fandarast
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A 26-year-old woman, gravida 2, para 1 at 39 weeks of gestation is admitted to the hospital in labor. Her cervix is dilated 5 cm and is 100% effaced, and fetal vertex is at + 1 station. You perform amniotomy and obtain 3+ meconium. You place a fetal scalp monitor and an intrauterine pressure catheter and you start amnioinfusion with normal saline. Fetal monitoring strip reveals five contractions in 10 minutes, and each contraction produces 50 mmHg of pressure. Three hours later, her cervix is 5 cm dilated and 100% effaced, and fetal vertex is at + 1 station. What is the next best step in management?
A. Augmentation with oxytocin
B. Cesarean section
C. Vacuum delivery
D. Magnesium sulfate
E. Methergine
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| inkspot
Forum Guru
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looks like stucked in first stage / little slow but augment with oxytocine would do!
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| nyimalay
Forum Elite
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B. Cesarean section
In active phase arrest inspite of adequate uterine contrations ( every 2 minute, 50 mmHg intensity), proceed to emergency CS.
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| bigdino
Forum Newbie
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I agree with B. Cesarean section. Contractions are adequate so oxytocin would have no value
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| Ivonne
Find a way or make one
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The contractions are good so we don't need oxytocin... Next step--------->C-section
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| fandarast
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The correct answer is B. Cesarean section
This is a clinical scenario where the patient has had arrest of dilation (i.e., there has been no change in dilation in the last 2 hours in this multiparous patient). Augmentation with oxytocin is not necessary because she has adequate contraction frequency (every 2 to 3 minutes) and intensity (50 mmHg) in a 10-minute period. This patient is not a candidate for vacuum delivery. To perform a low vacuum deliver the cervix must be fully dilated, the station must be +2 or greater, the rotation of fetal head is unnecessary, and a valid indication for use of vacuum must be present (i.e., fetal distress, prolonged second stage of labor, or maternal disease process [e.g., heart condition or brain aneurysm], which benefit from reduction in pushing during the second stage of labor). There is no need to use a tocolytic to slow down labor. You want to achieve the opposite.
Methergine is used for postpartum hemorrhage.
Edited by fandarast on 03/14/08 - 11:22 PM
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| inkspot
Forum Guru
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Thanks!
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