A 25-year-old woman, gravida 1, para 0 at 39 weeks of gestation has been laboring for a few hours. Her cervix is dilated to 6 cm, 80% effaced, and fetal vertex is at 0 station. Membranes have been ruptured for 20 hours and her labor is being augmented with oxytocin. The intrauterine pressure catheter detects contractions every 1 to 2 minutes at 80 mmHg of pressure and lasting 2 minutes. Fetal heart rate baseline by scalp electrode is 90 bpm for the last 2 minutes (FHR baseline 30 minutes ago was 140 bpm). What is the best next step in management?
A. Penicillin B. Cesarean section C. Left lateral position D. Discontinue oxytocin E. Amnioinfusion
nyimalay Forum Elite
Topics: 10 Posts: 282
03/18/08 - 06:03 AM
#2
D
jasmin Forum Junior
Topics: 7 Posts: 40
03/19/08 - 11:33 AM
#3
d
fandarast Forum Junior
Topics: 15 Posts: 53
03/22/08 - 12:26 AM
#4
The answer is D. This clinical scenario is describing hyperstimulation of the uterus caused by excessive stimulation by oxytocin, which has caused a nonreassuring fetal heart rate (in this case, bradycardia). No level of oxytocin is predictive of hyperstimulation because there are variations in response to oxytocin between individuals and different gestational ages. Remember that normal labor contractions last about 1 minute, produce up to 50 mmHg, and occur every 2 to 3 minutes. When the uterus is hyperstimulated, blood vessels are compressed for an extended period (greater than the fetal reserve), the blood flow to the fetus is reduced, and the fetus becomes hypoxic. None of the other answer choices address the problem of hyperstimulation, which has caused the nonreassuring fetal hearl rate pattern.
GOGETA I'm Dr. GOGETA
Topics: 323 Posts: 2,721
05/26/08 - 08:44 AM
#5
why is not b ___________________ As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
lq2006 Forum Elite
Topics: 43 Posts: 382
05/26/08 - 07:31 PM
#6
Answer is discontinue oxytocin
hero Forum Guru
Topics: 38 Posts: 519
05/26/08 - 11:17 PM
#7
GOGETA wrote: why is not b
will be than if fetal heart tracing is non-reassuring - late decels or fetal acidosis. At this time they describe fetal bradicardia, see what could cause it.
