A woman in labour with twins successfully delivers her first baby vaginally. The second baby however is in breech position and still intrauterine.
Which of the following is the least appropriate management?
Correct Answer A:
Under such unusual circumstances, when a second twin is breech or a breech vaginal birth is progressing quickly, a cesarean is neither recommended nor possible.
There are several different types of vaginal breech deliveries:
A pregnant woman presents in labor at 39 weeks gestation. Her fetus is at zero station and she is dilated 10 cm. She also is noticed to have a bulging membrane.
What is the most appropriate management?
Correct Answer D:
The 1st stage, from onset of labor to full dilation of the cervix (about 10 cm), has 2 phases, latent and active. During the latent phase, irregular contractions become progressively better coordinated, discomfort is minimal, and the cervix effaces and dilates to 4 cm.
During the active phase, the cervix becomes fully dilated, and the presenting part descends well into the midpelvis. On average, the active phase lasts 5 to 7 hours in nulliparas and 2 to 4 hours in multiparas.
If the membranes have not spontaneously ruptured, some clinicians use amniotomy (artificial rupture of membranes) routinely during the active phase. As a result, labor may progress more rapidly, and meconium-stained amniotic fluid may be detected earlier.
Amniotomy during this stage may be necessary for specific indications, such as facilitating internal fetal monitoring to confirm fetal well-being. Amniotomy should be avoided in women with HIV infection or hepatitis B or C, so that the fetus is not exposed to these organisms.
What is the most common cause of neonatal mortality in twin pregnancies?
Which one of the following is not an initial screening investigation for infertility?
The process to diagnose the cause for infertility usually begins with physical exams and health and sexual histories. If there are no obvious problems, like poorly timed intercourse or absence of ovulation, tests will be needed.
For a man, doctors usually begin by testing his semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.
For a woman, the first step in testing is to find out if she is ovulating each month. There are several ways to do this. A woman can track her ovulation at home by recording changes in her morning body temperature (basal body temperature) for several months. Doctors can also check if a woman is ovulating by doing blood tests and an ultrasound of the ovaries. If the woman is ovulating normally, more tests are needed.
Hysterosalpingography and laparoscopy can be done after the initial tests if necessary.
A 40-year-old man and his 34-year-old wife are being evaluated for infertility. The woman's gynecologist reports that the woman had a normal anatomic and physiologic evaluation and suggests the need for assessment of potential male factors. On examination, the man is 188 cm (6 ft 2 in) tall with fair skin and little facial hair. His testicles are small and firm, and he has mild gynecomastia. No sperm are seen on analysis of his semen.
Which of the following tests is most likely to establish the underlying cause of the infertility?
This history is typical of Klinefelter syndrome, in which boys have an extra X chromosome. Despite this fact, they are normal in appearance before puberty. Though they are normal in appearance before puberty, after puberty they have gynecomastia, small and firm testes, and disproportionately long legs and arms. The test most likely to establish the chromosome pattern is karyotype from peripheral leukocytes.
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