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Spontaneous rupture of membranes, oligohydramnios

Room 5GA 38+3G1P031 yRuptured 09:00, scant clear liquor

6 cm, deep variable decelerations with every contraction. Needs assessment.

38+3wksG1P0 · 31 y
  1. Triage
  2. Latent
  3. Active
  4. Second stage
  5. Delivery
  6. Postpartum

12:00: 6 cm, 100% effaced, station -1

Maternal

BP
112/70
HR
96
Temp
37
Labs
no flags
Running
None

Fetal

Monitor
Deep variables
Presentation
Cephalic, occiput posterior, station minus 1
Membranes
Ruptured 09:00, scant clear liquor
Next
Examine for cord

Summary

31-year-old G1P0 at 38+3, spontaneous rupture of membranes, oligohydramnios. 6 cm, deep variable decelerations with every contraction.

Membranes
Ruptured 09:00, scant clear liquor
Fetal presentation
Cephalic, occiput posterior, station minus 1
Board status
Needs assessment

Notes

  • A scan last week showed a deepest pocket of 1.8 cm (oligohydramnios) with normal growth and Doppler; induction had been booked for 39 weeks.
  • Since 11:40 the monitor shows deep variable decelerations with every contraction, slower to recover, and the baseline has risen from 145 to 155.
  • Occiput posterior on the last examination.

Plan

  1. Vaginal examination now: cord, progress, position
  2. Reposition; discuss amnioinfusion with the senior
  3. Prepare for delivery if the pattern progresses

Medications

  • None: Requesting an epidural

Maternal vitals

TimeHRBPTemp
09:3088116/7436.9
12:0096112/7037

Labs

  • Haemoglobin115 g/L
  • GBSNegative

What to watch

  • Cord at the examination
  • Baseline and variability trend over the next 30 minutes
  • Response to amnioinfusion if used
  • Progress: 6 cm at 12:00 with an occiput posterior position

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