Question 1

Q: A 28-year-old woman, gravida 2, para 1, at 40 weeks of gestation is admitted to the hospital in active labor. The patient has attended many prenatal appointments and followed her physician's advice about screening for diseases, laboratory testing, diet, and exercise. Her pregnancy has been uncomplicated. She has no history of a serious illness. Her first child was delivered via normal vaginal delivery. Her vital signs are within normal limits. Cervical examination shows 80% effacement, 5 cm dilation and softening without visible fetal parts or prolapsed umbilical cord. A cardiotocograph is shown. Which of the following options is the most appropriate initial step in management?

Repositioning. ***Repositioning*** - The cardiotocograph likely shows **variable decelerations**, which are often caused by **umbilical cord compression**. - **Maternal repositioning** (e.g., to the left lateral side) can relieve cord compression and improve fetal oxygenation, making it the most appropriate initial, non-invasive step. *Operative vaginal delivery* - This is a more invasive procedure and should not be the initial step for a potentially correctable issue like cord compression, especially with a cervix that is only 5 cm dilated and no visible fetal parts. - It's typically considered for **prolonged second stage of labor** or **fetal distress** with a fully dilated cervix when less invasive measures have failed. *Administration of beta-agonists* - Beta-agonists (like terbutaline) can relax the uterus, potentially reducing uterine contractions and improving uterine blood flow, which might be considered in cases of **uterine hyperstimulation** or persistent decelerations, but generally not as the first line for variable decelerations. - This intervention is more appropriate when there is evidence of excessive uterine activity rather than simply cord compression. *Amnioinfusion* - **Amnioinfusion** involves introducing saline into the uterine cavity and is considered for **recurrent severe variable decelerations** due to **oligohydramnios** or cord compression that doesn't respond to repositioning. - It is a more invasive procedure than repositioning and should not be the initial step. *Urgent Cesarean delivery* - **Cesarean delivery** is reserved for situations where there is persistent fetal distress despite conservative management or when there is an obstetric indication that precludes vaginal delivery. - It is a major surgical procedure and premature for a situation that might be resolved with a simple maternal position change.

Question

A 28-year-old woman, gravida 2, para 1, at 40 weeks of gestation is admitted to the hospital in active labor. The patient has attended many prenatal appointments and followed her physician's advice about screening for diseases, laboratory testing, diet, and exercise. Her pregnancy has been uncomplicated. She has no history of a serious illness. Her first child was delivered via normal vaginal delivery. Her vital signs are within normal limits. Cervical examination shows 80% effacement, 5 cm dilation and softening without visible fetal parts or prolapsed umbilical cord. A cardiotocograph is shown. Which of the following options is the most appropriate initial step in management?

Accepted Answer

Repositioning

Answer

Operative vaginal delivery

Answer

Administration of beta-agonists

Answer

Amnioinfusion

Answer

Urgent Cesarean delivery

Stages of labor — MCQs

Stages of labor — MCQs

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