A gravida 2 para 1, 22 years old, uneventful pregnancy however in the last week developed high blood pressure: today not feeling well, visual disturbances and 1+protein in her urine, PE bloods taken, waiting results:
For Induction of Labour (IOL)@ 40 weeks.
Last baby spontaneous vaginal birth after an 8 hour labour, perineum intact.
admitted to ward at 1400hrs pre prostin CTG, normal reactive trace.
CTG recommenced post prostin 2mg @ 1600 hours..... describe the CTG and what action would you take...... what are your options and the womans options?
it would be interesting to know the Bishops Score?
ReplyDeleteHi Pam, Thank you for your great response.
ReplyDeleteThis is an interesting trace, I have the advantage as I was present....yes left lateral and call for help was the start.....the baseline is 150 bpm with persistant decelerations, the baby reacted to the prostin gell, the cervix was closed and there were no contractions....maternal pulse rate was 90bpm.... the client was turned left and right lateral, with no changes to the CTG.... we do not administer Oxygen unless there is maternal collapse due to the oxygen causing more harm to the fetus (due to free radicals). Yes I agree that there were some variable decelerations, however I felt that the variablity was still ok.
I have never seen such a marked reaction to prostin with no contractions present....an attempt to remove the prostin was made and as the trace did not improve the woman went for a c/s. I have seen this happen when the uterus is overstimulated (contractions)but not like this. The outcome was very good, baby apgars were 8 & 9 and the cord gasses were within normal limits.... so no adverse outcome, possibly as the obstetrician made the decision early. It is important to say that it is very hard to get clinicans to agree on a CTG interpretation... especially when it comes to some types of decelerations....early, late and complicated variable....