Obstetrics & Gynecology>>>>>Normal and Abnormal Labor and Delivery
Question 4#

You are following a 22-year-old G2P1 at 39 weeks in labor. At 4-cm dilated she is given an epidural for pain management. Three hours later, her cervical examination is unchanged. Her contractions are now every 2 to 3 minutes, lasting 60 seconds. The FHR tracing is 120 beats per minute with accelerations and early decelerations.

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 B


Arrest of labor cannot be diagnosed during the first stage of labor until the cervix has reached 4-cm dilation and until adequate uterine contractions (both in frequency and intensity) have been documented. The actual pressure within the uterus cannot be measured via an external tocodynamometer; an IUPC needs to be placed. It is generally accepted that 200 MVUs (number of contractions in 10 minutes × average contraction intensity in mm Hg) are required for normal labor progress.