A 22-year-old primigravida woman at 38 weeks gestation is in active labor for 4 hours. Cervical dilatation is 5 cm, +1 station. Examination 5 hours later demonstrates no change com... A 22-year-old primigravida woman at 38 weeks gestation is in active labor for 4 hours. Cervical dilatation is 5 cm, +1 station. Examination 5 hours later demonstrates no change compared to the previous findings. Contractions occur every 3 minutes and lasts 60 seconds. Fetal heart rate is of category 1 cardiotocograph. Which of the following is the most appropriate next step?
Understand the Problem
The question presents a clinical scenario of a primigravida woman in labor with no cervical change in 5 hours despite adequate contractions and a category 1 fetal heart rate tracing. We need to determine the most appropriate next step in management. The key concepts are: prolonged labor, failure to progress, fetal heart rate monitoring, and obstetric interventions.
Answer
The most appropriate next step is to consider a diagnosis of arrest of active labor and further evaluate the patient for possible interventions like amniotomy or oxytocin augmentation.
Given the lack of cervical change for 5 hours despite adequate contractions in a primigravida at 38 weeks, the most appropriate next step is to consider a diagnosis of arrest of active labor and further evaluate the patient for possible interventions. Options include amniotomy if membranes are intact or oxytocin augmentation.
Answer for screen readers
Given the lack of cervical change for 5 hours despite adequate contractions in a primigravida at 38 weeks, the most appropriate next step is to consider a diagnosis of arrest of active labor and further evaluate the patient for possible interventions. Options include amniotomy if membranes are intact or oxytocin augmentation.
More Information
Arrest of active labor is diagnosed when there is no cervical change for 4 hours despite adequate contractions or no cervical change for 6 hours with inadequate contractions. In this case, the patient has had no cervical change for 5 hours with adequate contractions. Amniotomy (artificial rupture of membranes) can augment labor if membranes are intact. Oxytocin is a synthetic form of a hormone that causes the uterus to contract and is often used to induce or augment labor.
Tips
It's important to differentiate between latent and active phases of labor. The active phase usually begins around 3-4 cm dilation.
Sources
- Normal Labor and Delivery - Medscape Reference - emedicine.medscape.com
- Management of Spontaneous Labour at Term in Healthy Women - jogc.com
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