Management of a Patient with an Unsatisfactory Labor Epidural, Now Going for Cesarean Delivery
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An obese 32-year-old woman in good health, G1P0, needs a cesarean delivery for failure to progress in labor. Her cervix has not dilated beyond 6 cm, despite ample time and strength of uterine contractions as demonstrated by the use of an intrauterine pressure catheter (IUPC). The patient is exhausted and anxious and has had a fair amount of breakthrough pain above her pubic symphysis and in her back, despite three MD-administered epidural boluses of local anesthetic and fentanyl. The patient’s block level to cold sensation is at T8 (L-1).