nbme 2 oby/gn 2 - dr_gladiator

[ArchivalUser]

24. A 19-year-old woman, gravida 2, para 1, at 39
weeks' gestation
is admitted in labor. Contractions occur every 2 to 3
minutes. The
cervix is 4 cm dilated and 80% effaced. She requests
an epidural for pain
control. Ten minutes after the epidural is
administered, she becomes
nauseated and diaphoretic and vomits. Her blood
pressure is 60/palpable
mm Hg. A fetal heart tracing shows sustained fetal
decelerations. The
cervix is now 8 cm dilated. The most appropriate next
step in
management is administration of which of the
following?

A
) Ephedrine

B
) Magnesium sulfate

C
) Nifedipine

D
) Oxytocin

E
) Terbutaline

[ArchivalUser]

Need to Stabilize BP 1st so AA (1st order is always to Take care of mom, otherwise fetus will also die)

[ArchivalUser]

to add: Tocolysis is Contraindicated during active labor

[ArchivalUser]

remember BP goes down b/c you lose sympathetic control this shouldn't happen if you give pt enough IV vol before the epidural. Add vdil to this and this is why hypotension occurs. At this point you can give low dose of ephedrine but if Ringer lactate is an potion always go with it first

[ArchivalUser]

why not oxytocin?? epedrine is usually used as a decongesant..