June 17, 2010

Preterm Labour

32 years old malay lady, G3P2 at 30W + 2/7 POA presented to labour room after noticing a gushing of clear fluid pass through her vagina at the morning. below is her CTG on admission


1) comment on the CTG

2) Outline your management to her

for answer to this question, please click [here]

1 comment:

  1. CTG raedings can be read as 3 patterns, Normal, Suspicious or Pathological.

    For this case, CTG is Normal as it has 4 reassuring features,

    I)Baseline Hear Beat is 145 bpm. (Normal between 110 -160)

    II)Presence of acceleration (this one I don't really know how to comment)

    III)No deceleration

    IV)variability in acceleration of 5-10 bpm.


    First thing first, must confirm her pregnancy date.
    -Ask about her last NORMAL menstrual period.
    -If unsure, first trimester ultrasound.

    Take full history of presenting complaint.
    -Ask about the fluid characteristic, smell, colour, consistency, volume, associated with pain/not (labour sign).
    -ask about fetal movement, still viable?
    -exclude differential diagnosis such as urinary incontinence, any history before?
    -exclude any infection, symptoms such as fever, dysuria, haematuria.

    Do Physical Examination.
    -Asses amniotic fluid volume, fetal lie, position, movement.
    - To exclude urinary incontinence, do vaginal inspection and ask patient to cough.

    Do investigation :
    -Non stres test CTG monitoring.
    -Low vaginal swab??
    -Ultra Sound Scan for fetal well being.

    This is my answer before I look at yours. Please comment and correct me. Thank you.


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