MEDizzy - A 24-year-old G1P0 woman at 32 weeks’ gestation presents to

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USMLE I Test Block II

A 24-year-old G1P0 woman at 32 weeks’ gestation presents to the emergency department after experiencing regular contractions approximately 10 minutes apart for 3 hours. Her temperature is 37.7°C (99.8°F), blood pressure is 136/87 mm Hg, pulse is 95/min, and respiratory rate is 18/min. While in the emergency department her membranes rupture spontaneously, and she progresses through labor and delivers a premature infant 6 hours later. Which of the following most likely caused premature labor and delivery in this patient?

Explanation The correct answer is A. The most common causes of SBO include peritoneal adhesions (from previous abdominal surgery), hernias, and cancer or tumors. The abdominal pain typically presents with nausea and/or vomiting and patients may have a distended abdomen along with high-pitched bowel sounds. Supine and upright x-rays of the abdomen are useful in making the diagnosis because dilated loops of small bowel can be seen, along with air-fluid levels and lack of gas in the colon. Some patients with partial SBO can initially be treated conservatively with close observation, intravenous fluids, and a nasogastric tube for proximal decompression. However, patients with peritoneal signs should be taken to the operating room for surgical decompression and repair.