Question

Client Profile

Baby Ethan was born via a normal spontaneous vaginal delivery (NSVD) at 36 weeks gestation. The mother arrived at the emergency room dilated to 9 centimeters and 100 % effaced. The mother also reports ruptured membranes for the past 22 hours. The fetal heart rate upon admittance to the emergency room is 170 bpm. The mother delivered in the emergency room 30 minutes after being examined. This is her seventh pregnancy, and she did not have prenatal care.

Case Study

Ethan was admitted to the observation nursery from the emergency room where he was born. He weighed 5 pounds and was 19 inches long. His APGAR scores were 6 at one minute, and 8 at five minutes. Points were initially taken off for tone, reflexes, and color. His initial glucose was 35 and vital signs were heart rate 150, respirations 76, and temperature 97.2. The nurse noted some nasal flaring, grunting, and coarse breath sounds. He was given 1 ounce of D5W orally; oxygen therapy, and his skin and pharynx were cultured. The orders also included that he be placed on a warmer with skin probe for temperature monitoring.

At two hours the baby's glucose was 40, the nasal flaring continued, respiratory rate was 100 with continued coarse breath sounds. He exhibited acrocyanosis, and his temperature was 96.8. The baby was treated for transient tachypnea of the newborn with oxygen therapy and a warm environment.

At four hours the nurse noted that the baby was lethargic and difficult to arouse. He appeared pale with circumoral cyanosis, nasal flaring, and grunting with sternal retractions. The nurse notified the doctor, an IV was started, and the baby was transferred to the neonatal intensive care unit at a hospital in the next town.

At six hours the mother called the NICU to check on his progress and was told that he had subsequently developed jaundice and was on a ventilator.

Questions

What do you think might have been done differently for this delivery had the mother come in at 4 to 6 cm instead of 9 cm? ( I have posted this question so many times but have not gotten a detailed response or the correct answer. Please explain and be very clear when answering this question. thanks. Also, if you use any source please cite it. thanks.

Also, I would like to understand if it is safe to slow down the contraction with a tocolysis drug after the membrane has already been rupture and the mother is about 5 cm dilated? (when the mother is experiencing precipitate labor). just concern.

Answer 1

According to American association of obstretician a women is in active labour if cervix dilated more than 7cm. In this case assumption is 5cm. That means patient is not in active labour. So inorder to have a healthy baby and prevent preterm labour complications following things can be done

• Antibiotics to mother to prevent possible infection to mother and child. Antibiotics is given to prevent group B streptococcus infection..
• steroids given intravenously to enhance baby's lung development
• Magnesium sulfate is given IV to prevent possible complications of cerebral palsy.
• Tocolytics can be given to reduce or stop contractions.
• Monitor baby's health continuously when in hospital and prolong the delivery till 37 week if possible.
• If mother have excess fluid leak and child is showing distress normal vaginal delivery can be done.