ST Case 1

Summary

39 year old G 1 P 0 Gest.week 41+5.

• 12:00 Admitted to the hospital with contractions beginning at 23:00 and SROM since 22:00, clear fluid noted. At arrival, SVE: Cx  3 cm dilated, 100% effaced, vx-2 station.
• 13:00 Epidural placed.
• 16:37 SVE : 4 cm dilated, 100% effaced, vx -1 station.  FSE applied and ST analysis initiated. Baseline heart rate increasing. Maternal temperature 38,2 C. IV antibiotics and  Tylenol given.
• 16:56 Oxytocin infusion started.
• 18:40 Recurrent late decelerations noted.
• 18:54 Baseline ST Event. Intrauterine resuscitation initiated.
• 18:59 Oxytocin decreased to half (12mU/min)
• 19:20 Obstetrician decides to perform a cesarean section.  Patient taken to the OR.
• 19:25 Preparation for cesarean delivery continues while patient being monitored. Baseline and Biphasic ST Events noted.
• 19:48 Baby girl born. Birth weight 3 510 g. Apgar Score 4/7/7.

Cord gases

Baby girl admitted to NICU for observation and antibiotic treatment. Presumed sepsis. Group B strep found. 

Comment

Fetal heart rate patterns with recurrent late decelerations, an increasing baseline heart rate and minimal variability would classify the pattern as a Yellow Zone. In the presence of maternal fever, close observation is warranted.

The first ST event was at 18:54, 54 minutes later, at 19:48, the delivery occurred. In view of the ST alert, Yellow Zone FHR status and no improvement with resuscitation efforts, more timely intervention would have been indicated.