Melissa is a 27 yo G2P1 at 40 1/2 weeks who presents at 4 am in active labor, 5 cm dilated, 80% effaced, -1 station, leaking clear fluid.     GBS neg.

120/62, P84, Afeb

4 am fhr

At 7:30 am she remains unchanged, but too painful to go home.

7:30 am  fhr

Options?

At 10 am,   you get called for decelerations in fetal heart rate.

10 am  fhr

7 cm dilated, 90%, 0sta.

What do you recommend? 

Any different monitoring planned?

Complete dilation at 11:30 am, pushes for 20 minutes.

11:50 fhr

Decelerations improve with breathing through some contractions without pushing, however. . .

12:14 fhr 

+2 station

Intervention?

 Teaching notes:

Augmentation – review the pitocin orders

Hyperstimulation – review use of terb as well as decreasing pitocin, other fetal resuscitation measures, internal monitors could be placed

Severe variables with pushing – review not necessarily correct to push harder

At terminal bradycardia – review vacuum