A 26-year-old G1P0 woman at 39 weeks’ gestation is admitted to the hospital in labor.

A 26-year-old G1P0 woman at 39 weeks’ gestation is admitted to the hospital in labor. She is noted to have uterine contractions every 7 to 10 minutes. Her antepartum history is significant for a nonimmune rubella status.
On examination, her blood pressure (BP) is 110/70 mm Hg and heart rate (HR) is 80 beats per minute
(bpm). The estimated fetal weight is 7 lbs.
On pelvic examination, she has been noted to have a change in cervical examinations from 4-cm dilation to 7 cm over the last 2 hours. The pelvis is assessed to be adequate on digital examination.

What is your next step in the management of this patient?

Next step in Management: Continue to observe the labor.

Learning Objectives In this Case

1. Know the normal labor parameters in the latent and active phase for nulliparous and multiparous patients.
2. Be familiar with the management of common labor abnormalities and know that normal labor does not require intervention.
3. Know that rubella vaccination, as a live-attenuated preparation, should not beadministered during pregnancy.

Case Discussion:

This 26-year-old G1P0 woman is at term (defined as between 37 and 42 completed weeks from the last menstrual period).
She is in the active phase of labor (generally about 4 cm of dilation) and her cervix has changed from 4 to 7 cm over 2 hours; her contractions are only every 7 to 10 minutes. Because she is nulliparous,
the expectation is that her cervix will dilate at a rate of at least 1.2 cm/hour during the active phase of labor. She has met these norms by a change of 1.5 cm/h (3 cm over 2 hours). The uterine contraction pattern appears suboptimal, but it is the change in the cervix per time and not the uterine contraction pattern that dictates normalcy in labor. Because she has had a normal labor, the appropriatem management is to observe her course without intervention.

The clinical pelvimetry is accomplished by digital palpation of the pelvic bones. This patient’s pelvis was judged on physical examination to be adequate. Unfortunately, this estimation is not very precise, and in clinical practice, the clinician would generally observe the labor of a nulliparous patient.

Importance of Rubella Immune status: Finally, the nonimmune rubella status should alert the practitioner to immunize for rubella during the postpartum time (since the rubella vaccine is live attenuated and is contraindicated during pregnancy).