Ob/Gyn 5
TheOne - 05-14-07 17:51

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?


a. Perform external podalic version to breech position and deliver vaginally, in order to decrease the likelihood of shoulder dystocia
b. Place the mother on a 500-calorie/day diet in order to slow fetal weight gain
c. Perform a cesarean section based on the clinical estimate of above-normal fetal size
d. Order ultrasonography and perform a cesarean section if estimated fetal weight is 4000 g
e. Plan vaginal delivery, with personnel in the delivery room who are trained to assist with a difficult shoulder delivery should it occur