Cpd???

  1. 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...
    Last edit by nurse79 on Jan 19, '07
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  2. 18 Comments

  3. by   burn out
    I am not an OB/LD nurse and I have a world of respect for them but I can tell you as a first time mother I only labored for 12 hours with pit and pushed for 4 hours when they decided cpd and did the c section. What a horrible experience for that new mom, will she ever be able to have any more children? That must be one of the hardest times in an ob/ld unit.
  4. by   HappyNurse2005
    Nurse79-

    how did she deliver-vag or c/sec? how big was the baby? (jsut curious)
  5. by   nurse79
    Happy, She went for C/S after we had left..not too sure how much the infant weighed.
  6. by   SmilingBluEyes
    Would have been sectioned sooner where I am. They are very hooked on the labor curve there, for the most part.
  7. by   nurse79
    thanks for ur input. So typically stuck at a certain cms for longer than 2 hrs isnt good..?
  8. by   KellNY
    If she wasn't fully dilated, then really it seems more an issue of FTP (failure to progress) than CPD. Both issues are often bogus, to throw my opinion out there.

    Here it would depend. As long as the baby was looking good, if the mother wanted to keep laboring, she would have been "allowed". If the mother had been pushing for a c/s most of our docs would have taken her back in a shorter period of time.

    A quick FYI-unless this woman had an IUPC, the mmHg on the toco doesn't mean much. I've seen women get Braxton Hicks up to 90, and women deliver a full termer while only registering in the 40s on the toco. I can't tell you how many times I've answered a call bell from a family member (or the woman herself!) "OMG! Come quick! She (I) just had a huge Ctx!!" so I go in, ask the usual questions (LOF, VB, mucus plug, etc). I ask how painful it was and I get "Oh, I didn't even hardly feel it. But you shoulda seen those numbers moving up!" Placement of the toco, position of the baby and uterus, body shape, body mass index, etc can all effect the readings. An external toco is really very relative.

    Burn out-Not trying to sound snarky, but a primip opting for a c/s after laboring for 12 hours (am I correct that labor was 12 hours and SROM was 20?) is far from being one of the hardest times here. Far far far, especially when mama and baby are alive and healthy in the end.
  9. by   CEG
    12 hours isn't really a very long labor. Isn't that the average length for a primip? Mine were both 18+ hours so I guess I was lucky to deliver where I did.
  10. by   nurse79
    Thats what I was thinking KEIINY,,re: the duration of her labor. and yes she had an IUPC and FSE in. She SROM at 0045. 3-4 cm -1 station and was in early labor... but started having regular UCs like at 930 am, and dilated to like 7.5cm by around 1500, still -1 station. 1900 still no change. Baby looked fine all day, no decels. I just thought it was rude for the next shift to wonder "what took so long for her to go to c/s" a PRIMIP (and only 16 years of age might i add). I didnt think my preceptor did anything wrong...did lots of hip rocking, hands and knees, etc to get baby to drop.
  11. by   CMCRN
    50 mm by IUPC is NOT adequate labor. UCs need to be 60 or greater. This sounds more lack of forces than CPD. We give moms all the time they need as long as progress is being made, and forces are adequate. An exhausted 16 year old, I might have encouraged her to get an epidural, increased the Pitocin and let her labor down.
  12. by   KellNY
    I'm thinking that she just wasn't in real labor. Even if she were "term" (and there's a good chance that dates are off), I think her body or her baby just weren't ready.

    Did anyone get her up to walk around for a little while?

    What a shame a 16 y/o had a primary c/s.
  13. by   nurse79
    Yes i agree regarding the intensity of her UCs. Unfortunately she would hyperstim when Pit was increased past 9mu..she also didnt want an epidural. Maybe just FTP ??
  14. by   CMCRN
    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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