Four hours after undergoing a cesarean delivery at term followed by tubal ligation, a 37-year-old wo

Discussion in 'USMLE Step 2 CK' started by samuel, Nov 16, 2014.

  1. samuel

    samuel New Member

    Four hours after undergoing a cesarean delivery at term followed by tubal ligation, a 37-year-old woman, gravida 2, para 2, has dizziness and confusion. The operation was uncomplicated, and blood loss is estimated to be 800 mL. Patient-controlled epidural analgesia has been moderately effective for pain. Her blood pressure now is 80/40 mm Hg, decreased from 120/72 mm Hg intraoperatively, and pulse is 152/min, increased from 96/min intraoperatively. Breath sounds are decreased bilaterally. No murmurs are heard. Abdominal examination shows distention and tenderness. Bowel sounds are absent. The incision is intact with no drainage. She is disoriented to person, place, and time. Her hematocrit is 23%; preoperative hematocrit was 35%. Which of the following is the most likely cause of the hemodynamic changes?

    A
    ) Epidural-related hypotension

    B
    ) Insufficient intraoperative fluid replacement

    C
    ) Postoperative intra-abdominal hemorrhage

    D
    ) Supine hypotensive syndrome

    E
    ) Underestimated intraoperative blood loss

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