Oxytocin
- PDF / 171,499 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 57 Downloads / 187 Views
1
Oxytocin Uterine tachysystole: case report A 40-year-old woman developed uterine tachysystole during induction of labour with oxytocin [outcome not stated]. The woman presented due to spots in her vision and headaches at 36 weeks and 2 days of gestation. She had been previously diagnosed with pre-eclampsia. At presentation, she was administered paracetamol [acetaminophen] despite which her headache continued. She also complained of "white spots" in her vision that appeared to be floating. She was again administered paracetamol, and re-evaluated. However, visual disturbances and headache continued. She then consulted to the maternal-fetal medicine department, and decision to induce labour was made. She was administered magnesium sulfate as a seizure prophylaxis. The fetus was in breech position prior to induction initiation. As she had a history of four vaginal deliveries, external cephalic version (ECV) was considered with an alternative of caesarean delivery. She consented for ECV, which was successfully completed with terbutaline and an epidural administration for pain management. Subsequently, labour induction was initiated with misoprostol for cervical dilation of 1cm. She received total two doses of misoprostol twice. The induction was continued with Foley bulb placement, and oxytocin [dosage and route not stated] was administered for augmentation. She experienced intermittent episodes of tachysystole due to increased doses of oxytocin [duration of treatment to reaction onset not stated]. The woman’s oxytocin dose was appropriately titrated. During the course, fetal course was reassuring. She then experienced abnormal BP and required IV labetalol and IV hydralazine therapy; however, BP did return to baseline. The fetal status became progressively less reassuring after 26h of induction. Fetal heart tone monitoring revealed decreasing variability and multiple variable decelerations that persisted despite supportive measures. She reported severe pain and was immediately administered an epidural bolus. A 6cm dilated cervix that was oedematous on palpation was noted during examination. Also, an abrupt, prolonged fetal deceleration was present despite resuscitative measures including supplemental oxygen, discontinuation of oxytocin, positional changes and administration of terbutaline [terbutaline sulfate]. An anterior lip dilation was noted on further cervical examination. She was urgently shifted to the operating room, where vacuum-assisted delivery was attempted. No change in the fetal station was noted even after two vacuum pulls. Hence, she underwent an emergency caesarean delivery under unspecified general anaesthesia. A large amount of blood was evacuated. Suction to the uterus showed a thin serosal layer overlying the uterus with an obvious uterine rupture. The fetus was floating within the serosal sac. The fetus was delivered without fetal heart tone, and was passed to the neonatologist after which the baby was successfully resuscitated. Uterine rupture was confirmed, and she underwent a left oophorectom
Data Loading...
