Delivery Emergencies

Chapter 95 Delivery Emergencies




Clinical Case Problem 1: ***


A 27-year-old at 39   weeks of gestation presents in active labor. Her pregnancy has been uncomplicated and her prior two deliveries were vaginal. Vital signs are normal, and fetal heart tones are reassuring. She is contracting every 3 to 6 minutes. Her cervix is 5 cm dilated, 100% effaced, and the head is at −3 station. The fetal head is not engaged. Twenty minutes later, the patient experiences a large gush of clear fluid, and deep variable decelerations appear, followed by fetal bradycardia. Contractions remain every 3 to 6 minutes.



Select the best answer to the following questions




1. What is the most likely diagnosis?


a. uterine rupture

b. placental abruption

c. placenta previa

d. cord prolapse

e. vasa previa

2. Which of the following is not a risk factor for this condition?


a. polyhydramnios

b. nulliparity

c. malpresentation

d. preterm labor

e. multifetal gestation

3. You accurately diagnose the problem. Her cervix is still 5   cm dilated. What is the appropriate immediate next step?


a. saline amnioinfusion

b. nonstress test (NST)

c. manual elevation of the presenting part

d. manual replacement of the umbilical cord

e. obstetric ultrasound examination

4. What is the best mode of delivery for this patient?


a. emergency cesarean section

b. operative vaginal delivery with forceps

c. operative vaginal delivery with vacuum

d. spontaneous vaginal delivery if fetal heart tones are reassuring


Clinical Case Problem 2: Bleeding during Labor


A 29-year-old multigravida presents to the emergency department with abdominal pain and vaginal bleeding. She is “about 8   months” pregnant and has had no prenatal care. She admits to cocaine use. Vital signs are blood pressure 155/82   mm Hg, pulse 110 beats/minute, respiratory rate 18 breaths/minute, and temperature 99.2° F. She is contracting every minute. Fetal heart tones are 175 with minimal variability. Bedside ultrasound examination reveals a fetus of 30-week size and a fundal placenta. Her cervix is 3 cm dilated, 25% effaced, and the head is at −2 station. with a moderate amount of blood coming from the os.



5. What is the most likely diagnosis?


a. placenta previa

b. placental abruption

c. uterine rupture

d. umbilical cord prolapse

6. What is the incidence of this condition?


a. 1/10,000

b. 1/1000

c. 1/100

d. 1/50

7. Risk factors for this condition include all of the following except


a. opiates

b. cocaine

c. preeclampsia

d. blunt abdominal trauma

8. Maternal risks associated with this condition include all of the following except


a. death

b. hysterectomy

c. disseminated intravascular coagulation (DIC)

d. myocardial infarction

e. renal failure

9. Which gestational age has the highest incidence of this condition?


a. 24 to 26 weeks

b. 28 to 30 weeks

c. 32 to 34 weeks

d. 36 to 38 weeks

e. 40 or more weeks

10. Which of the following is the most accurate statement about this condition?


a. vaginal bleeding is always present

b. it may be mistaken for preterm labor

c. ultrasound has a high diagnostic sensitivity

d. fetal distress is always present

e. labor is usually protracted


Clinical Case Problem 3: Bleeding before Labor


A 22-year-old primigravida at 31   weeks presents with vaginal bleeding since last night, a few hours after vaginal intercourse. She is from out of town and has no prenatal records. The bleeding has remained at a light trickle. She denies abdominal pain, contractions, dizziness, or decreased fetal movement. Vital signs are normal. Fetal heart tones are reassuring. Her hemoglobin is 12. An intravenous line is placed.



11. What is the appropriate next step?


a. obstetric ultrasound examination

b. digital cervical examination

c. laboratory studies for inherited bleeding disorders

d. emergent cesarean section

12. Ultrasound examination shows the placental edge extending to, but not covering any part of, the internal cervical os. What term best describes her condition?


a. complete placenta previa

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Delivery Emergencies

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