st us toco fecg st-events vsm

ST Case 19

Check FECG

Summary

A 36 year old G1 P0 in gestation weeks 41+6 with normal pregnancy is admitted to the labour ward for induction of labour. First set of prostaglandin gel is inserted at 20.00. Weak contractions are noted at midnight and established labour at 08.00.

  • 10.12 VE: Cx fully effaced, oedematous, 3 cm dilated, vx -2. ARM performed and clear liquor draining. FSE applied and ST Analysis initiated.
  • 14.00 VE: Cx fully effaced, 5 cm dilated, vx -1. Oxytocin infusion is started and increased per protocol.
  • 14.30 Epidural sited on maternal request.
  • 17.30 VE: Cx fully effaced, 5 cm, vx -1.
  • 19.39 Loss of contact, no T/QRS ratios received.
  • 21.42 VE: Cx fully effaced, oedematous, 6 cm dilated, vx -1. FSE removed. External CTG started.
  • 01.40 VE by physician: Status quo. Physician decides to perform a CS section for failure to progress.
  • 02.03 Caesarean section. Baby boy born. Birth weight 4 490 g.

Apgar score 10,10,10.

Cord gases

pH pCO2 BE
Artery 7.31 6.92 3.1
Vein 7.35 5.83 2.7

 

Comment

This is a case that shows a poor signal quality because of a split R-tag. The crosses are fluctuating and trigger a number of ST Events. In this situation it is recommended to improve the signal quality and if necessary reapply the FSE.

It is important to always check the ECG waveform at the beginning of the recording and if you see a split R tag it may be difficult to obtain a good signal quality throughout labour.

uploaded 2012-11-21 by Neoventa Medical