Test 26 – Obstetrics
A 29 year-old G1P0 at 41 weeks gestation presents for a prenatal visit. Her prenatal course is complicated by tobacco abuse and intermittent prenatal care. Her last visit was at 35 weeks. Prenatal l
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Test 26 – Obstetrics
A 29 year-old G1P0 at 41 weeks gestation presents for a prenatal visit. Her prenatal course is complicated by tobacco abuse and intermittent prenatal care. Her last visit was at 35 weeks. Prenatal labs are unremarkable except cervical culture positive for Chlamydia, which was treated, and a Pap smear with low-grade squamous intraepithelial lesion. Ultrasound at 21 weeks was consistent with gestational age. Her vitals reveal a blood pressure of 128/76; pulse 74; and temperature 98° F, 36.7°C . Fundal height is 39 cm with estimated fetal weight of 2700 gm. Cervix is dilated to 1 cm, 50% effaced, -2 station. What is the next best step in the management of this patient?
a) Non-stress test
b) Vibroacoustic stimulation test
c) Oxytocin challenge test
d) Return visit in 1 week
e) Cesarean section
Correct!!! The non-stress test is an assessment of fetal well-being that measures the fetal heart rate response to fetal movement. The normal or reactive non-stress test occurs when there are two fetal heart rate accelerations of 15 beats/minute for 15 seconds within 20 minutes. Vibroacoustic stimulation is not indicated unless the NST is non-reactive. Contraction stress test assesses uteroplacental insufficiency and looks for persistent late decelerations after contractions (3/10 minutes); however, it is not necessary to perform, as the non-stress test will assess fetal well being, also. Observation only would not be proper care as the patient is post-term. In the presence of abnormal testing, labor would be induced or a Cesarean section performed.
A 29 year-old G1P0 at 41 weeks gestation presents in early labor. The prenatal course was uncomplicated. Ultrasound at 21 weeks was consistent with gestational age. Her vitals reveal a blood pressure of 128/76; pulse 74; and she is afebrile. Fundal height is 36 cm with estimated fetal weight of 2700 gm. Cervix is dilated to 1 cm, 50% effaced and the fetal vertex is at -2 station. The nurse calls you to evaluate the fetal tracing. Which statement best describes the tracing seen below?
a) Normal fetal heart rate with good variability and regular contractions
b) Fetal tachycardia with good variability and regular contractions
c) Normal fetal heart rate with poor variability and regular contractions
d) Fetal tachycardia with poor variability and irregular contractions
e) Normal fetal heart rate with poor variability and irregular contractions
Correct!!! The baseline fetal heart rate is normal with good accelerations and regular contractions. There is no tachycardia. This is a reassuring tracing.
A 19 year-old G3P0 with spontaneous rupture of membranes for 13 hours presented to labor delivery. She had no prenatal care. Her vital signs are: blood pressure 120/70; pulse 72; afebrile; fundal height 36 cm; and estimated fetal weight of 2700 gm. Cervix is dilated to 1 cm, 50% effaced, -2 station. Which statement best describes the tracing seen below?
CONTINUED.....
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