tailieunhanh - Thực hành xử lý sản khoa - Trường hợp 9

Tham khảo tài liệu 'thực hành xử lý sản khoa - trường hợp 9', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 32 A healthy 19-year-old Cl PO at 29 weeks gestation presents to the labor and delivery area complaining of intermittent abdominal pain. She denies leakage of fluid or bleeding per vagina. Her antenatal history has been unremarkable. She has been eating and drinking normally. On examination her BP is I 10 70 HR 90 min and temperature 99 F. The fetal heart rate tracing reveals a baseline heart rate of 120 bpm and a reactive pattern. Uterine contractions are occurring every 3 to 5 min. On pelvic examination her cervix is 3-cm dilated 90 effaced and the fetal vertex is presenting at -1 station. What is the most likely diagnosis What is your next step in management 266 CASE FILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 32 Preterm Labor Summary A healthy 19-year-old Gl PO at 29 weeks gestation complains of intermittent abdominal pain. Her vital signs are normal. The fetal heart rate tracing reveals a baseline heart rate of 120 bpm and is reactive. Uterine contractions are noted every 3 to 5 min. Her cervix is 3-cm dilated 90 effaced and the fetal vertex is presenting at -1 station. Most likely diagnosis Preterm labor. Next step in management Tocolysis try to identify a cause of the preterm labor antenatal steroids and antibiotics for GBS prophylaxis. Analysis Objectives 1. Understand how to diagnose preterm labor. 2. Understand that the basic approach to preterm labor is tocolysis identification of an etiology and steroids if appropriate . 3. Know the common causes of preterm delivery. Considerations This 19-year-old nulliparous woman is at 29 weeks gestation and complains of intermittent abdominal pain. The monitor indicates uterine contractions every 3 to 5 min and her cervix is dilated at 3 cm and effaced at 90 . This is sufficient to diagnose preterm labor in a nullip-arous woman. If she had a previous vaginal delivery the diagnosis may not be as clear-cut. Because of the significant prematurity many practitioners may elect to treat for preterm labor. A .