Theme: Obstetrics
A 31 year old primigravida presents in spontaneous labour at 39+4 weeks gestation. The pregnancy has been uncomplicated thus far. On initial vaginal examination her cervix is 4 cm dilated and she in contracting regularly. She is in significant pain and requests an epidural which is inserted uneventfully. She is examined 4 hours later and there hasn’t been any further progress. The obstetric team review and recommend an artificial rupture of membranes (ARM) and an oxytocin infusion. Two hours after the ARM and having had issues with hyperstimulation on the oxytocin infusion, the emergency buzzer is pulled. The patient is profoundly hypotensive, desaturating and is becoming increasingly anxious and agitated. There is a persistent fetal bradycardia on the CTG.
