A 26-year-old female, G3-P0-Tab2, with a full term uncomplicated pregnancy, experienced pain and leaking fluid. She was unsure if she was in labor, and called her obstetrician, who advised her to use a peripad, rest, and call back if the symptoms increased. About two hours later she went to the ED in severe pain. She was admitted to the Labor & Delivery unit at 8:15 p.m., presenting with leaking green/brown fluid.
The L&D nurse placed an electronic fetal monitor (EFM). The patient was 1-2cm dilated and 50 percent effaced. Per EFM, the fetus was showing heart rate decelerations to 90 and decreased beat-to-beat variability. Meconium was present on the patient’s peri-pad. The patient requested analgesics for pain, and the RN called the obstetrician. She advised him that the EFM strip looked good, and requested an order for Nubain IM for pain, which was administered shortly thereafter.
The obstetrician arrived at 9:20 p.m. Meconium was still present, and the EFM strip showed some decelerations and decreased variability. The obstetrician questioned if it might be due to either the Nubain or to the EFM picking up the maternal pulse. He decided to treat her conservatively with hydration and oxygen. The patient was 3cm dilated, and she received an epidural.
At 10:50 p.m., as the EFM showed late decelerations and decreased variability, the RN called the obstetrician to the patient’s room. The patient was now 5cm dilated. Fetal scalp PH tests were performed by the obstetrician, and results were abnormal at 7.15. The obstetrician determined the fetus was in distress, and ordered an emergency C-section.
An infant girl was born at 11:24 p.m., weighing 2940 grams, with Apgar scores of 1 at 1 min., 5 at 5 min. and 7 at 10 min. Her heart rate was less than 80, and she required vigorous resuscitation. Upon admission to the neonatal ICU, the baby’s hematocrit was noted to be only 12; the retic count was 12.3, and cord PH was 7.001. A Kleihauer-Betke test revealed significant feto-maternal bleed. The infant ultimately developed seizures and was diagnosed with hypoxic ischemic encephalopathy. She suffers neurological sequelae from CP, such as: right sided hemiparesis, cognitive difficulty and speech delays.