A woman aged 28yrs came in labour ward. This is her fourth pregnancy and she has had three previous spontaneous vaginal deliveries at term. This pregnancy has been uncomplicated and she has been admitted with contractions at 37wks and 6 days of GA.
P/A: the abdomen is soft with intermittent contractions continuing, fetus was palpated to be normal size, cephalic and 2/5 palpable abdominally, initially auscultation of the fetus was reassuring and the heart rate has continued to be normal (around 140b/min) on intermittent auscultation.
V/s temp - 37.6°C, pulse - 89b/min, resp - 20br/min, Bp- 110/76mmHg.
PVE: cx soft, 3cm dilated, ARM done with clear liquor, station 0
Plan was SVD anticipated and monitoring a progress of labour.
After 3hrs she shouted and urge to push at that stage and then become confused and disorientated saying that she could not breathe and was going to die.
O/e: pale ++, unconscious and unrouseable to painful stimuli. V/s Bp: 98/40mmHg, heart rate 120b/min, Spo2- 82% on air and respiratory rate 20br/min. The heart sound are normal but on chest examination there are inspiratory crackles throughout the chest. And immediately following this she collapsed.
Abdomen is soft with intermittent contractions continuing, and in fact the fetal head is now visible at the perineum and there was no vaginal bleeding.
Questions:
- What is likely diagnosis and differential diagnosis?
- How would you manage this woman?.
Karibuni.