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UW Labor Question

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DrVirgo
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04/17/08 - 08:46 AM

24 y/o G2P2 at 38 weeks admitted for labor.
6 hours ago she was in the active phase and cervix was 4cm dilated.
She was given epidural and placed under external tocometer.
Her contractions were regular and occured Q2-3 minutes, lasting 40-60 seconds.
She progressed to 7cm dilation but she has not changed in the past 4 hours.
Fetus is at LOA, 1+ Station.
Internal pelvic assesment shows prominent ischial spines.
Fetal heart tracing shows 140bpm and good variability.
Her U/S at 37 weeks showed no abnormality.
What is the most likely cause of her anomoly of labor.
A. Inlet dystocia
B. Midpelvis contraction
C. Macrosomic baby
D. Hypotonic Uterine Contractions
E. Injudicious Analgesic

Please explain the answer and how you ruled out the other choices.
Thanks.

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Markus2009
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04/17/08 - 08:53 AM

Since the baby is already in 1+ station and the mom has prominent ischial spines then it should be midpelvis contraction.

DrVirgo
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04/17/08 - 08:55 AM

Markus2009 wrote:
Since the baby is already in 1+ station and the mom has prominent ischial spines then it should be midpelvis contraction.

You are right.
Can you please explain the concept of
"midpelvis contraction." and what does it mean to see "prominent ischial spines"
Thanks... sorry, but i'm a little unfamiliar with this topic.

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Markus2009
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04/17/08 - 08:58 AM

A: No because the baby is already in 1+
B: No, there is nothing in the history related to diabetes or other clue
D: No, the contractions are perfect
E: No, it was given at the right time and she did well afterwards

Markus2009
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04/17/08 - 09:03 AM

You remember in the anatomy of the pevis, they divide it in 3 parts, the ischial spines are located in the midpelvis and if their leght is increased then the diameter of the midpelvis will be reduced.

DrVirgo
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04/17/08 - 11:40 AM

Thanks.

How would A and E present?

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Markus2009
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04/17/08 - 06:59 PM

E: As a prolonged latent phase.

ricardoricardo
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04/18/08 - 12:46 AM

contracted pelvis

ricardoricardo
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04/18/08 - 12:50 AM

we can check for contarcted pelvis by:

1.history of accident,rickets,osteomalacia
2.pubic angle ( doesnt admitt two fingers )
3.interischial spine space
4.papable sacral promontary

DrVirgo
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04/18/08 - 07:56 AM

#10

Thanks... so the term "contracted pelvis" basically means small pelvis?

And what is the management of this patient?

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Markus2009
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04/18/08 - 12:06 PM

#11

C-section

DrVirgo
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04/18/08 - 12:20 PM

#12

Markus2009 wrote:
E: As a prolonged latent phase.

ok.
How about A. Inlet dystocia

what is it? How would that present? And what would we do as the next step?

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