Mia is a G7P6 who is 39 weeks and 2 days. She has come to obstetrics (OB) triage complaining of contraction pain every 3 to 5 minutes, has a large amount of bloody show, and tells you her last two deliveries took about 2 hours.
What would you expect her diagnosis to be and what would be your next step?
She is experiencing labor dystocia. The provider will be called to assess the need for an immediate cesarean section, and you would begin to prepare the patient for surgery.
She is at risk for a precipitous labor. The provider will be called to the bedside immediately while you remain at Mia's side providing support and preparing her for delivery.
She is at risk for cephalopelvic disproportion. The provider will be called to assess the need for a forceps delivery, and you will call the blood bank in order to have blood on standby.
She is experiencing false labor. The provider will be called to reassess and you will monitor her closely.
The Correct Answer is B
Choice A rationale
Labor dystocia involves prolonged labor. Her fast delivery history suggests the opposite, indicating rapid labor progress.
Choice B rationale
Rapid labor progression, frequent contractions, and previous short labors suggest she is at risk for precipitous labor, requiring immediate preparation for delivery.
Choice C rationale
Cephalopelvic disproportion indicates size mismatch between baby and pelvis, not rapid labor. Her history of quick deliveries does not align with this condition.
Choice D rationale
False labor typically involves irregular, less intense contractions. Her regular, intense contractions and labor history suggest active labor, not false labor.
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Correct Answer is C
Explanation
Choice A rationale
Dexamethasone does not directly stop labor contractions; instead, it is used to enhance fetal lung maturity.
Choice B rationale
Dexamethasone is not for infection prevention; antibiotics are used for that purpose in cases of premature rupture of membranes.
Choice C rationale
Dexamethasone is administered to enhance fetal lung maturity, reducing the risk of respiratory distress syndrome in preterm infants.
Choice D rationale
Dexamethasone is not used for pain relief in preterm labor; other medications are prescribed for pain management.
Correct Answer is A
Explanation
Choice A rationale
Methylergonovine (Methergine) is used to manage postpartum hemorrhage by stimulating uterine contractions. It is especially useful in cases like this where rapid uterine tone is needed.
Choice B rationale
Magnesium sulfate is used to prevent seizures in preeclamptic patients, not to manage postpartum hemorrhage. This choice is incorrect in this context.
Choice C rationale
Carboprost-tromethamine (Hemabate) is also used for treating postpartum hemorrhage but is typically a secondary option to methylergonovine and may have more side effects.
Choice D rationale
Fresh frozen plasma (FFP) is used to replace clotting factors in cases of coagulopathy, not as a primary intervention for postpartum hemorrhage in this patient.