Regarding this question: A 36 year old woman with 3 previous vaginal births presents in spontaneous labour at 39 weeks gestation. At 07:00 the cervix is 5 cm dilated with intact membranes. At 11:00, the cervix is fully dilated and the membranes are intact. The vertex is at the spines with a direct occipito-anterior position and the woman has started active pushing. There are 3 contractions every 10 minutes and fetal heart rate monitoring is normal.
The answer to this was VE in 30min but according to NICE you would do a VE in 30 min if there are no signs of progress in labour. So I don't understand why the answer isnt continue pushing for 1h? The best answer would be to reassess progress in 30 min, but it's obviously not on the list, so I thought the next best would be to continue pushing for 1h, no?
Posted by Farrukh G.
How do you reassess progress in the second stage without a VE?
Reply to Farrakh G
Posted by Fatima A.
Lots of ways to assess progress. VE isnât always necessary. Eg if there are new external signs, or if the presenting part is visible.
Posted by Farrukh G.
That is interesting. Have you ever been in a stuation where you are told there are external signs of progress only for the woman to be undelivered 1h later and you find the caput is visible but the head is at +2 with an op position?
I think you mis-understand what the question is asking you. When you are given the details of the question you are asked for your management. You need to make a plan that covers everything. So you say there could be external signs of full dilatation. I say the woman could be delivered..... You said the best answer is reassess in 30 mins but that was not there so you thought continue pushing for 1h in violation of NICE guidelines which say 'reassess in 30 mins if no signs of progress' is better than VE in 30 mins? What is so bad about doing a VE in 30 mins???
I am afraid your approach to this and your other post is to make assumptions which are not presented in the question. There are many other assumptions that you can make that lead you to a different answer. You need to answer the question asked and SELECT SQL_CALC_FOUND_ROWS the BEST option, not one that is best for the assumptions you have made.
