st us toco fecg st-events

ST Case 21

Stan guidelines followed

Summary

A 23 year old G1 P1. Gestation weeks 40+2. Normal pregnancy. Admitted to the labour ward with mild contractions and SROM. VE: Cx fully effaced, dilated 3 cm, vx -2, clear liquor.

  • 20.30 Epidural sited on maternal request.
  • 21.41 VE: Cx fully effaced, dilated 3 cm, vx-2, clear liquor draining. Oxytocin infusion started due to slow progress.
  • 23.44 Epidural top up.
  • 02.04 VE: Cx fully effaced, 3-4 cm dilated, vx-1.
  • 02.58 Epidural top up.
  • 05.02 VE: Cx fully dilated, vx +1. Epidural top up.
  • 06.05 Active pushing started.
  • 06.30 Physician is assessing the fetal state and interpreting the CTG trace, decides to perform a vacuum extraction.
  • 06.42 To OR
  • 06.53 Vacuum extraction. Baby boy born. Birth weight  3 410 g. Apgar score: 8, 10, 10.

Cord gases

pH pCO2 BE
Artery 7.15 9.7 -7.9
Vein 7.28 8.1 -7.5

 

Comment

STAN guidelines are followed with no delay after the ST Event. CTG tracing shows that the fetus has difficulties to keep its baseline heart rate and with reduced variability.

Note that the decelerations are disappearing at 02.04 for a short time, related to the vaginal examination when the cervix dilatation is measured. The fetal head pressure is less against the cervix and therefore the decelerations are disappearing for a short period.

uploaded 2013-04-17 by Neoventa Medical