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COTW Catch of the week 14/12/09

Discussion in 'Clinical Placements & Electives (Midwifery)' started by iolaus, Dec 14, 2009.

  1. cupcake1

    cupcake1 Member

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    Well. first baby wasn't huge, so fundal measurement not too concerning. As the lead midwife has already flagged this up and the scan has seen good function and growth, I wouldn't worry too much about this at the moment. Seems dates are accurate, so induction it is!

    I agree with the others though, most women don't seem to know they can refuse induction and go with the flow....... but having had 3 myself, although never induced, I can see how women would just want it to be over with, especially when you already have one to run around after!!

    So, whats the next instalment Iolaus? Things seem far too tickety-boo at the moment! Hopefully mum is happy and settled in on the ward by now, so monitor and see how induction goes!
  2. iolaus

    iolaus RM and Head of Clinical Practice Staff Member

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    3mg of prostin administered into posterior fornix with consent, irregular tightening over night and the following morning

    9.30 she goes to labour ward for ARM and syntocinon.
    Abdominally fundus=36cm, long cephalic LOP 3/ths palpable. BP 120/70, P – 82, Temp 36.5

    Pre ARM CTG
    DR - IOL
    M -yes
    C – mild irregular
    Bra – 135-140bpm
    V - >5bpm
    A – present with movements
    D – nil

    9.45 VE with consent cervix soft, 80% effaced, slightly posterior 3cm dilated, PP cephalic at -2 PP cephalic anterior fontanelle at 10o’clock. Membranes ruptured with consent, blood stained liquor draining.

    Post ARM CTG (20mins)
    DR - IOL (ARM)
    M -yes
    C – mild irregular
    Bra – 135-140bpm
    V - >5bpm
    A – present with movements
    D – nil
  3. cupcake1

    cupcake1 Member

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    no idea whats next! Could the blood stained liquor be because of the arm, or is it something more serious?

    Sorry I don't have a clue! Still learning loads!!!!
  4. AutumnMaple

    AutumnMaple Moderator

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    I was wondering about the blood stained liquor too - what does this mean/ Or is that what you would expect with ARM?
    Otherwise I would just try to make her comfortable - maybe keep her moving between monitoring. All seems to be going ok so far (I think...) x
  5. TickledPink

    TickledPink Member

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    might be way off the mark as I am looking for worst case senerio in my Myles Manual!!!! .. could the blood stained Liquor be a indication of either a partial Uterine rupture or Uterine hyperstimulation as a result of the pessary?

    Hopefully it is something of nothing and everything is ok :D
  6. iolaus

    iolaus RM and Head of Clinical Practice Staff Member

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    Quite often at ARM it's a bit blood stained as you have a show mixed in with it, especially if it's not a huge pocket of liquor you've ruptured, then once all the show is washed away it goes clear
  7. TickledPink

    TickledPink Member

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    phew I will breathe again then.. have just been reading some dreadful case studies on the internet about blood loss after ARM.. think sometimes too much info is not a good thing :?

    think i will sit back and wait for the next instalment :D
  8. Niteowl

    Niteowl Events Moderator Staff Member

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    Seems to be going ok so far from what I know, but have to admit that isn't a lot! I would encourage her to mobilise, wondering whats recommended for possibility of taking a bath after ARM, if this is ok I would suggest she may want to take a bath as a form of pain relief as contractions still mild and irregular xxx
  9. josiedee

    josiedee Member

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    Very interested to see where this one goes as similar happened to me at my son's birth 12 weeks ago. Slightly different; labouring at home (wanting homebirth), everything normal, FHR normal, coping well, 8cm dilated when had show followed by SROM. Slightly blood-stained liquor as a result. The midwives absolutely INSISTED that I transfer because of this. Was even arguing with them between contractions that surely the liquor would be mixed with show hence the blood-staining and response I got was "yes, probably it is that, but just to be on the safe side you have to go to hospital as it could be something more serious".

    So very interested to see what happens next as feel a bit peed off at the "must transfer" reaction of my midwives. Keen to know if this causes panic stations in this scenario.
  10. GrowingRoses

    GrowingRoses RM

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    oooh I'm pleased you said may be related to show iolaus as that was what I was thinking (i am learning after all!)
    I have never observed an induction as of yet but is it normal for ARM at 3cm after only 1 lot of prostin? Wouldn't 3cm simply be a multips os? I don't really know enough about ARM atm but will pop off and read up on it now.
    re: Rachel...again just wait, observe and wait for her instruction really

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