tailieunhanh - Tình huống sản khoa - Tình huống 7

Tham khảo tài liệu 'tình huống sản khoa - tình huống 7', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 6 A 26-year-old ỉ I PO woman at 39 weeks gestation is admitted in labor. She is noted to have uterine contractions every 7 to 10 min. Her antepartum history is significant for a nonimmune rubella status. On examination her BP is 1 10 70 and heart rate HR is 80 minutc. The estimated fetal weight is 7 lb. On pelvic examination she has been noted to have a change in cervical examinations from 4-cm dilation to 7-cm over the last 2 hr. The pelvis is assessed to be adequate on digital examination. What is your next step in the management of this patient 64 CASE s. OBSTl TRICS AND GYNECOLOGY ANSWERS TO CASE 6 Labor Normal Active Phase Suiiiiiiary A 26-ycar-old GI PO woman at term with an adequate pelvis on clinical pelvimetry nonimmune rubella status is in labor. Her cervix has changed from 4-cm to 7-cm dilation over 2 hr with uterine contractions noted every 7 to 10 min. Next step in management Continue to observe the labor. Analysis Objectives 1. Know the normal labor parameters in the latent and active phase for nulliparous and multiparous patients. 2. Be familiar with the management of common labor abnormalities and know that normal labor does not require intervention. 3. Know that rubella vaccination as a live-attenuated preparation should not be administered during pregnancy. Considerations This 29-ycar-old Gl Pt woman is at term defined as between 37 to 42 completed weeks from the last menstrual period . She is in the active phase of labor generally 2 4 cm of dilation and her cervix has changed from 4 cm to 7 cm over 2 hr her contractions arc only every 7 to 10 min. Because she is nulliparous the expectation is that her cervix will dilate at a rate of at least cm per hr during the active phase of labor. She has met these norms by a change of cm hr 3 cm over 2 hr . The uterine contraction pattern appears suboptimal but it is the change in the cervix per time and no the uterine contraction pattern that dictates normalcy in labor. Because she has had a .