A 25-year-old primigravida at 38 weeks of gestation is being monitored in the Labor and Delivery Ward. Abdominal examination reveals an average size fetus of 3 kg in cephalic prese... A 25-year-old primigravida at 38 weeks of gestation is being monitored in the Labor and Delivery Ward. Abdominal examination reveals an average size fetus of 3 kg in cephalic presentation and well engaged head. Cervical examination shows 5 cm dilated, 70% effaced and -3 station for the last 4 hours. She is not distressed and not on epidural analgesia. Fetal monitoring is done (see image). Which of the following is the best next step of management? A. Start MgSO4 B. Start Oxytocin C. Cesarean section D. Reassess in 2 hours
Understand the Problem
The question describes a 25-year-old first-time mother at 38 weeks of gestation, and asks what the best next step of management is, with the following options: Start MgSO4, Start Oxytocin, cesarean section, or reassess in 2 hours.
Answer
Start Oxytocin
The best next step is to start oxytocin to augment labor and promote progression.
Answer for screen readers
The best next step is to start oxytocin to augment labor and promote progression.
More Information
Starting oxytocin is a common method to augment labor when there is a lack of progress, especially when the patient and fetus are stable.
Tips
A common mistake is opting for cesarean too early without attempting less invasive methods like oxytocin.
Sources
- Induction of labour at or beyond 37 weeks' gestation - PubMed Central - pmc.ncbi.nlm.nih.gov
- Cesarean Delivery: Overview, Preparation, Technique - emedicine.medscape.com
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