Free active labor review questions sample from Med-Challenger.
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This week’s case-based question:
A 40-year-old gravida 2 para 1001 woman presents to you at 40 weeks of gestation with painful contractions that she feels every 4 minutes.
On vaginal examination, her cervix is 4 cm dilated, 70% effaced, and the head is at -1/5 station. Membranes are still intact. On external tocometry, she is contracting every 3 to 5 minutes. Fetal monitoring is reassuring. Her examination 2 hours later is 5 cm dilated, 80% effaced, and -1/5 station; she is still contracting every 3 to 5 minutes and fetal monitoring remains reassuring.
Which of the following is the appropriate care for this patient?
Perform amniotomy as per routine.
Continue expectant management.
Perform amniotomy and begin oxytocin for prolonged active phase of labor.
Perform amniotomy, place an intrauterine pressure catheter to quantify her contraction strength, and deliver the fetus by cesarean delivery for active phase arrest if she is still 5 cm dilated in 2 hours despite adequate Montevideo units (MVUs > 200).
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