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UW: Prolonged Latent Phase

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DrVirgo
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04/23/08 - 08:03 AM

27 year old G2P1 @37 weeks. Twin pregnancy.
Comes in for management of labor. She has had regular painful contractions for 4 hours. Membranes ruptured before arrival.
Her prenatal course, tests and fetal growth have been normal with no complications.
Her previous pregnancy was uncomplicated and she delivered a 3500g (7lb) baby vaginally.
Exam shows a soft cervix that is 50% effaced, and 2cm dilated. US shows twin gestation in the vertex-vertex presentation. After 12 hours, the cervix has not significantly changed. Cardiac activity of both fetuses shoes repetitive accelerations with a baseline of 140bpm. Which of the following is the most appropriate next step in management:

A. Therapeutic Rest
B. Ripenining of the cervix using prostaglandin
C. Administer IV Oxytocin
D. Do forceps delivery
E. Do a low-segment C section.

Please EXPLAIN your answer and I am especially interested in discussing the options B and C as they apply to this case.
Thanks.

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drshvetasm
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04/23/08 - 11:58 AM

i'm much less sure for this one...somehow i find obgyn very confusing but I'd go for C oxytocin...they do say regular painful uterine contractions but they dont say how frequent...maybe they arent frequent enough...i think whats most commonly done is augmentation of labour with oxytocin. i dont have a very strong arguement against b either but i still think augmentation of uterine contractions ultimately leading to cervical dilatation and ripening with oxytocin is better than pgs.

again...ck or step3?

Ivonne
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04/23/08 - 01:09 PM

The babys are Ok based in their heart rate and variability. She needs augmentation with oxytocin.

C

Would be nice if someone post the use of prostaglandin in this case.

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DrVirgo
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04/25/08 - 09:01 AM

drshvetasm wrote:
i'm much less sure for this one...somehow i find obgyn very confusing but I'd go for C oxytocin...they do say regular painful uterine contractions but they dont say how frequent...maybe they arent frequent enough...i think whats most commonly done is augmentation of labour with oxytocin. i dont have a very strong arguement against b either but i still think augmentation of uterine contractions ultimately leading to cervical dilatation and ripening with oxytocin is better than pgs.

again...ck or step3?

Yes, very good! smiling face

The explanation said that since she has a twin pregnancy, she could be having hypotonic contractions... I didn't know we are just supposed to assume this if the question doesn't mention it specifically. sad

And also you cant ripen the cervix once it has already started dilating so that choice for PGE is wrong.

By the way this Q is from UW CK.

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sfk
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05/06/08 - 09:59 PM

prostaglandins are used to induce labor, here the patient is already in labour!!

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