ST Case 12

Summary

A 36 year old G2 P1. Gest. weeks 41+6.  Admitted to the hospital in spontaneous labor with SROM of meconium stained fluid at noon.  Unremarkable pregnancy.

• 22:10 SVE: Cx 5 cm dilated, 100% effaced, vx -1. FSE applied and ST analysis initiated. Thick meconium stained fluid noted.
• 22:45 Epidural given and Oxytocin infusion started.
• 23:26 Baseline ST Event.
• 23:51 Baseline ST Event.
• 00:10 SVE: Cx 8 cm dilated, 100% effaced, vx at 0 station.
• 00:13 Baseline ST Event.
• 00:24 Baseline ST Event.
• 00:34 Poor signal quality noted.
• 00:43 FSE reapplied.
• 00:51 Active pushing started.
• 01:07 SVD. Birth weight 4050 g.  Apgar Score 10/10/10. 

Cord gases

Comment

Prior to the application of the FSE and at the onset of ST Analysis the FHR tracing was categorized as a Green Zone tracing. Between 23:12 - 23:50 it is hard to determine the Baseline Heart Rate. It is also unclear whether there are accelerations or decelerations present? The physician in this case interpreted the decelerations as early decelerations and therefore categorized the FHR pattern as a Green Zone tracing.  The STAN guideline recommendation during a Green Zone tracing is expectant management and continued observation.