Match each intrapartum clinical scenario to the most likely obstetric diagnosis.
- A patient laboring after a prior classical cesarean delivery experiences sudden cessation of uterine contractions, loss of fetal station, and severe, tearing abdominal pain. Fetal monitoring shows profound bradycardia.Uterine rupture
- Immediately after artificial rupture of membranes for a fetus at -3 station, fetal monitoring shows sudden, prolonged bradycardia. Vaginal examination reveals a palpable, soft pulsating structure ahead of the presenting part.Umbilical cord prolapse
- During the second stage of labor, the fetal head is delivered but then tightly retracts against the maternal perineum. Standard gentle downward traction fails to deliver the anterior shoulder.Shoulder dystocia
- A patient with chronic hypertension presents in active labor with severe, unremitting abdominal pain, a rigid, hypertonic uterus, and dark vaginal bleeding. Fetal monitoring reveals frequent late decelerations.Placental abruption
- A patient with a known velamentous cord insertion experiences painless, bright red vaginal bleeding immediately upon spontaneous membrane rupture. Fetal monitoring rapidly evolves to a sinusoidal heart rate pattern.Ruptured vasa previa
Cevap
The correct matches pair each classic clinical presentation with its corresponding obstetric emergency: 1) Prior uterine surgery with sudden loss of contractions and fetal station indicates Uterine rupture. 2) Amniotomy with an unengaged head leading to a palpable pulsating mass indicates Umbilical cord prolapse. 3) Retraction of the fetal head against the perineum ('turtle sign') indicates Shoulder dystocia. 4) A rigid, hypertonic uterus with painful dark bleeding in a hypertensive patient indicates Placental abruption. 5) Painless vaginal bleeding with membrane rupture and a fetal sinusoidal pattern in a patient with velamentous cord insertion indicates Ruptured vasa previa.
This question requires distinguishing the classic clinical presentations of major intrapartum emergencies. Uterine rupture typically occurs in patients with prior uterine scars and presents with severe pain, sudden cessation of uterine contractions, and loss of fetal station. Umbilical cord prolapse happens when the cord descends alongside or past the presenting part, often triggered by amniotomy at a high station, presenting with abrupt fetal bradycardia and a palpable pulsating mass. Shoulder dystocia occurs when the anterior fetal shoulder becomes impacted, leading to the hallmark 'turtle sign' (retraction of the delivered fetal head). Placental abruption involves premature separation of the placenta, is strongly associated with hypertension, and presents with painful, dark vaginal bleeding and a rigid, hypertonic uterus. Finally, ruptured vasa previa occurs when unprotected fetal vessels tear upon membrane rupture; because the bleeding is fetal, it leads to rapid exsanguination marked by painless bleeding and a sinusoidal fetal heart rate pattern.
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Anahtar Kavram
Differentiation of acute intrapartum obstetric emergencies based on their classic clinical and pathophysiologic presentations.