This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
[{'content': 'A primigravida with full term pregnancy in labor for 1 day is brought to casualty after dia handing. On examination she is dehydrated, slightly pale, bulse 100/min, BP120/80 mm Hg. abdominal examination reveals a fundal height of 36 weeks, cephalic presentation, foetal heart absent, mild uterine contractions present. On P/V examination, cervix is fully dialted, head is at +1 station, caput with moulding present, pelvis adequate. Dirty, infected discharge is present. What would be the best management option after initial work-up? \nSelect and explain. \nA. Cesarean section, B. Oxytocin drip, C. Ventouse delivery, D. Craniotomy and vaginal delivery', 'role': 'user'}, {'content': 'Answer: A \nExplanation: Well friends lets first analyse the condition of patient and then think about its management:\n\nPatient is primigravida\nOn examination:\n\n– Dehydration is present\n– P/R is 100/min, i.e. tachycardia present.\nPIA\n\nFundal height-36 weeks\nPresentation-cephalic\nFHS-Absent\nMild uterine contractions are present.\n\nP/V\n\nCervix-fully dilated\nStation = + 1\nCaput present\nMoulding present\nDirty infected discharge is present.\n\nMost importantly–Pelvis is adequate.\nThis patient is undoubtedly a case of obstructed labour. As we all know in nulliparous females in case of obstructed labour— a state of uterine exhaustion is reached manifested as weakened uterine conditions.\n\nIn such cases, if oxytocin drip is given it may lead to rupture of uterus as lower segment is thinned out (i.e. option ‘b’ ruled out).\nCraniotomy and other destructive procedures are not carried out in modern obstetrics (i.e., option ‘d’ ruled out).\n\nMgt: of obstructed labor cesarean section', 'role': 'assistant'}]