Doc750
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A 28 year old G3P2 woman presents to the labor and delivery triage unit at 39 weeks gestation complaining of regular uterine contractions at intervals of 5-15 minutes. The patient's pregnancy was complicated by preterm labor at 31 weeks gestation. Sterile speculum examination at the time revealed no pooling within the vaginal vault, a negative Nitrazine blue test, and a negative fern test. Her cervix was found to be dilated to 2 cm. The patient was given two doses of betamethasone and 24 hours of IV magnesium. She was discharged on bed rest and had no further complications. On PE now, the patient is afebrile with a BP of 115/70mm Hg. her cervix is dilated to 4.5 cm and 25% effaced.
1) What is the most likely diagnosis?
2) What is the most important initial diagnostic test?
3) What are common causes of prolongation of the 1st stage fo labor?
4) When does fetal descent began?
5) What is considered a normal amount of blood loss in a vaginal delivery?
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| smal
Forum Guru
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1.I stage labour
2. Diagnostic test probably GBS smear?????
3. common cause of prolongation of 1st stage-epidural,CPD,exhausted mother
4.foetal descent befins with onset of labour
5.normal amount of bleed loss is equivalent to 500 gm clot
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| Doc750
transfer:step 3 prison
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1. More specifically this is active phase of stage 1 of labor.
First stage of labor is divided into latent and active stage.
- latent stage: begins at 3-4 cm of cervical dilation and lasts 4-11 hours
- active stage: begins at >4 cm dilation and ends at 10 cm dilation. This stage can last 2-6 hours.
Second stage of labor occurs from complete cervical dilation at 10 cm to delivery of the infant and can last from 5 min to 3 hours.
Third stage of labor includes the delivery of the placenta and usually lasts 1-30 min.
2. Most important initial diagnostic test is US to assess fetal presentation.
3. Causes of prolongation of 1st stage: excessive sedation, hypertonic uterine contractions. It is also assoc with cephalopelvic disproportion.
4. Rapid descent of the fetus begins in the later stages of active dilation, commencing at about 7-8 cm in nulliparous women and becoming most rapid after 8 cm. The fetus generally remains in the 0 position throughout the latent phase of the 1st stage of labor and only reaches a +1 position at the onset of active labor. Rapid descent to +3 and +4 positions only occurs with further dilation.
5. Blood loss <500 mL is considered normal in a vagiinal delivery, which usually corresponds to a 3 point drop in hematocrit.
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Experience is a hard teacher because she gives the test first, and the lesson afterwards.
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