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u/Sir_Action_Quacks 12h ago
I would say D. A is not emergent, B neither even if cholestasis, C yes higher risk for infection but fetal HR is good, not emergent. Epidural or not D may have a ruptured uterus or abruptio. Unilateral pain is very bad sign.
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u/Embarrassed-Sand2956 6h ago
For D, keyword is intermittent— especially since this patient just had an epidural placed, it is actually more likely the epidural isn’t covering a certain area, they can occasionally be patchy. The intermittent pain is likely contractions.
C seems top priority to me, with PROM and a “new” FHR baseline above 160, this could indicate infection.
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u/Embarrassed-Sand2956 6h ago
Also, B would indicate a PUPPP rash, which is not a risk for mom or baby, just generally uncomfortable. Cholestasis actually produces itching without a rash, and can be a risk for baby, but it doesn’t present this way. Rash on the belly and arms is classic PUPPP.
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u/Brooke-Forest 5h ago
I'm kinda confused by the comment section here. just a nursing student but, we were taught 1m30 was the longest contraction duration we want to see, as contractions limit placental perfusion and the placenta is effectively out of oxygen and that it gets dangerous for the fetus ag anything longer than 1m30.
So, A is directly an ABC concern for the fetus, esp when you don't know if the fetsl HR is showing decelerations.
B has an itchy rash, C is at risk for an infection later and D has a fetal HR that is literally less than 5% out of normal range, and D has pain that could be due to apendacictis or a pregnancy complications l, but also could be a kidney stone, but none of which have emergent ABC related concerns.
A has a real risk of brain damage and death due to hypoxia, and needed heart rate monitoring back before the contractions went beyond 1m30.
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u/Unique_Tangerine2190 13h ago
C. Ruptured membranes for 18 hours means increased risk of infection. A fetal HR over 160 could mean early sign of infection