07-20-2009, 06:59 AM
whats the mode of delivery.............
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platypelloid pelvis - northeast
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07-20-2009, 08:20 AM
Trial of labor.
If there is indeed CPD, then C/S. This was recently discussed. I would love to hear differing views... http://www.usmleforum.com/showthread.php?tid=429553
07-20-2009, 08:23 AM
what is source of info docholiday
any reliable online links ? I am not able to find any useful info on platypelloid pelvis this q is important.
07-20-2009, 08:26 AM
i agree. vaginal delivery is the answer in that NBME q because fetal head is descending.
if not possiblethan CS
07-20-2009, 08:51 AM
Harry: the fact that I do not have solid references bothers me. From searching around in everything from ObGYN books to mid-wives books, the only mention I ever see about the platy, is 'typically a TOL is recommended'.
I have no solid source that presents a formal guideline or clinical recommendation. I'll keep looking though. I agree also that this q is important... Where are the OBGYN residents? Actually, my Wife's friend is an Ob/Gyn attending. Perhaps I'll give her a call. I'll be sure to post any info that I find.
07-22-2009, 11:41 PM
OK...sorry for the delay.
According to the obsetrician that lives two doors down from me, the currently practiced management of a platy is TOL. But there are many factors to consider. For instance, if the kid is known to be macrosomic, section. If it looks like a normal sized kid, give it a shot. If it doesn't work out, section. But its also up to Mom. If Mom is concerned about this, and wants the section, then the provider may just schedule a date and do it.
07-23-2009, 07:53 AM
this is the question:
26. A 26-year-old primigravid woman at 38 weeks' gestation is admitted to the hospital because she is in labor; contractions occur every 3 minutes and last 60 seconds. The patient's prenatal course has been uncomplicated. Labor curve is now normal and fetal heart rate tracing shows good variability with an occasional mild deceleration. Her patient chart indicates that a previous physician thought she might have a platypellic pelvis. She is now 10-cm dilated. The fetus is at +1 station with a mentum-anterior face presentation. Which of the following is the most appropriate management at this time? A) Deliver the child vaginally after manually rotating the fetus to a mentum-posterior presentation B) Deliver the child vaginally with the aid of forceps C) Deliver the child vaginally with the aid of vacuum extraction D) Deliver the child vaginally without intervention E) Deliver the child via emergency cesarean delivery I think: Answer=B  The question asks: œmost appropriate management at this time “maybe, after that, we need to make a different management if the first attempt or trial doest work. If the management of 'this condition' was only one, the question would ask for œthe next step  Gestation: at term  Contractions: good  No maternal factor risks, except platypellic pelvis [the wide suprapubic arches similar to gynecoid tend to allow vaginal delivery]; the problem would be a transverse arrest  Labor curve is normal and fetal heart activity is good  Good cervical dilation 10 cm [maximum in Bishop scoring system  Station: +1 [just past the ischial spines] maximum scoring in Bishop scoring  Only problem: malpresentation [face]; but vaginal delivery is possible ONLY IF THE FETUS IS MENTUM ANTERIOR-[if mentus posterior cannot delivery vaginally]  Mentoanterior delivery: is possible with episiotomy and assistance with forceps [ventouse extractor is contraindicated]=> failure to progress in the next stage of labor necessitates a cesarean section A=incorrect [mento posterior presentation=cesarean indication] C=contraindicated D=she need any intervention E=possible next step if a trial of vaginal delivery with forceps fails |
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