repetitive accelerations

Discussion in 'USMLE STEP 2 CS' started by Devil., Apr 25, 2008.

  1. Devil.

    Devil. Guest

    27 year old G2P1 @37 weeks. Twin pregnancy.
    Comes in for management of labor. She has had regular painful contractions for 4 hours. Membranes ruptured before arrival.
    Her prenatal course, tests and fetal growth have been normal with no complications.
    Her previous pregnancy was uncomplicated and she delivered a 3500g (7lb) baby vaginally.
    Exam shows a soft cervix that is 50% effaced, and 2cm dilated. US shows twin gestation in the vertex-vertex presentation. After 12 hours, the cervix has not significantly changed. Cardiac activity of both fetuses shoes repetitive accelerations with a baseline of 140bpm. Which of the following is the most appropriate next step in management:

    A. Therapeutic Rest
    B. Ripenining of the cervix using prostaglandin
    C. Administer IV Oxytocin
    D. Do forceps delivery
    E. Do a low-segment C section.

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