ST Case 2

Summary

23 year old G1 P0. Gest. week 41+6.  Unremarkable pregnancy.

• 16:00 Admitted in early labor with mild contractions.  SVE: Cx2 cm dilated, 1 cm long, vx -2.
• 18:20 SVE: Cx 2 cm dilated, 1 cm long, vx -2. Decision made for AROM and FSE placement. AROM performed and thin meconium stained fluid noted. FSE applied. ST Analysis initiated.
• 19:00 Tachycardia and a prolonged deceleration noted. Patient assisted to left lateral position.
• 19:03 Baseline ST event.  The Obstetrician decides that labor can continue.
• 19:07 Baseline ST event. SVE: Cx dilated 2 cm, 100% effaced, vx -2.
• 19:47-20:00 Bradycardia noted.
• 19:57-19:59 3 Baseline ST events and an Episodic ST event noted.
• 20:08 SVE: Cx 3 cm dilated, 100% effaced, vx -2.
• 20:21 Baseline ST event noted.  Tachycardia, minimal variability and prolonged deceleration noted.
• 20:22 Decision made to perform a cesarean section.
• 20:48 Baby girl born. Apgar Score 4/7/8. Birth weight 2 720 g.

Cord gases

Baby girl admitted to NICU, discharged after 7 days.

Comment

The STAN Guidelines were not followed.  The management recommendation for a Yellow Zone tracing with ST Event(s) is “direct physician assessment, Intrauterine resuscitation as appropriate, If no improvement in fetal condition, expeditious delivery”.