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Daily Test ( 15 sep )
1. A 27-year-old nondiabetic multiparous woman at 39 weeks gestation has had a previously uncomplicated pregnancy. Fundal height and estimates of fetal size have been at the upper limits of normal for several weeks. Today the fundus measures 44 cm from the pubis and you estimate on palpation that the fetus is large. Clinical pelvimetry is normal.
Which one of the following treatment plans is supported by objective clinical evidence-
No study has demonstrated improvement in fetal outcome with cesarean delivery for estimatedfetal weight above 4800 g, either estimated by fundal measurement and palpation or byultrasonography, except in the case of diabetic women.
Statistical estimates show greater increased morbidity and mortality for the mother than any achievable decrease in fetal morbidity and mortality. Therefore, vaginal delivery should generally be planned with delivery room personnel present to assist, should shoulder dystocia occur.
An extremely low-calorie diet would be contraindicated and dangerous to both mother and fetus.
External podalic version would be contraindicated and place the fetus at risk of a dangerous breech delivery.
2. Severe growth retardation is diagnosed in the fetus of a 19-year-old unmarried white female at 36 weeks gestation. The diagnosis is based on biparietal diameter and there is scant amniotic fluid.Which one of the following is the most appropriate management?
Appropriate management of the preterm infant who is severely growth retarded depends onseveral factors. Generally those near term should be delivered promptly. By the time that growthretardation has become severe, the fetus is usually mature enough to survive if deliveredpromptly. However, the fetus must be monitored carefully during labor, with facilities forimmediate cesarean section if there is deterioration, and the neonate must receive excellentneonatal care beginning immediately after delivery.
3. Following a prolonged labor and traumatic delivery, a 5015 gram (11 lb 1 oz) white male infant holds his right arm in an abducted and internally rotated position with extension at the elbow, pronation of the forearm, and flexion of the wrist. Although the grasp reflex is intact, the biceps and brachioradialis reflexes are absent.
The most likely diagnosis is a-
The clinical picture in this infant is typical of brachial plexus injury.
Most cases of brachial plexus injury follow a prolonged and difficult labor culminating in a traumatic delivery.
Duchenne-Erb (upper arm) paralysis, resulting from injury of the fifth and sixth cervical roots, isby far the most common manifestation of this disorder. The infant with upper arm paralysis holdsthe affected arm in a characteristic position, reflecting involvement of the shoulder abductors andexternal rotators, forearm flexors and supinators, and wrist extensors.
In addition, the Moro, biceps, and brachioradialis reflexes are absent.
Cerebral injury is usually evidenced by other signs of central nervous system damage. Typically, rotator cuff tears are not associated with neurologic findings
4. Which one of the following is an absolute contraindication to tocolytic treatment for preterm labor?
Before tocolytic treatment is instituted, absolute contraindications to tocolysis must be ruled out.
Chorioamnionitis may precipitate preterm labor and is an absolute contraindication to tocolysis. It may be present in a febrile pregnant patient even with intact membranes. In this case amniocentesis may be required to rule out infection.
5. Ultrasonography reveals placenta previa in a 41-year-old asymptomatic gravida 4 para 3 at 21 weeks gestation. Appropriate management would be:
The incidence of placenta previa ranges from 6% to 45% in the second trimester, but more than95% of these resolve by the third trimester. However, it remains a cause for concern and shouldbe watched, not ignored, even if there is no bleeding. This patient should have repeatultrasonography in her third trimester. Weekly speculum examinations would create a risk of hemorrhage.Delivery at 28 weeks would not be appropriate in a patient with no symptoms and withoutconfirmation of the persistence of placenta previa.
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