Welcome to episode 521 of the Divine Intervention Podcasts. In today's podcast, I'm going to be

continuing the series on the free 120 for step two, the one that's presently right now in

24 on the USMLEs website. We've done the first 20 questions. So this is going to be part four.

We're going to start off from question 21. All right. Let's get right into it. A 36-year-old woman, Gravita 2, Paral 1 at 39 weeks gestation, is admitted to the hospital in labor. She reports painful contractions that occur every two to three minutes and last 60 seconds.

She has not had vaginal bleeding.

She has no history of serious illness and pregnancy has been uncomplicated.

Temperature is 37 degrees Celsius, that's 98.6 degrees Fahrenheit.

Pulse is 84 per minute and regular, and blood pressure is 100 over 70 millimeters of mercury.

The abdomen is non-tender and consistent in size with a 39-week gestation.

External fetal monitoring shows a heart rate of 150 per minute with moderate variability, several spontaneous accelerations, and no decelerations.

An external tochometer shows regular uterine contractions every two to three minutes.

The cervix is six centimeters dilated and 100% effaced.

The vertex is at zero station.

Autosanography shows the fetus in a cephalic presentation.

The membranes are artificially ruptured, yielding copious clear fluid. 30 minutes later,

the cervix is 9 cm dilated and 100% effaced. The vertex is a plus 1 station. A fetal

heart rate tracing is shown. Which of the following is the most appropriate next step in management?

Option A says, advising the patient to begin pushing.

Option B says amnion fusion.

Option C says expectant management. Option says forcepts assisted vaginal delivery and option

E says immediate caesarian delivery and of course they put this fatal heart rate whatever

thingy at the top to be honest with you I don't care about this picture. Let me just ask you

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