Labour: uterine tachysystole: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Labour: uterine tachysystole

Sample item

A woman at 40 weeks who had a dinoprostone vaginal insert placed 6 hours ago now has 7 contractions in 10 minutes with recurrent late decelerations. What is the most appropriate immediate action?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Remove the insert, place her in the left lateral position and consider subcutaneous terbutaline

Tachysystole is more than five contractions in 10 minutes averaged over 30 minutes, and it is significant when accompanied by fetal heart rate abnormalities. A removable insert should be taken out, the woman positioned laterally, oxygen and fluids considered, and terbutaline 0.25 mg subcutaneously given if needed. Further stimulation would worsen fetal hypoxia.

Option by option

  • A. Start an oxytocin infusion

    Oxytocin would add further uterine stimulation.

  • B. Remove the insert, place her in the left lateral position and consider subcutaneous terbutaline (correct)

    Correct. Stop the stimulant, reposition and consider tocolysis for tachysystole with fetal compromise.

  • C. Proceed to forceps delivery

    Forceps are not possible before full dilatation and do not address the cause.

  • D. Increase the dose of dinoprostone

    More prostaglandin would aggravate the hyperstimulation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Remove the insert, place her in the left lateral position and consider subcutaneous terbutaline. Tachysystole is more than five contractions in 10 minutes averaged over 30 minutes, and it is significant when accompanied by fetal heart rate abnormalities.

Why is "Start an oxytocin infusion" not the answer?

Oxytocin would add further uterine stimulation.

Why is "Proceed to forceps delivery" not the answer?

Forceps are not possible before full dilatation and do not address the cause.

Why is "Increase the dose of dinoprostone" not the answer?

More prostaglandin would aggravate the hyperstimulation.

What concept does this question test?

It tests Labour: uterine tachysystole in OBG. A removable insert should be taken out, the woman positioned laterally, oxygen and fluids considered, and terbutaline 0.25 mg subcutaneously given if needed. Further stimulation would worsen fetal hypoxia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Labour: uterine tachysystole?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.