01-07-2009, 01:06 AM
16 is aa
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15 16 17 - showman
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01-07-2009, 01:06 AM
16a
in a patient who is reliable, with a small, unruptured ectopic pregnancy, methotrexate may be the treatment of choice. This would allow the ectopic pregnancy to be treated without the patient needing to have surgery. In a patient who is hemodynamically unstable, laparotomy is usually the best management. This patient is between these two extremes with what seems to be a ruptured ectopic (given her history, physical, laboratory, and ultrasound findings), but she is not hemodynamically unstable; therefore, laparoscopy would be the most appropriate management of this patient.
01-07-2009, 01:06 AM
17. The correct answer is E. In modern obstetric practice in
many countries, most patients have electronic fetal monitoring during labor and delivery. A nonreassuring fetal heart rate is one of the most common indications for cesarean delivery. It is, therefore, vital to be able to interpret and respond appropriately to various fetal heart rate patterns. The patient in this scenario has uterine hyperstimulation. Uterine hyperstimulation is defined as a persistent pattern of more than five contractions in 10 minutes that may or may not result in a nonreassuring fetal heart rate pattern.Hyperstimulation can also be defined as contractions lasting 2 minutes or more, or contractions or normal duration occurring within 1 minute of each other. During uterine hyperstimulation, fetal oxygenation often is impaired, which can result in nonreassuring fetal heart rate patterns, such as bradycardia or decelerations (as this patient had). The first step when addressing a nonreassuring fetal heart rate pattern caused by uterine hyperstimulation is to stop the oxytocin infusion. To initiate amnioinfusion (choice A) would not be correct at this time. Amnioinfusion is used during labor and delivery for persistent variable deceleration or meconium, but this patient™s main problem seems to be uterine hyperstimulation. The oxytocin therefore should be turned off as the first step. To perform cesarean delivery (choice B) at this point in the management of this patient would not be correct. The uterine hyperstimulation is likely causing this nonreassuring fetal tracing; therefore, this problem should be addressed by stopping the oxytocin that is stimulating the uterus to contract. If the fetus continues to have a nonreassuring fetal heart rate tracing despite this or other measures, cesarean delivery can be undertaken. To perform fetal scalp pH sampling (choice C) would not be correct. Fetal scalp sampling can be used during labor and delivery to further evaluate a fetus with a nonreassuring fetal heart rate tracing. This fetus, however, needs relief from the uterine hyperstimulation as the primary measure. To perform forceps-assisted vaginal delivery (choice D) would not be correct. The patient is not fully dilated. She is only 8 cm dilated and, therefore, forceps should not be used.
01-07-2009, 01:06 AM
17. The correct answer is E. In modern obstetric practice in
many countries, most patients have electronic fetal monitoring during labor and delivery. A nonreassuring fetal heart rate is one of the most common indications for cesarean delivery. It is, therefore, vital to be able to interpret and respond appropriately to various fetal heart rate patterns. The patient in this scenario has uterine hyperstimulation. Uterine hyperstimulation is defined as a persistent pattern of more than five contractions in 10 minutes that may or may not result in a nonreassuring fetal heart rate pattern.Hyperstimulation can also be defined as contractions lasting 2 minutes or more, or contractions or normal duration occurring within 1 minute of each other. During uterine hyperstimulation, fetal oxygenation often is impaired, which can result in nonreassuring fetal heart rate patterns, such as bradycardia or decelerations (as this patient had). The first step when addressing a nonreassuring fetal heart rate pattern caused by uterine hyperstimulation is to stop the oxytocin infusion. To initiate amnioinfusion (choice A) would not be correct at this time. Amnioinfusion is used during labor and delivery for persistent variable deceleration or meconium, but this patient™s main problem seems to be uterine hyperstimulation. The oxytocin therefore should be turned off as the first step. To perform cesarean delivery (choice B) at this point in the management of this patient would not be correct. The uterine hyperstimulation is likely causing this nonreassuring fetal tracing; therefore, this problem should be addressed by stopping the oxytocin that is stimulating the uterus to contract. If the fetus continues to have a nonreassuring fetal heart rate tracing despite this or other measures, cesarean delivery can be undertaken. To perform fetal scalp pH sampling (choice C) would not be correct. Fetal scalp sampling can be used during labor and delivery to further evaluate a fetus with a nonreassuring fetal heart rate tracing. This fetus, however, needs relief from the uterine hyperstimulation as the primary measure. To perform forceps-assisted vaginal delivery (choice D) would not be correct. The patient is not fully dilated. She is only 8 cm dilated and, therefore, forceps should not be used. |
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