A Failed Epidural Followed by a Failed Spinal (Part 1)
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A 27-year-old obese diabetic woman, G1P0, receives a labor epidural which works perfectly for 2 h but then stops working after she changes position repeatedly and vigorously for Foley catheter placement (L-1). The resident had accessed the epidural space easily and passed the catheter 3 cm into the space (L2), but did not perform the Cohen maneuver (L-3) before he applied the sterile dressing. The patient’s contractions are becoming more frequent and painful and the resident is preparing to replace the epidural when the fetus begins to have late decelerations (L-4). The obstetricians temporize by administering terbutaline – which slows uterine contractions substantially – and the fetal heart rate normalizes (L-5), so the patient is taken back to the OR for a cesarean delivery under non-emergent conditions (L-6).