From the Guidelines
Given the patient's prolonged labor at 7cm dilation and the presence of a fever, the most appropriate management is to proceed with a cesarean delivery (CD) as it is a safer option, especially if cephalopelvic disproportion (CPD) cannot be ruled out with a reasonable degree of certainty 1. The patient's condition, with a fever and prolonged labor, increases the risk of complications, and a CD is a more prudent choice to avoid potential harm to the mother and fetus. Some key points to consider in this scenario include:
- The patient has been at 7cm cervical dilation all day, indicating a potential protraction or arrest of labor
- The presence of a fever may indicate an underlying infection, which increases the risk of complications
- The patient completed a steroid course 10 hours ago, which may not have had sufficient time to take effect
- The intact membranes may increase the risk of infection and other complications The evidence suggests that a CD is a safer option in cases where CPD is suspected or cannot be ruled out, as it reduces the risk of complications and improves outcomes for both the mother and fetus 1. In this scenario, it is essential to prioritize the safety of the mother and fetus, and a CD is the most appropriate management option.
From the Research
Management of Patient with Fever and Intact Membranes
There are no research papers to assist in answering this question, as the provided studies focus on the use of the SF-36 health survey questionnaire for evaluating patient outcomes in various medical conditions, rather than managing patients with fever and intact membranes.
- The studies 2, 3, 4, 5, 6 discuss the validity, reliability, and acceptability of the SF-36 questionnaire in different patient populations, but do not address the specific clinical scenario presented.
- None of the studies provide guidance on the management of a patient with a fever, who has completed a steroid course, has been at 7cm cervical dilation all day, and has intact membranes.
- The provided evidence does not include any information on the appropriate management of this patient's condition, and therefore, no recommendations can be made based on the available studies.