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Old 08-15-2011
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ObGyn Labor Arrest at 5 CM Dilatation!

A 25-year-old G3P2 at 39 weeks is admitted in labor at 5 cm dilated. The fetal heart rate tracing is reactive. Two hours later, she is reexamined and her cervix is unchanged at 5 cm dilated. An IUPC is placed and the patient is noted to have 280 Montevideo units (MUV) by the IUPC. After an additional 2 hours of labor, the patient is noted to still be 5 cm dilated. The fetal heart rate tracing remains reactive. Which of the following is the best next step in the management of this labor?

A) Perform a cesarean section
B) Continue to wait and observe the patient
C) Augment labor with Pitocin
D) Attempt delivery via vacuum extraction
E) Perform an operative delivery with forceps
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Old 08-15-2011
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MUV is normal ( >200 ) so we should do cesarean section ....
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Old 08-15-2011
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It is B

The patient has dilation arrest.

You do C-section when you find any trouble with the fetus.
Augmentation with oxytocin is not indicated because she is in labor as Montevideo units are indicating.
Vacuum and Forceps are only performed when the patient achieves a complete dilation.
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Old 08-15-2011
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Montevideo units (MUV) by the IUPC.???? what is this ididnt hear about it bf
can anyone explain to me ?
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Old 08-15-2011
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Quote:
Originally Posted by miss patho View Post
Montevideo units (MUV) by the IUPC.???? what is this ididnt hear about it bf
can anyone explain to me ?
Intrautrine pressure catheter , which measures power of contraction , More than 200 is normal.
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Old 08-15-2011
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Quote:
Originally Posted by Sadalssud View Post
It is B

The patient has dilation arrest.

You do C-section when you find any trouble with the fetus.
Augmentation with oxytocin is not indicated because she is in labor as Montevideo units are indicating.
Vacuum and Forceps are only performed when the patient achieves a complete dilation.
this case is arrest of active phase . there are three causes of it. passage, passenger and power . we can change only power if they r not enough . here power is normal , so prob with either passenger ( may be big baby or other things ) or passage ( small pelvis or any other ) . so here we dont have any other option , need to do CS .
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Old 08-15-2011
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Quote:
Originally Posted by usmlekzz View Post
this case is arrest of active phase . there are three causes of it. passage, passenger and power . we can change only power if they r not enough . here power is normal , so prob with either passenger ( may be big baby or other things ) or passage ( small pelvis or any other ) . so here we dont have any other option , need to do CS .
it is active arrrest....althought i hadnt heard of the montevideo the first time....The three reason state CS...hmm although observation can still be true considering it might change with maneuvering....
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Correct answer is A, perform C section.

The patient is having adequate uterine contractions as determined by the intrauterine pressure catheter. Therefore, augmentation with Pitocin is not indicated. The patient's diagnosis is secondary arrest of labor, which requires cesarean section. In the active phase of labor, a multiparous patient should undergo dilation of the cervix at a rate of at least 1.5 cm/h if uterine contractions are adequate. There is no indication for the use of vacuum or forceps in this patient because the patient's cervix is not completely dilated and the head is unengaged. Assisted vaginal delivery with vacuum or forceps is indicated when the patient is completely dilated, to augment maternal pushing when maternal expulsive efforts are insufficient to deliver the fetus. It is not recommended to continue to allow the patient to labor if dystocia is diagnosed, because uterine rupture is a potential complication.
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