NORCET 2 - 2021 (shift-1)
Obstetrics & Gynaecology
Easy
In which condition is Stallworthy's sign seen?
Appeared in: NORCET 2 - 2021 (shift-1)
Explanation
- Stallworthy's sign is a specific clinical finding associated with placenta previa, particularly when the placenta is located on the posterior wall of the uterus.
- The sign is defined as fetal bradycardia (slowing of the fetal heart rate) that occurs upon applying pressure to the fetal head into the pelvis, with recovery of the heart rate upon release of pressure.
- This phenomenon is caused by the compression of the umbilical cord between the fetal head and the placenta, which is situated over the sacral promontory, leading to a temporary reduction in fetal blood supply.
Why Other Options Were Wrong
- Option A: Hydatidiform mole is a gestational trophoblastic disease involving abnormal placental development, not a specific placental position that would cause cord compression upon fetal head pressure.
- Option C: A circumvallate placenta is an anomaly of placental shape, not its location relative to the cervical os. It does not create the specific anatomical setup for cord compression seen in posterior placenta previa.
- Option D: Eclampsia is a severe hypertensive disorder of pregnancy characterized by seizures. It is a systemic maternal condition and has no association with the mechanical cord compression that defines Stallworthy's sign.
Related Visual
- Visual 1: Diagram - The four types of placenta previa (total, partial, marginal, and low-lying) showing the relationship between the placenta and the internal cervical os. This helps visualize the underlying condition.
- Visual 2: Illustration - A sagittal view of the pelvis showing the mechanism of Stallworthy's sign. The image should depict a posterior placenta previa, with the fetal head being pressed down, compressing the umbilical cord against the placenta and the mother's sacral promontory.
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs associated with obstetric complications, specifically placenta previa as background academic context rather than a clinical decision trigger.
- Recognizing Stallworthy's sign is clinically important as it can be a subtle indicator of a posterior placenta previa, which carries a high risk of severe hemorrhage.
- The most critical nursing action for any suspected case of placenta previa is to AVOID all digital and speculum vaginal examinations, as this can provoke life-threatening bleeding.
- Management of placenta previa requires close maternal and fetal monitoring, securing IV access, and preparing for a potential emergency cesarean delivery.
How to Approach the Question
- This is a factual recall question based on an eponym (a condition named after a person).
- First, identify the key term in the question: 'Stallworthy's sign'.
- Recall or deduce the definition of this sign. It relates to a change in fetal heart rate upon a specific maneuver (pressing on the fetal head).
- Connect the mechanism of the sign (cord compression against a low-lying posterior placenta) to the given options.
- Evaluate each option: Placenta previa is a condition involving abnormal placental location. The other options (hydatidiform mole, circumvallate placenta, eclampsia) have different pathophysiologies.
- Select 'Placenta previa' as it is the only condition that fits the anatomical and physiological basis for Stallworthy's sign.
Concept Tested & Keywords
- Concept Tested: Clinical signs associated with obstetric complications, specifically placenta previa.
- Stem keywords: Stallworthy's sign
- Lead-in keywords: In which condition
Question ID
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