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 D
Explanation
Choice A rationale
A respiratory rate of 18 breaths/min is normal and does not indicate magnesium toxicity or the need for calcium gluconate.
Choice B rationale
Urinary output of 30 mL/hr is within the acceptable range and does not suggest magnesium toxicity. This indicates adequate renal function.
Choice C rationale
Patellar reflexes rated at one indicate mild hyporeflexia, which can be a side effect of magnesium sulfate but does not necessitate immediate intervention.
Choice D rationale
Serum magnesium level of 10 mg/dL is significantly elevated, indicating magnesium toxicity. Calcium gluconate is the antidote for magnesium toxicity and should be administered
promptly to prevent severe complications.
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale
Massaging the fundus helps to stimulate uterine contractions, reducing bleeding and promoting firmness in the uterus. Ensuring IV access is critical for administering medications and
fluids quickly.
Choice B rationale
Methylergonovine (Methergine) is used to prevent and control postpartum hemorrhage by promoting uterine contractions. Oxytocin bolus also helps stimulate contractions, preventing
further blood loss.
Choice C rationale
Carboprost tromethamine (Hemabate) is another uterotonic agent used to control severe postpartum hemorrhage by causing uterine contractions. Its use depends on the patient's
response to other treatments.