[Answered]: INDICATION: Prolonged fetal heart rate deceleration

INDICATION: Prolonged fetal heart rate deceleration. PROCEDURE: Vaginal delivery. COMPLICATIONS: Shoulder dystocia, relieved with McRobert’s maneuver. PREAMBLE: The patient is a 33-year-old gravida 3, para 2, 38 week, 3 days gestation. The patient presented to her physician’s office and was a straight admit. The patient was quite uncomfortable and had artificial rupture of membranes followed by labor progression to full dilation. She then began pushing, and some prolonged fetal heart rate decelerations down to about 90 beats per minute were noted Because of this, a decision was made to proceed with vacuum extraction to assist in expediting delivery. PROCEDURE NOTE: Maternal bladder was emptied using straight catheter. Pelvic examination was carried out and the cervix was confirmed to be fully dilated. Fetal vertex was present at +1 station. The small kiwi cup vacuum (supports delivery vacuum assisted) was then applied to the fetal vertex. On the second pull, there was one pop off, but this was after good descent of the fetal head had been achieved. Baby then delivered and was a live-born male infant. There was moderate shoulder dystocia present (supports delivery complicated by shoulder presentation) and this was relieved with McRobert’s maneuver. The baby was handed off to the NICU team and is currently in the NICU for further observation. Apgar’s (a newborn maturity scoring method) are not available at this time. Cord blood gas is also pending. After an episiotomy, a second-degree perineal tear still occurred during delivery. This was repaired using 3-0 chromic in usual manner. The patient tolerated this procedure well. Estimated blood loss during delivery was 200 cc.