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Normal Labor/ Abnormal Labor (Stages of Labor (Stage 1 Latent begin 0cm-…
Normal Labor/ Abnormal Labor
Learn what is normal, vocab, and time points (normal)
normal is diff for 1st time mom
Cervical change:
occurs 2/2 breakage of disulfide bonds
softening
effacement
gets shorter
dilation
gets wider
position
aims the cervix in
adventitious
direction
happen bc of
fetal head engagement
in Abn labor: simulate w/ Rx or :balloon:balloon
OCT or PGE
Where is baby? Fetal station
where baby :baby::skin-tone-3: is relative to mom :pregnant_woman::skin-tone-6:
Landmarks are ischial spine
spine = 0
:baby::skin-tone-3: head in uterus = (-)
:baby::skin-tone-3: head toward vagina = (+)
new
way
5 cm in either direction
objective measurement using the ischial spine
Fetal Position
Longitudinal cephalic (correct way)
:baby::skin-tone-3: axial skeleton in line w/ :pregnant_woman::skin-tone-6:
head is down
Longitudinal Breach
:baby::skin-tone-3: axial sk. in line w/ :pregnant_woman::skin-tone-6:
head is in
wrong direction
Transverse Breach
:baby::skin-tone-2: axial sk.
not in line
w/ :pregnant_woman::skin-tone-6:
Find clinical position w/
Leopold Maneuver
@ week
37
place hands and find the :baby::skin-tone-4: head
prove it w/ US
Breach Birth?
C Section
a paradigm, but there are exceptions
abnormal lie = external version
twist baby from the outside
Low yield Baby legs
what the hips are doing
what the knees are doing
Frank Breach
flexed
hips
extended
knees
Complete Breach
flexed
hips
bent
hips
Footling Breach
extended
hips
Stages of Labor
Stage 1 Latent
begin 0cm- ends 6cm
begins w/ onset of contractions
cervix has not started changing
dilated: 0cm
slowly dilates to
critical point
6cm
then v. quick to max dilation
10cm
Stage 1 Active
6cm-10cm
1.
2
cm/hr (
n
)
1.5 cm/hr (
m
)
faster
Stage 2
10cm-fetus
2
hr (
n
)
3 hr (
m
)
longer
Stage 3
Fetus delivery-placenta delivery
< 30m (regardless)
Stage 4
not real: the end
Prolonged delivery of Placenta?
Must be Power problem
OCT may already be given, when its exhausted then prolonged stage 3
Uterine massage
then
OCT
then
Manual extraction
D&C unnecessary
Passenger
Pelvis
hand in hand, baby big or mom small pelvis
can't really control either in a delivery
C section
Power
↑power w/ Rx:
OCT
Adequacy of contraction
old: >3 con/10min = good enough (frequency only)
new: MVU
≥200MVU/10min
> : contractions adequate, no Rx indicated, can jump to C section :hocho:
< : should augment w/ OCT to >200MVU before sx :hocho:
(-) =
C section
(+) =
Foreceps vs Vacuum
modern assessment of prolonged or arrested active phase
0 ∆ 4 hrs (n)
5 hrs (m)
not happening?
Help:
Balloon :balloon:
insert, inflate, tug
Amniotomy (sac intact)
rupture membrane so baby head can engage
misoprostol
OCT (right answer)
↑freq and strength of contractions
OCT failure
C-section
total arrest of labor
C section
Normal if
<
2
0hrs (
n
ulliparus)
<14hrs (
m
ultiparus)
shorter
memorize the numbers
normal: follows rule of "2's"
