A 21-year-old G1 at 40 weeks, who underwent induction of labor for severe preeclampsia, delivered a 3900-g male infant via vaginal delivery after pushing for 21/2 hours. A second-degree midline laceration and sidewall laceration were repaired in the usual fashion under local analgesia. The estimated blood loss was 450 cc. Magnesium sulfate is continued postpartum for the seizure prophylaxis. Six hours after the delivery the patient has difficulty voiding. Which is the most likely cause of her problem?
b. Infusion of magnesium sulfate
c. Vulvar hematoma
d. Ureteral injury
e. Use of local analgesia for repair
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is c; Vulvar hematoma.
An inability to void often leads to the diagnosis of a vulvar hematoma. Such hematomas are often large enough to apply pressure on the urethra. Pain from urethral lacerations is another reason women have difficulty voiding after delivery. Both epidural anesthesia, which can cause urinary retention, and oxytocin, which has an antidiuretic effect, can lead to an overdistended bladder and an inability to void. In this case an indwelling catheter should be inserted and left in for at least 24 h to allow recovery of normal bladder tone and sensation. Preeclampsia often leads to edema, which generally leads to diuresis postpartum.