TEALE FENNING

farha · Century Club Joined: 18 May 2007 Posts: 144

Options for Questions 1 AND 2 most APPROPRIATE MANAGEMENT

(A) Emergency caesarean section
(B) Ultrasound scan for placental site
(C ) Induction of labour with prostaglandins
(D) Elective caesarean section at 37 weeks
(E ) Oxytocin augmentation of labour
(F) Fetal scalp blood sampling
(G) Induction of labour with oxytocin
(H) Umbilical artery Doppler
(I) Elective caesarean section at 39 weeks
(J) Arrange antenatal clinic follow-up
(K) Expectant management
(L) Transfer to high dependency unit
(I ) Maternal blood transfusion
(N) Vaginal operative delivery

Question 1 A 20 year old woman complains of constant abdominal pain and vaginal bleeding at 34 weeks gestation. Her BP is 130/60 and pulse is 90bpm. CTG shows contractions every 3 minutes with deep variable decelerations. The cervix is partially effaced and the os is closed.

Question 2 A 35 year old woman presents at 41 weeks gestation with spontaneous rupture of the membranes and heavily blood-stained liquor. Maternal pulse and BP are normal and the CTG is reactive. The cervix is partially effaced and 1cm dilated. There are no uterine contractions.

EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

I will go for A for the first senario as deep deceleration meens FD and the patient has close cervix.

for the second, I think Fetal scalp Bd sample will be justified as the patient has normal vital signs, I cm Dil. so if fetal condition is well we can progress to Induction of labour.

farha · Century Club Joined: 18 May 2007 Posts: 144

Dear emak u r right for Q1 but for 2 why u want to wait she is 41 week let her deliver otherwise she will keep u awake for whole night so answer is induction with oxytocin(G). ; By the way how u will manage fetal scalp samplin at 1cm; :?

EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

Dear Farha
I don't want her to wait, I just want to prove fetal well being before let her to go throught induction with pitocin reactive CTG doesn't give reasurance especially the mother has bleeding which could be fetal in origion, so FBS is more specific in detecting FD, so I need it to decide mode of delivery ....
What is your opinion ? Rolling Eyes

drhatta · Joined: 20 Feb 2007 Posts: 32 Location: Malaysia

EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

Ok, Agreed , I will go for induction by oxytocin.
THx.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 918

1 -- A -- agree

2 -- E -- ok agree for now , but.................

patient is only 1 cm, not contracting, heavy blood stained liquor may be SROM with heavy show --- so why not observe for a hour or so and then possibly induce with PGs , the CTG is normal, so one can do this too.
PGs will help better your Bishop's score, we will be more likely to get a vag deli.

if all fails or things worsen -- well we always have the abd approach.

what do you guys say???
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

bronwyn · Posted: Thu Jul 26, 2007 2:19 pm Post subject:

Hi Raj

I agreee with farha for question 2, I would get on and induce her with Oxytocinon. Yes it may be a heavy show but it may also be a marginal abruption and the CTG is only good for the time it's strapped on. At least if you put Synto up you'll have to minitor her continuously and will be able to act on signs of fetal compromise.
Also there is no difference in rate of LSCS for PG vs Synto in term prelabour SROM.....
From Cochrane review 2007
"Based on eight trials, prostaglandins were associated with a decrease in epidural analgesia, odds ratio of 0.85, 95% confidence interval 0.73 to 0.98 and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups. "

Have I convinced you to get on with it?! Very Happy

BB
_________________
Bronwyn Bell
SpR
Portsmouth

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 788

Agree with Farha,
I would think the best is to go for induction with oxytocin.

More so because we are not sure if the lady has abruption or not. Atleast with oxytocin we have the safety of cutting of the infusion if the CTG worsens and go ahead with further plan.

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 788

Induction with prostaglandins would have been better choice if the lady had clear liquor-I think (guideline says both are equally effective)

RCOG guideline-

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 918

hi bron,

good to discuss with you again.

i have agreed with farah already ( u know me with my arm s and synto drips Wink

) ----- just wanted some more thinking to be done on that one.

how's portsmouth?
see u at the teaching.

tc.
r

p.s -- still have ur book.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region