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
Questions
1) comment on the CTG
2) Outline your management to her
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CTG raedings can be read as 3 patterns, Normal, Suspicious or Pathological.
ReplyDeleteFor 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.
Management:
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.