It was my last labour ward call. It wasn't as peaceful as I thought it could.
At almost 3am, a primigravida was brought in as active phase labour with hyperstimulation in her 35 weeks gestation. She was induced with one Prostin 3mg for preterm prelabour rupture of membrane (PPROM) >24 hours. Tocolytic was given. There was no sign and symptom of chorioamniotis then and CTG was reactive.
The labour progressed well till the midwife shouted:
"Baby flat!"
With immediate attention, I gloved up to aid in resuscitation before the Paediatrics team arrived. MO oncall was alert. The case was summarized to MO with the emphasis of reactive CTG, clear liquor and second stage took merely 11 minutes.
True enough, the CTG showed reactive trace throughout the whole second stage. MO went on further and noticed the change of baseline heart rate from 150bpm to 120bpm for the last 25 minutes. There was otherwise good beat to beat variation and acceleration with no deceleration. Venous cord pH was 7.12 with base excess of -22mmol/L.
The last 25 minutes...
I felt bad as MO just rested for barely less than an hour and there came a bad outcome. As a soon-to-be posting leaver who should be well entrusted, I failed to ensure things checked and reported for appropriate intervention. In this case, a change of baseline was not picked up earlier.
But of course, the reason for a flat baby is often uncertain. The patient herself exerted multiple risk factors such as preterm labour, PPROM, induction of labour as well as hyperstimulation. This baby was intubated but subsequently discharged well.
Obstetrics is a field of litigation. People move on with good outcome but once there is a bad outcome, every single step will be traced backward for error picking. Every small matter needs to be dealt with extra caution.
Lesson learnt.
At almost 3am, a primigravida was brought in as active phase labour with hyperstimulation in her 35 weeks gestation. She was induced with one Prostin 3mg for preterm prelabour rupture of membrane (PPROM) >24 hours. Tocolytic was given. There was no sign and symptom of chorioamniotis then and CTG was reactive.
The labour progressed well till the midwife shouted:
"Baby flat!"
With immediate attention, I gloved up to aid in resuscitation before the Paediatrics team arrived. MO oncall was alert. The case was summarized to MO with the emphasis of reactive CTG, clear liquor and second stage took merely 11 minutes.
True enough, the CTG showed reactive trace throughout the whole second stage. MO went on further and noticed the change of baseline heart rate from 150bpm to 120bpm for the last 25 minutes. There was otherwise good beat to beat variation and acceleration with no deceleration. Venous cord pH was 7.12 with base excess of -22mmol/L.
The last 25 minutes...
But of course, the reason for a flat baby is often uncertain. The patient herself exerted multiple risk factors such as preterm labour, PPROM, induction of labour as well as hyperstimulation. This baby was intubated but subsequently discharged well.
Obstetrics is a field of litigation. People move on with good outcome but once there is a bad outcome, every single step will be traced backward for error picking. Every small matter needs to be dealt with extra caution.
Lesson learnt.
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