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Re: Ob: Arrest of dilatationFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Wed Aug 2 19:42:04 2006
At Wed, 2 Aug 2006, Garry E. Siegel, M.D. wrote: > >21 YO P0 at term with mild gestational hypertension was ripened and >induced. > >Admission, 1.5/50--cervidil 8 PM. > >SROM next day 0830; Pitocin begun, epidural eventually > >1500--4 cm/80% (CNM) >1700--no change per me, EFW 3500g, narrow arch, tight spines, and easily >reached diagonal conjugate. Station -3, unchanged. Told >patient/husband of lack of progress and poor pelvic architecture. IUPC >immediately shows adequate labor, C/S discussed and advised. >1900--no change, labor very adequate, C/S advised and refused. > >What's next? > >How long do you wait before making the diagnosis of arrest of >dilatation? > >Garry > I rarely make the diagnosis of cpd at 4cm, especially if I have not done the exams myself. I think what you recommended is appropriate especially in this day and age; that being said the patient has an epidural, the baby is being monitored continuously so I would have no problem continuing for another 2-3 hours. Of course it means you will be doing the delivery or c-section around midnight. I was on call yesterday I had a patient who was at 8cm for 3 hrs and offered her a c-section, she was keen on continuing; I went back one hour latter still 8cm but now begging for a c-section. The c-section was done at 1:00 am.
--
Take care, John
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