Social Sciences Main社会医学 21-29.pptxVIP

Social Sciences Main21-29Q 1A 32~year-old woman at 42 weeks of gestation is admitted to the labor and delivery unit because of increased fetal movement and uterine contractions every 7 minutes. Her biood pressure is 120/60 mm Hg, pulse is 78/min: and respirations are 12/min. Fetal heart monitoring indicates that the fetus is in mild distress. An ultrasound confirms fetal macrosomia and findings suspicious for oligohydramnios. The patient is informed of the need for cesarean section. She is told that she is at significant risk of perineal laceration with vaginal delivery and that the fetus is at risk for asphyxia and death without an emergent cesarean section. However, she refuses to undergo cesarean section and insists on vaginal delivery. Further discussion reveals that she fully understands the risks of refusing the procedure, but insists on vagina! delivery. Which of the following is the most appropriate next step?A.Proceed with emergent cesarean section because there is evidence of fetal distressB.Proceed with emergent cesarean section because the fetus rights are more important than the patients autonomyC.Respect the patients decision, and proceed with vaginal deliveryD.Seek out an alternative decision maker who will make better decisionsE. eek a court order forcing the mother to undergo emergent cesarean sectionA 1 Correct answer: CThis patient presents with post-term pregnancy, defined as a pregnancy that extends to or beyond 42 weeks gestation. Fetal risks from post-term pregnancy include asphyxia, death, meconium aspiration, and intrauterine infection. Current recommendations advise emergent cesarean section if there are signs of fetal distress or oligohydramnios, as seen in this patient. Otherwise, expectant management with vaginal delivery is an option in select stable patients.In obstetrics, the medical decisions made by one patient (the mother) can directly affect the outcome of another (the fetus). In certain situations, such as this one, conflict can