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"M.M., a 25-year-old Hispanic primigravida at 41 weeks and 6 days gestation, presented to the labor and delivery unit for postdates induction of labor, accompanied by the father of the baby. She reported normal fetal movement and denied any loss of fluid or vaginal bleeding," scientists writing in the Journal of Midwifery & Womens Health report (see also Life Sciences).
"Her prenatal course was uncomplicated. The fetal heart rate was reassuring. Occasional contractions were recorded by the tocometer, but not felt by M.M. A pelvic exam found her cervix to be I cm dilated, 80% effaced, soft and posterior, with the vertex at -2 station with membranes, intact. Based on a Bishop score of 7, the decision was made to proceed with induction of labor with intravenous oxytocin per hospital protocol of 1 mU every 15 minutes to a maximum of 5 contractions in 10 minutes lasting no more than 60 to 90 seconds or a maximum dose of 20 mU/min. Three hours after oxytocin was initiated, M.M.'s cervical exam was 2 cm dilated, 80% effaced, with the vertex at -2 station. The fetal heart rate baseline was 135 beats per minute with moderate variability and no decelerations. Six hours after admission, M.M. requested pain relief. Her cervical exam was 4 cm dilated, 90% effaced, with the vertex at -1 station. The oxytocin was infusing at 16 mU/min and the fetal heart rate was reassuring. Pain management options were discussed with the client and, after being counseled on the risks and benefits, she opted for epidural anesthesia. Eight hours after admission, M.M.'s uterine contractions became difficult to detect with the external tocometer. At examination, her cervix was found to be 7 cm dilated, 100% effaced, with the vertex at 0 station. The oxytocin was infusing at 20 mU/min. The midwife counseled the client on the need to monitor uterine contractions when receiving oxytocin and the decision was made to rupture M.M's bag of waters ...