A 26-year old primipara at term gestation with labour pains presents with cervical dilation 3 cm, 60% effacement, Meconium stained liquor & decreased fetal hea rate: management is...
Fetal hea rate lesser than 110 is fetal distress and after the initial resuscitation the best management is Cesarean section. Fetal distress is the commonest cause of Cesarean section in modern obstetrics. Also, 'meconium in the liquor' indicates present or recent fetal strain. If the fetal hea rate is reassuring and patient is likely to deliver soon, then we can do amnio-infusion to dilute the meconium in the liqour with strict fetal monitoring and expedite delivery. Here since the patient is only 3 cm dilated and delivery is not imminent, it is advisable to perform an emergency LSCS, this reduces the chances of 'Meconium aspiration syndrome " of the new born which can lead to pnemonitis in the fetus and secondarily hypoxic injury to the brain.
Oxytocin drip to accelerate labour pains
IV drotaverine to improve cervical dilatation
Attempt a Vaccum delivery
Sta oxygen and shift to OT for emergency LSCS
Obstetrics