ST Case 5

Summary

34 year old G 2 P 1. Gest. week 41+5.  Unremarkable pregnancy.

• 12:00 Admitted to the hospital for induction of labor. SROM occurred 48 hours earlier, clear fluid noted. SVE: Cx 1 cm dilated, 1 cm long, vx -2.  2 mg Prostaglandin given.
• 16:40 Patient in active labor. SVE: Cx 3 cm dilated, 100% effaced, vx -2. Epidural placed.  ST analysis initiated.
• 18:01 Baseline ST Event. SVE: Cx 6 cm dilated, 100 % effaced, vx -1. FHR classified as a Green Zone tracing.
• 21:15 Baseline ST Event SVE: Cx 8 cm dilated, 100% effaced, vx -1. FHR classified as a Green Zone tracing.
• 22:32 Oxytocin infusion started.
• 22:50 SVE: Unchanged.
• 00:33 Increasing baseline heart rate noted. Maternal temperature 38,1 C. IV antibiotic and Tylenol given.
• 00:58 Tachysystole noted and the Oxytocin infusion is turned off. SVE/Cx 10cm dilated, 100%effaced, vx 0 station. Active pushing begins.
• 02:30 Physician contacted and made aware of patient’s slow progress. The physician is busy in an operation room.
• 03:45 Physician contacted and made aware of patient’s status.
• 03:58 Baseline ST Event. FHR classified as a Yellow Zone tracing.
• 04:09 Baseline ST Event. FHR classified as a Yellow Zone tracing.
• 04:10 Physician present, decides to deliver with a vacuum.
• 04:15 Unsuccessful Vacuum extraction, decision made to perform a cesarean section.
• 04:21 Baseline ST Event. FHR classified as a Yellow Zone tracing.
• 04:22 Patient is off of FHR monitor.
• 04:48 Cesarean section. Baby girl 3 345 g. Apgar Score 1/ 3/ 5.

Cord gases

Comments

The STAN Guidelines were not followed.  In the presence of ST Event(s) during a Yellow Zone in second stage with active pushing the STAN guideline recommendation is expeditious delivery.