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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.

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Routine Prenatal LABS

by trimester?

1st

2nd

3rd

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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

INTERPRETATION:
strongly predictive of normal
acid-base status at this time
ACTION: routine monitoring

INTERPRETATION:
not predictive of abnormal acidbase status at this time
ACTION: continued surveillance &
reevaluation

Category III

ABNORMAL

ABSENT VARIABILITY plus any of following:

Recurrent LATE decelerations
Recurrent VARIABLE decelerations
Bradycardia
Sinusoidal pattern

INTERPRETATION:
strongly predictive of abnormal
acid-base status at this time
ACTION: intrauterine resuscitation;
if no resolution then prompt
delivery

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