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Re: Full dilatationFrom: Braun, R. Daniel (rbraun@iupui.edu)Tue Dec 2 04:51:43 2003
Number 2 to begin with. Dan -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Monday, December 01, 2003 9:17 PM To: Multiple recipients of list OB-GYN-L Subject: OB: Full dilatation How would y'all handle this one? 39 YO P0010 at 40w0d, patient of our CNM practice (meaning prenatal care and delivery by CNMs unless MD needed for something)presents in early labor, around 0600, at 4/100%/-1, 6/100% at 0800, give or take. Pregnancy issues: advanced maternal age, normal first trimester markers and MFM scans, Rh negative unsensitized, and complete previa in the mid-trimester which resolved. Otherwise healthy. By 1230, is ruptured (thin meconium), and is completely dilated, and begins to push. She has an epidural, which was cut off for a time to allow better pushing, and now is back on. Contractions every 3 to 5 minutes, and I was asked to assess her at 1530 hours, after 3 hours of pushing. Exam: Afebrile, EFW 3650g (baby weighed 3568g!), C/C/+1/OA, and pushes to +2. Pelvis gynecoid, smallish (sorry), and the head doesn't really fill it. Fetal heart tones are normal. What would you do? 1. Nothing; keep pushing (if so, for how long/what endpoint?). 2. Place an IUPC, and measure contraction strength, and augment is appropriate. 3. Augment. 4. Offer an operative vaginal delivery. 5. Move to primary section. 6. Other. Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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