Overview
A Tracing That Changes in One Contraction
A 33 year old patient, G3P2, at 39 weeks is undergoing a trial of labour after one previous low transverse caesarean delivery.
NCLEX-RN
NCLEX-RN
A 33-year-old patient, G3P2, at 39 weeks is undergoing a trial of labour after one previous low-transverse caesarean delivery. Cervical dilation is 8 cm and an oxytocin infusion is running. The fetal heart rate suddenly decreases to 65/min for four minutes. BP is 86/48 mmHg and HR is 136/min. The patient has severe continuous abdominal pain and vaginal bleeding, and the presenting part, previously at +1 station, is now at −2 station. Before reading on, ask yourself what single event could explain all of it at once: the fetal heart rate, the shock, the pain, and a baby who has moved back up. The answer to suspect is complete uterine rupture with maternal haemorrhage and acute fetal compromise. The priority is to activate the obstetric emergency response, stop oxytocin immediately according to the emergency protocol, assess maternal airway and circulation, initiate resuscitation and prepare for immediate operative delivery. Notice how much this patient is showing you. Most patients will show you less. Sudden fetal bradycardia may be the earliest or most prominent sign of uterine rupture. Severe abdominal pain, vaginal...
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