized that in order to do an amniotomy, the fetal head has to be in contact with the inner cervix... the case says: "no presenting part is palpable in the pelvis." so this is wrong.
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| GOGETA
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So I choose D and is wrong 
So US was the correect answer base on the mod explanation?
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| nightflight1945
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A) Ultrasonography
for amniotony or every sort of induction you have to know the presenting part of the fetus , and even in the case of head presentation , if it is not engaged , amniotomy is relatively contraindicated because it can cause fetal umbilical cord prolapse.
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| nightflight1945
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Gogeta ,
Whay are you reluctant to do Sono in Ob-Gy cases?
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STEP 1 99/269 , STEP 2 99/276 AND I'M STUDYING FOR STEP 3 . "My comments are the exact truth , you understand some now and the rest one day in the future , Do not regret then!" "Silly Questions are followed by Silly answers , Life's fair isn't it?" REGARDS
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| GOGETA
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nightflight1945 wrote:
Gogeta ,
Whay are you reluctant to do Sono in Ob-Gy cases?
This is my tendon de aquiles
Im very weak/lost with OB 
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| Eagle_303
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Gogeta !! Why are you shaking in your Avatar ??
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