Obstetrics & Gynecology>>>>>Normal and Abnormal Labor and Delivery
Question 5#

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. Perform amniotomy
e. No intervention; labor is progressing normally

Correct Answer is C

Comment:

The patient is having adequate uterine contractions as determined by the IUPC. Therefore, augmentation with Pitocin is not indicated. The patient’s diagnosis is secondary arrest of labor, which requires cesarean delivery. In the active phase of labor, a multiparous patient should undergo dilation of the cervix at a rate of at least 1.5 cm/h if uterine contractions are adequate.