Procedure Ready: Ob/Gyn3 Des 2017

Indications for a c-section during labor

When does a laboring patient need a cesarean delivery? This episode covers the six key indications – from nonreassuring fetal heart tracings to cord prolapse – including the specific time criteria for arrest disorders and what fetal heart rate findings are the most concerning.

Show Outline:

Nonreassuring Fetal Heart Tracing – Category 2 remote from delivery; minimal/absent variability as the most significant predictor of fetal acidemia; Category 3 at any time is emergent delivery
Failed IOL – Most commonly defined as 12–24hrs ruptured membranes on pitocin without active labor
Arrest of Dilation – Must be in active labor (6cm+). Adequate contractions (IUPC with MVUs >200–250): no change over 4hrs. Inadequate or no IUPC: no change over 6hrs
Arrest of Descent – Primip with epidural: 3hrs; without: 2hrs. Multip with epidural: 2hrs; without: 1hr
Cord Prolapse – Emergency!
Malpresentation – Breech, transverse, compound

About the Speaker:

Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

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