This case features a post term spontaneous labor with meconium and expected large fetus, where the mother declined induction and intervention. What does it mean when there’s lack of cycling and an increase of baseline and variability, but without decelerations? This is where the importance of the overall clinical context, time factor and the physiology behind development of chorioamnionitis comes in.

Background:

  • Primigravida
  • BMI 40
  • 20 week scan – no structural problems, increased PI uterine arteries – serial growth scans
  • 39 week scan – 90th centile, normal dopplers, normal amniotic fluid
  • IOL recommended at 40w and declined
  • Spontaneous labor at 41w, 3cm meconium

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