A 29-year-old woman, gravida 1, para 0, at 36 weeks' gestation is brought to the emergency department after an episode of dizziness and vomiting followed by loss of consciousness lasting 1 minute. She reports that her symptoms started after lying down on her back to rest, as she felt tired during yoga class. Her pregnancy has been uncomplicated. On arrival, she is diaphoretic and pale. Her pulse is 115/min and blood pressure is 90/58 mm Hg. On examination, the patient is lying in the supine position with a fundal height of 36 cm. There is a prolonged fetal heart rate deceleration to 80/min. Which of the following is the most appropriate action to reverse this patient's symptoms in the future?
APerforming the Muller maneuver
BGentle compression with an abdominal binder
CLying in the supine position and elevating legs
DLying in the left lateral decubitus position
EPerforming the Valsava maneuver
A 30-year-old woman, gravida 2, para 1, comes for a prenatal visit at 33 weeks' gestation. She delivered her first child spontaneously at 38 weeks' gestation; pregnancy was complicated by oligohydramnios. She has no other history of serious illness. Her blood pressure is 100/70 mm Hg. On pelvic examination, uterine size is found to be smaller than expected for dates. The fetus is in a longitudinal lie, with vertex presentation. The fetal heart rate is 144/min. Ultrasonography shows an estimated fetal weight below the 10th percentile, and decreased amniotic fluid volume. Which of the following is the most appropriate next step in this patient?
ASerial nonstress tests
BEmergent cesarean delivery
CAmnioinfusion
DReassurance only
EWeekly fetal weight estimation
A 27-year old primigravid woman at 37 weeks' gestation comes to the emergency department because of frequent contractions for 4 hours. Her pregnancy has been complicated by hyperemesis gravidarum which subsided in the second trimester. The contractions occur every 10–15 minutes and have been increasing in intensity and duration since onset. Her temperature is 37.1°C (98.8°F), pulse is 110/min, and blood pressure is 140/85 mm Hg. Uterine contractions are felt on palpation. Pelvic examination shows clear fluid in the vagina. The cervix is 50% effaced and 3 cm dilated. After 4 hours the cervix is 80% effaced and 6 cm dilated. Pelvic examination is inconclusive for the position of the fetal head. The fetal heart rate is reassuring. Which of the following is the most appropriate next step?
AAdminister oxytocin
BPerform external cephalic version
CAdminister misoprostol
DPerform Mauriceau-Smellie-Veit maneuver
EPerform ultrasonography
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