USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

(Kiana) #1

OB TRIAD


Prolonged   Latent  Phase

Diagnosis. Prolonged latent phase requires that, in the face of regular uterine
contractions, the cervical dilation is <6 cm for a duration of >20 h in a primipara
or >14 h in a multipara.


Cause. Latent-phase abnormalities are most commonly caused by injudicious
analgesia. Other causes are contractions, which are hypotonic (inadequate
frequency, duration, or intensity) or hypertonic (high intensity but inadequate
duration or frequency).


Management. This involves (a) therapeutic rest with narcotics or sedatives, (b)
oxytocin administration, or (c) amniotomy. Cesarean delivery is never
appropriate management for prolonged latent phase.


Pregnant    with    regular uterine contractions
Cervix dilated 2 cm
No cervical change in 14 h
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