Two hours ago, a patient at 39 weeks' gestation was 3 cm dilated, 40% effaced, and +1 station. Frequency of contractions was every 5 minutes with duration 40 seconds and intensity 50 mmHg
The current assessment is 4 cm dilated, 40% effaced, and +1 station. Frequency of contractions is now every 3 minutes with 40–50 seconds' duration and intensity of 40 mmHg. The priority intervention would be: 1. Beginning oxytocin after assessing for CPD.
2. Giving terbutaline to stop the preterm labor.
3. Starting oxygen at 8 L/min.
4. Having the anesthesiologist give the patient an epidural.
1
Rationale 1: The patient is having hypertonic contractions. The presence of CPD can prolong labor, so it is important to rule this out. Oxytocin (Pitocin) can create a more productive labor pattern by strengthening the contractions.
Rationale 2: Terbutaline would not be recommended. The contraction pattern is incoordinate, but the contractions need to be enhanced, not stopped.
Rationale 3: Oxygen will not hurt, but it is not the priority.
Rationale 4: An epidural will not change the incoordinate contraction pattern.
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