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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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J 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
Category III ABNORMAL
ABSENT VARIABILITY plus any of following:
Recurrent LATE decelerations
Recurrent VARIABLE decelerations
Bradycardia
Sinusoidal pattern
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INTERPRETATION:
strongly predictive of normal
acid-base status at this time
ACTION: routine monitoring
INTERPRETATION:
not predictive of abnormal acid-
base status at this time
ACTION: continued surveillance &
reevaluation
INTERPRETATION:
strongly predictive of abnormal
acid-base status at this time
ACTION: intrauterine resuscitation;
if no resolution then prompt
delivery
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