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Zorluk: OrtaLabor, Delivery, and Puerperium

A 28-year-old primigravida at 39 weeks gestation is undergoing an induction of labor for gestational hypertension. She currently receives a continuous intravenous infusion of oxytocin. The patient's blood pressure is 134/82 mm Hg, and her pulse is 88/min. She has continuous epidural analgesia. Over the past 30 minutes, the tocodynamometer records 6 to 7 uterine contractions in every 10-minute window. The fetal heart rate baseline is 135/min with minimal variability and recurrent late decelerations. The nursing staff promptly stops the oxytocin infusion, repositions the patient to the left lateral decubitus position, and provides an intravenous fluid bolus. Ten minutes later, the frequency of contractions remains unchanged, and the late decelerations persist on the monitor. Which of the following is the most appropriate next step in management for this patient?

  1. Subcutaneous administration of terbutalineCevap
  2. B
    Operative delivery via cesarean section
  3. C
    Initiation of transcervical amnioinfusion
  4. D
    Administration of intravenous ephedrine
  5. E
    Performance of an artificial rupture of membranes

Cevap

The correct answer is the administration of a tocolytic agent, such as subcutaneous terbutaline, to relieve the persistent uterine tachysystole.
This patient is experiencing uterine tachysystole (defined as more than 5 contractions in a 10-minute window) leading to uteroplacental insufficiency, evidenced by recurrent late decelerations and minimal variability. Because initial conservative resuscitative measures (stopping the oxytocin infusion, maternal repositioning, and intravenous fluid bolus) failed to resolve the excessive contractions, a short-acting beta-2 agonist (terbutaline) should be administered. This tocolytic relaxes the myometrium, immediately improving uteroplacental blood flow and correcting the fetal hypoxia.

Adım Adım Çözüm

1
Analyze the uterine contraction pattern and the fetal heart rate tracing.
Identification of uterine tachysystole (>5 contractions in 10 minutes) causing uteroplacental insufficiency (late decelerations with minimal variability).
To establish the underlying etiology of the fetal distress in a patient receiving exogenous oxytocin.
2
Evaluate the patient's response to the initial resuscitative measures.
Recognition that stopping oxytocin, maternal repositioning, and IV fluids were insufficient to correct the contraction pattern.
To determine if further medical intervention is required before proceeding to definitive surgical delivery.
3
Select the appropriate secondary intervention for refractory tachysystole.
Administration of a fast-acting tocolytic agent.
To rapidly relax the myometrium, restore blood flow to the intervillous space, and improve fetal oxygenation.

Anahtar Kavram

The management of oxytocin-induced uterine tachysystole with abnormal fetal heart rate involves stopping oxytocin, repositioning, and fluid bolus. If these fail, a tocolytic (terbutaline) is administered.
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Konular

Labor, Delivery, and Puerperium

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