Clinical Pearls

The first steps in assessing fetal bradycardia after artificial rupture of membranes are distinguishing the fetal heart rate from the maternal pulse and examining the vagina to assess for cord prolapse.

The best therapy for umbilical cord prolapse is elevation of the presenting part and emergency cesarean delivery.

The risk of cord prolapse with a vertex presentation or frank breech presentation is very low; the risk with a footling breech or transverse lie is substantially higher.

The most common finding with uterine rupture is a fetal heart rate abnormality.

The best treatment of suspected uterine rupture is immediate cesarean delivery.


Cunningham FG. Leveno KJ. Bloom SL. Hauth JC, Gilstrap LC III, Wenstrom KD. Intrapartum assessment. In: Williams obstetrics, 22nd ed. New York: McGraw-Hill. 2005:447-456.

Bashore RA. Staisch KJ. Fetal surveillance during labor. In: Hacker NF, Moore JG, Gambone JC. eds. Essentials of obstetrics and gynecology, 4th ed. Philadelphia: Saunders, 2004:136-145.

A 30-year-old parous woman notes a watery breast discharge of 6 months' duration. Her menses have been somewhat irregular. She denies a family history of breast cancer. The patient had been treated previously with radioactive iodine for Graves' disease. Currently, she is not taking any medications. On examination, she appears alert and in good health. Her blood pressure is 120/80 and heart rate 80 bpm. The breasts are symmetric and without masses. No skin retraction is noted. A white discharge can be expressed from both breasts. No adenopathy is appreciated. The pregnancy test is negative.

^ What is the most likely diagnosis?

♦ What is the likely mechanism for this disorder?

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