10/21/13&

USMLE Step 2 CK
Obstetrics-Gynecology
OB Supplement – part 1

Elmar P. Sakala, MD, MPH

Professor of Gynecology & Obstetrics
Loma Linda University School of Medicine
October, 2013
© Elmar P. Sakala, MD, MPH (2013) No part of this document can be reproduced or transmitted,
in any form, or be any means, without the written permission of the author.

J J

1&
 10/21/13&

J J

J J

2&
 10/21/13&

J J

J
Routine Prenatal LABS
by trimester?

1st 2nd 3rd

3&
 10/21/13&

J J

J J

4&
 10/21/13&

J J

J J

5&
 10/21/13&

J J

J J

6&
 10/21/13&

J J

J J

7&
 10/21/13&

J J

J J

8&
 10/21/13&

J J

J J

9&
 10/21/13&

J J

J J

10&

J 3-tiered categorization of FHR patterns
Category I NORMAL
 Baseline rate: 110-160 beats/min
 Baseline variability: moderate
 Late or Variable decelerations: absent
 Early decelerations: present or absent
 Accelerations: present or absent
Category III ABNORMAL
ABSENT VARIABILITY plus any of following:
 Recurrent LATE decelerations
 Recurrent VARIABLE decelerations
 Bradycardia
 Sinusoidal pattern
J J
10/21/13&
INTERPRETATION:
strongly predictive of normal
acid-base status at this time
ACTION: routine monitoring
INTERPRETATION:
not predictive of abnormal acid-
base status at this time
ACTION: continued surveillance &
reevaluation
INTERPRETATION:
strongly predictive of abnormal
acid-base status at this time
ACTION: intrauterine resuscitation;
if no resolution then prompt
delivery
11&