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A 26-year-old primigravida woman comes to the labor and delivery ward at term with regular, painful contractions. Her prenatal course was unremarkable. She has a past medical history suggestive of mitral valve prolapse with regurgitation which is demonstrated on echocardiography. She takes no medications and has no allergies to medications. Examination shows that her cervix is 4 centimeters dilated and the fetus is in vertex presentation. The fetal heart rate is reassuring. Which of the following is the most appropriate management for this woman:

A 26-year-old primigravida woman comes to the labor and delivery ward at term with regular, painful contractions. Her prenatal course was unremarkable. She has a past medical history suggestive of mitral valve prolapse with regurgitation which is demonstrated on echocardiography. She takes no medications and has no allergies to medications. Examination shows that her cervix is 4 centimeters dilated and the fetus is in vertex presentation. The fetal heart rate is reassuring. Which of the following is the most appropriate management for this woman: Correct Answer Administer intravenous antibiotics 30 minutes prior to the delivery

Explanation

  • Antibiotics are frequently prescribed medication during pregnancy and lactation.

Key Points 

  • It is mainly focused to prevent neonatal Group B streptococcus (GBS) sepsis or cesarean prophylaxis.
  • The antibiotics help the baby from infection.
  • But only if given during labor.
  • We will not give antibiotics before labor because the bacteria can grow back quickly.​
  • A commonly suggested type of antibiotic is beta-lactam.
  • It is a combination of penicillin and ampicillin.

Important Points 

Vertex presentation -

  • vertex presentation indicates that the crown of the head or vertex of the baby is towards the cervix.

Primigravidae:

  • it is defined as a woman who goes pregnant for the first time.

Mitral valve prolapse can lead to mitral insufficiency.

Stage 1: from Onset of true labor to full dilation of the cervix

  • Latent Phase
    • Cervix dilates 3-4cm
    • Mild and short contractions
  • Active Phase
    • The cervix dilates to 4-7cm
    • Moderate to strong contractions (5min apart)
    • Bloody show
  • Transition Phase
    • Cervix dilates 7-10cm
    • Strong contractions (1-2min apart)
    • Leg tremors, perspiration, and flushed faces

Related Questions

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Statement : Residents from Model Colony coming under North Ward of City X have complained to the Ward Officer that for last three days the tap water in the ward is contaminated and no action is being initiated by municipal staff.

Courses of Action :
I. The Ward Officer of North Ward should initiate action against residents who have lodged complaints against municipal staff.
II. The Ward Officer should ask his junior officer to visit Model Colony to assess the actual condition of water with his staff and to get samples of water tested from laboratories.
III. The Ward Officer should ask Ward Engineer to check water installations and pipelines in the Model Colony area.
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