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Case lâm sàng sản khoa - Case 9

Tham khảo tài liệu 'case lâm sàng sản khoa - case 9', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 27 A 23-year-old G1 PO woman at 40 weeks gestation is undergoing labor induction with oxytocin for oligohydramnios. She has been at 6-cm dilation for 3 hr. A significant amount of caput is noted on cervical examination. Her uterine contractions are every 2 to 3 min and palpate firm liach contraction lasts for 60 sec. The estimated fetal weight is 7.5 lb and the pelvis clinically seems adequate. The fetal heart tones are in the 145 to 150 bpm range without decelerations. What is your next step What is the most likely diagnosis 226 CASE 1 1 LI S OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 27 Eabor Arrest of Active Phase Summary A 23-year-old G1 PO woman at 40 weeks gestation is being induced. Her cervix has remained at 6-cm dilation for 3 hr and a significant amount of caput is noted on examination. Her uterine contractions arc every 2 to 3 min and palpate firm. Each contraction lasts for 60 sec. The estimated fetal weight is 7.5 lb and the pelvis seems adequate. Next step Cesarean delivery some clinicians would consider the placement of an intrauterine pressure catheter to assess contraction pattern. Most likely diagnosis Arrest of active phase. Analysis See also Case 6. Objectives 1. Know the normal latent phase and active phase of labor. 2. Understand that when the labor is abnormal then the 3 Ps need to be considered. 3. Understand the criteria for adequate uterine contractions. Considerations This 23-year-old woman is being induced for oligohydramnios at 40 weeks gestation. She has not changed her cervix from 6 cm for 3 hr which is arrest of active phase 2 hr of no change is sufficient for the diagnosis . When there is a labor abnormality the next step is to consider the 3 Ps which arc pelvis passenger and powers. On examination the pelvis seems clinically adequate and the estimated fetal weight is not excessive 7.5 lb . The assessment of the powers may be either clinical contractions every 2 to 3 min firm by palpation and lasting CLINICAL CASES 227 for 40 to