Charlene is a 31 year old G1Po attorney who has been treated in the infertility clinic for several years to achieve this very desired pregnancy . Her prenatal care has been uncomplicated . Her only problem was epigastric pain she takes antacid tablets with some relief . She comes to labor and delivery today at 40 6/7 weeks of gestation . She says the baby has been very active and she couldn't sleep well last night because of discomfort .she states that she has been having contractions about every 5 - 7 minutes for about 10 hours and she exhausted . She wants the pregnancy to be over . She was not having leaking of fluid or vaginal bleeding , but did notice some bloody , sticky discharge at about 3:00 a.m .
A vaginal exam reveals her cervix to be about 2cm dilated , 100% effaced , with a vertex presentation at - 3 station . Fetal heart tones are in the 140seconds with an external monitor . Another external monitor confirms uterine contractions about every 5 minutes . Her vital signs are stable and her physical examination is otherwise unremarkable .
Dipstick urinalysis reveals no protein , glucose ,or ketones . A blood clot to type and is sent to the laboratory per hospital policy . A CBC is normal .
Charlene is admitted to labor and delivery where an IV line is placed . Two hours later there has been no change in the cervical exam and she asks for pain medications . Narcotic medication is ordered and soon falls sleep . The fetal heart tones remained stable and the contractions has frequency decreased . Charlene awakened about two hours after the narcotic dose by painful contractions that appear on the monitor about every three minutes . A cervical exam is done revealing to change a 5 cm dilation , 100% effaced , and - 2 station are some caput noted . The membranes are artificially ruptured , revealing copious amounts of clear fluid ,internal fetal scalp and pressure monitors are placed . Charlene requests an epidural anesthesia . The epidural functions well and the internal uterine catheter show uterine contractions every 7 - 10 minutes measuring 30 - 40 cmHg . The fetal heart tracing remains reassuring . After another two hours , the cervix is unchanged and the station has remained at -2 . Oxytocin is started by intravenous pump .the uterine contractions become more frequent to every 2 -4 minutes and reach 50- 60 cmHg . Her temperature has climbed slightly , to 99.8 F . Two hours later the cervix is still 5cm dilated and has a temperature of 101F . The fetal heart rate is reassuring , but the base line has increased to the 160s . An operative delivery is planned . What was your impression ? lavender or lilac wedding collections