A 24-year-old woman was booked early in her second pregnancy; she had a previous full-term spontaneous vaginal birth. Her booking body mass index (BMI) was 23.4 kg/m2 and her blood pressure (BP) was 104/86 mmHg. Her antenatal course was complicated with gestational diabetes, which was well-controlled with diet. Serial ultrasound fetal growth scans showed normal fetal growth, amniotic fluid volume and fetal Dopplers.
She presented at 39 weeks and 4 days gestation with a history of leaking fluid per vagina 12 hours earlier. The maternal observations on admission (21:30 hours, Day 1) to the delivery suite were:
- pulse rate (PR): 88 bpm
- BP: 110/71 mmHg
- temperature 36.7°C.
A dipstick of urine showed 2+ for blood, 1+ for leucocytes and a mid-stream specimen of urine was sent for culture and sensitivity. Cardiotocograph was commenced on admission and the fetal heart rate was 140 bpm. A speculum examination and Amnisure ROM™ test confirmed spontaneous rupture of membranes, her cervix was closed. Induction of labour was planned the following morning (9 hours later).
However, she had spontaneous onset of labour and received epidural analgesia for pain relief. At 08:10 hours (Day 2) her cervix was 8 cm dilated with bulging membranes. Forewater amniotomy was performed. Haemoglobin (HB) was 119 g/l, platelet count (PLT) was 103 x 109/l and white cell count (WCC) was 7.4 x 109/l. She had a spontaneous vaginal birth at 08:30 hours. The baby was born in good condition.
Following the expulsion of placenta and membranes, vaginal bleeding was noted. The uterus was well contracted; there was a second-degree perineal tear and bleeding from the clitoral region. Help was requested. The estimated blood loss (EBL) was 700 ml. Ergometrine 0.5 mg intramuscular was administered and oxytocin intravenous infusion was commenced. The clitoral and perineal lacerations were sutured; the EBL noted was 1000 ml. Maternal observations post-delivery at 09:13 hours were:
- PR: 132 bpm
- BP: 82/50 mmHg
- temperature: 36.7°C.
See the MEOWS chart below: