Question

Select the correct action from drop-down for this scenario below.

A G1P0 at 38 weeks is transferred to the Antepartum holding/testing area from her doctor’s office for monitoring and evaluation. In the office her cervix was 2-3 cm and 50% effaced. Earlier in the day, on admission, she had complained of irregular contractions and a persistent headache for the last 24 hours and decreased fetal movements as well as complaints of heart burn that had not been relieved with the OTC Tums. Blood pressures are 160-180/90-100. After 2 hours on the monitor the uterine activity monitor shows regular uterine contractions every 2-5 minutes apart, with the patient complaining of pain with a 7 out of 10 pain scale. The fetal heart rate of 130 has minimal to moderate variability and an absence of accelerations. Non-reassuring decelerations are ABSENT at this time. Many of the patient’s blood tests are pending; however, the labs that have been received are showing a low platelet count, elevated (ALT, AST) liver enzymes. Urine test is 2+ for protein. The patient’s cervix is examined again and is now 3-4 cm dilated and 80%.

DROP DOWN:

• Admit to Antepartum testing/holding center for an outpatient
• Admit to High-risk Antepartum Unit
• Admit to Labor and Delivery Unit
• Discharge Home
• Prepare for Surgical Intervention or Cesarean Section

Answer 1

The patient is already in antepartum testing or holding center for investigations

80 % effacement means the patient is nearing to labour This patient lab values are suggestive of pre eclampsia and is a high risk case.

The contraction happening in every 2 to 5 minutes is a strong indicator that its time for labour and the mother to be shifted to the delivery unit

The patient is at risk and cannot be discharged home

Surgical intervention is not possible because of very low patient and may risk patient to bleed excessively without ant any intervention

Ans:Admit to labor and Delivery unit.