Ibrah II: Delivery Problems

Pregnancy, Childbirth, & the Puerperium


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G14_F1.jpg"}},{"insert":"\n\nYou first met Ibrah, a 33-year-old G4P3A0 stay-at-home mom of an Iraqi migrant family around seven months ago. She was referred to your clinic after antenatal screening showed her to be anemic. You diagnosed her to have iron deficiency anemia, and started treatment.\n\nDuring her subsequent follow up, you found biochemical and ultrasound evidence that her fetus might have an aneupolidy: most likely trisomy 21 (Down syndrome). Ibrah refused invasive diagnostic testing and wished to carry the pregnancy to term.\n\nWhile Ibrah\u0027s previous three children were delivered at home, you strongly recommended that she deliver her new baby at your hospital. She conditionally agreed \u2013 while she didn\u0027t want to be confined ahead of time, she promised to come over as soon as her waters broke, or contractions started.\n\nIbrah\u0027s story continues now\u2026\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G14_F2.jpg"}},{"insert":"\n\nYou receive a call from the labor and delivery ward. One of your patients has been admitted: Ibrah.\n\nIbrah is now at 37 weeks + 2 days of gestation. She tells you that contractions started around 6 hours ago, but she couldn\u0027t come to hospital until now because there was no-one to leave her children with. Her waters broke around an hour ago as well. The amniotic fluid was white-yellow in color. There was no vaginal bleeding.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G14_F3.jpg"}},{"insert":"\n\nYou proceed to perform a physical examination. \n\nIbrah is afebrile. Her pulse is 110 bpm, and blood pressure is 135\/80 mmHg. Her contractions are strong, occurring every 2 minutes, and last for 40 seconds each. The fetal head is at station -2. The cervix is dilated to 10 cm. The anterior lip of the cervix is grossly edematous and rotated slightly towards your right side. You are able to easily palpate the fetal anterior fontanelle, orbital ridge, and forehead. There is ++ molding of the fetal head and ++ caput formation. The fetal heart rate is 180 bpm. \n\nYou obtain a CTG, which reveals an ongoing prolonged deceleration.\n"}]}


{"ops":[{"insert":"You step back and ponder for a moment. Clearly this is a cephalic presentation \u2013 but what type?\n"}]}
1. Vertex presentation
2. Face presentation
3. Brow presentation