USMLE Forum Archives - USMLE Step 3 - Obstetrics- Shoulder dystocia
Obstetrics- Shoulder dystocia
harry206 - 05-13-09 04:25
A 36-year-old gravida 6, para 5 Caucasian woman at 41 weeks of gestation is admitted to the labor and delivery unit after experiencing regular uterine contractions every 10 minutes and the spontaneous rupture of membranes. Her previous pregnancies were unremarkable except for asymptomatic bacteriuria that developed when she was pregnant with her first and third children and a cesarean delivery for her fourth child because of breech positioning. This current pregnancy had been uncomplicated except for obesity, and she weighed 272 lbs at admission. An oral glucose tolerance test was administered at 29 weeks of gestation and while her fasting plasma glucose was elevated, the other glucose levels were considered normal. The woman’s fundal height was 42 cm the day prior to admission. As her labor progresses, the cervix thins and completely dilates. The vertex of the fetus appears after 15 minutes of second stage labor. However, the fetal anterior shoulder is now proving undeliverable by gentle traction. What is the most appropriate next step?
harry206 - 05-13-09 04:25
A 36-year-old gravida 6, para 5 Caucasian woman at 41 weeks of gestation is admitted to the labor and delivery unit after experiencing regular uterine contractions every 10 minutes and the spontaneous rupture of membranes. Her previous pregnancies were unremarkable except for asymptomatic bacteriuria that developed when she was pregnant with her first and third children and a cesarean delivery for her fourth child because of breech positioning. This current pregnancy had been uncomplicated except for obesity, and she weighed 272 lbs at admission. An oral glucose tolerance test was administered at 29 weeks of gestation and while her fasting plasma glucose was elevated, the other glucose levels were considered normal. The woman’s fundal height was 42 cm the day prior to admission. As her labor progresses, the cervix thins and completely dilates. The vertex of the fetus appears after 15 minutes of second stage labor. However, the fetal anterior shoulder is now proving undeliverable by gentle traction. What is the most appropriate next step?
The correct answer and explanation will be available after you answer.
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#24
Re: Obstetrics- Shoulder dystocia babbu5508 - 08-30-10 01:28 My answer is: c.
Perform McRoberts maneuver for delivery of the impacted shoulder after delivery of the head...as here fetal anterior shoulder is now proving undeliverable by gentle traction
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