Obstetrics & Gynecology>>>>>Normal and Abnormal Labor and Delivery
Question 3#

You are following a 38-year-old G2P1 at 39 weeks in labor. She has had one prior vaginal delivery of a 3800-g infant. One week ago, the estimated fetal weight was 3200 g by ultrasound. Over the past 3 hours her cervical examination remains unchanged at 6 cm. The FHR tracing is reactive. An IUPC reveals two contractions in 10 minutes with amplitude of 40 mm Hg each.

For the description of labor, select the most appropriate next step in management.

a. Initiate Pitocin augmentation
b. Place an intrauterine pressure catheter (IUPC)
c. Perform a cesarean delivery
d. Place a fetal scalp electrode
e. No intervention; labor is progressing normally

Correct Answer is A

Comment:

The best evidence available indicates that this labor is hypotonic and that the contractions are inadequate. Two contractions of 40 mm Hg intensity during a 10-minute period equates to 80 MVUs. About 200 MVUs are needed to consider contractions to be adequate to affect delivery. Since the ultrasound indicates a fetus without obvious abnormalities and smaller than her first infant, we assume the absence of cephalopelvic disproportion (CPD). Oxytocin is the treatment of choice in this situation.