A multiparous woman has had painful uterine contractions every 2 to 4 minutes for the past 17 hours. The cervix is dilated to 2 to 3 cm and effaced 50%; it has not changed since admission.
1.Epidural block
2.Meperidine 100mg intramuscularly
3.Oxytocin intravenously
4.Midforceps deliver
5.Cesarean section
exp:
The multiparous patient is in prolonged latent phase, characterized by painful uterine contractions without significant progression in cervical dilation. Prolongation of the latent phase is defined as 20 hour in nulliparous and 14 hour in multiparous. The diagnosis of this category of uterine dysfunction is difficult Normal and Abnormal Labor and Delivery Answers 149 and is made in many cases only in retrospect. Only rarely is there need to resort to oxytocic agents or to cesarean section. The recommended management is meperidine (Demerol) 100 mg intramuscularly; this will allow most patients to rest and wake up in active labor. About 10% of patients will wake up without contractions and the diagnosis of false labor will be made. Only about 5% of patients will wake up after meperidine in the same state of contractions without progression. Epidural block may lead to abnormal labor patterns and to delay of descent of the presenting part.