2. Maternal Profile
• 34 years old, G3P1+1 at 40w POA,
• SOD with dating scan done at 9w, p=d
• ANC :
(1) GDM on diet control
- optimal BSP with HbA1C of 7.9%
(2) H/O abortion in 2015 with D&C done
• She admitted for induction of labour at term
in view of GDM on diet control
3. 05.07.2016
• Otherwise, she was asymtomatic of labour –
no contraction pain, no show, no leaking
liquor
• Her foetal movement was well perceived
• Clinically she was not pallor, with good
hydration
• BP 134/ 86 mmHg, PR 88 bpm, FHR : 133-137
bpm
• CTG reactive with no contraction
4. • PA : SNT, uterus at term size, SFH : 40cm,
singleton, cephalic, longitudinal lie, head : 5/5th
up, EFW : 3.6-3.8 kg.
• VE : VV NAD, Cx : 2cm, firm, posterior; Os 1cm, St
: high with the BS of 1/13
• Hence, Prostin 3mg was inserted at 0915H
• Plans : CRIB for 1 hour
Postprostin CTG in 1 hour
Postprostin VE in 6 hours
Watchout hyperstimulation
5. @1330H
• Patient c/o strong contration, CTG noted to
have hyperstimulation with 4-5 : 10 strong
contraction
• Vaginal examination done noted the Cx 2cm
with Os 3cm
6. @1420H
• Another vaginal examintion done by MO and
noted Cx 1cm and Os 4cm
• Amniotomy was done and noted clear liquor
• Patient was sent to labour ward for delivery in
view of favourable BS
7. In labour ward
• Patient was seen by MO in labour room
• PA : SNT, uterus at term size, SFH : 40cm,
singleton/ cephalic/ longitudinal lie, head : 3/5th
up, EFW : 3.6-3.8kg.
• Patient was in 7 hours of 1st stage of labour, was
tocolyzed with IV Terbutaline for one and a half
hour in view of hyperstimulation, Oxytocin
augmentation was not started in view of optimal
contraction
• Patient was anticipated to have big baby when os
full
8. @2135H
• Foetal head delivered at 2133H, diagnosis of
dystocia made at 2135H, informed specialist
oncall
• Anterior shoulder – foetal right
• All manouvres attempted by Registrar and MO –
Mc Robert’s position, suprapubic pressure,
Woodscrew, reverse Woodscrew and finally
delivery of posterior arm (foetal left)
• Finally delivered posterior arm with much
difficulty and baby delivered at 2145H (dystocia
for 9 minutes)
9. • Baby immediately handed to Paeds team
• Cord blood gas with pH of 7,2
• Placenta delivered via CCT and checked –
complete
• Perineal examination done and noted Grade
3C perineal tear
• Patient was scheduled for EUA and repair
done in OT
