Cpd???

Specialties Ob/Gyn

Published

Just curious..my preceptor had a nulliparous pt last month. At change of shift when she received report, the pt. was a good 4 cms, 90%, -1 station, NOT on pitocin, UCs like 5-7 mins apart. My preceptor started her on Pit like an hour later. The pt. went to like 7-7.5 cms, 100% and still -1 station, 11 hours later.

The pt was did not have an epidural, and my preceptor told me that she could feel molding on the babies head(by end of our shift). She was ruptured for going on 20 hours(no temps, no tachy baby, no decels)..and the doc was updated during the entire shift regarding her progress. The UCs became regular like an hour after she was started on pit, but not stong (no greater then 50 mmHg per IUPC). Should the doc have called a c/s EARLIER than the 12 hours she labored for us for CPD? And when do they determine CPD (esp in primips)????

p.s. the main reason why i am asking is bc the nurse receiving report for the next shift felt that she labored "too long" SO CONFUSED...thanks gals!!! any feedback would be great...

Specializes in L&D,Lactation.

I understand that she didn't want an epidural, another sure sign of inadequate ucs after all those hours,IMHO, but sometimes an epidural can help correct a situation like this, with the relaxation. Sometimes inadequate hydration status can also make a dysfunctional pattern like this too. Was she black? I have noticed over many years that black women tend to hold the babies at a high station until the end of the labor.

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Specializes in Mother/Baby;L/D.

..IMHO? not too sure what that stands for CMCRN.. Not sure what else she could have done. And no, she was not African-American.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

IMHO means "in my humble opinion"....

And in "IMHO", it seems ever so easy to for us all to sit here and "armchair quarterback" this situation and call all kinds of "foul plays" ...fact is, none of us was there, so all we can do is speculate.

Now to me, it sounds like the csection was indeed warranted if she was in adequate labor. Don't beat yourself up about "shoulda-coulda's".....Really, in days gone by, this poor lady might have been much worse-off, for all we know. I am glad she was at least safely delivered and hopefully, baby and mom will be just fine once home.

I do know, we are seeing more and more cases of CPD due to the fact, babies are getting bigger and bigger and gestational diabetes is epidemic.....

Was this the case in the particular situation?

Anyhow, I see a lot of teen moms going for csections due to small pelvises and big babies that are just TFTF (too fat to fit).

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Specializes in Mother/Baby;L/D.

oh yea i completely agree that this is just speculation...its good to hear other feedback though. Other perspectives help to open my eyes esp. being new to l/d. and yes i do believe baby was just too big to fit as u put it. mom was pretty avg. size for teen and mayb her pelvis was just too small for babe. It was just hard bc all i heard was "why didnt u guys take her to c/s earlier?" "poor girl". etc. I thought as long as baby was fine, mom was ok..doc was contuously updated, that she was alright. i mean the doc is the one to order and finally determine if he wants a c/s or not. thanks for the input all!!

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Specializes in L&D.

Two hours of documented adequate contractions (using an IUPC) with no cervical change usually means a C/S. But if you weren't getting adequate contractions and the baby was doing well, there is no hurry. The next shift just wanted you to have done the C/S so they didn't have to.

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Specializes in Mother/Baby;L/D.

Thats exactly what i had thought nursenora! ;) my preceptor didnt see any rush, md didnt either, only the next shift. sad sad sad.

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I've had many patients that have labored much longer than what you are describing and had a successful vag delivery. Our docs will let pts labor for at least 48 (and sometimes 72) hours as long as they are progressing (even in the cervical change is very slow) and FHT, temps, etc all look good. If the pt/family is pushing for a c/s, our docs usually give after about 24-36hrs of labor.

In this particular case, sounds like FTP (no change for 4 hours, right? 1500-1900), but sometimes FTP can be a result of CPD. Our docs will c/s after 4 hrs of no cervical change with adq ctx unless pt wants to cont laboring.

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