US ST Case 6 – Importance of CTG interpretation

Summary

26 year old G 1 P 0 Gest. week 40+6.  Admitted to hospital in spontaneous labor.  SVE at admission: Cx  7 cm dilated, 100% effaced, vx -2. Unremarkable  pregnancy. Patient denies need for analgesic, using breathing technique for comfort.

• 10:35 Baseline ST Event. Oxytocin infusion started.  Patient still denies need for analgesic, using breathing technique for comfort.
• 11:05 Baseline ST Event. Oxytocin infusion increased per protocol.
• 12:21 Baseline ST Event.
• 13:55 SVE: Cx 10 cm dilated, 100% effaced, vx +1.
• 15:00 Active pushing started.
• 16:20 Spontaneous vaginal delivery. Baby boy 3 820 g. Apgar score 5/6/9.

Cord gases

Admitted to NICU

Comment

ST Analysis must be initiated during a period of time when it is highly likely the fetus is well oxygenated. In this case, the tracing suggested that a significant risk for hypoxemia was already present. Therefore, expeditious delivery would have been the recommended management rather than initiating STAN monitoring.