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Trans #10 Group #10: Anonas, Bangayan, Go, Liberato, Pineda, Talla 1 of 8
abdomen, the head is not yet engaged (referred as floating
presenting part)
When one hand of the examiner is arrested before the other, a
portion of the head is said to be engaged
If hands do not touch, the presenting part is not engaged
Ruptured Membranes
Inspected with the use of a speculum
Pooling in the fornix (amniotic bag rupture)
accumulation of amniotic fluid
Figure 1. Leopold Maneuvers. (A) Fundal Grip, (B) Umbilical Grip, (C) Pawlick’s Fluid, which has accumulated in the posterior fornix, indicating
Grip, (D) Pelvic Grip. (Cunningham et al., 2014) the integrity of the membranes whether they are ruptured or not.
The pH of amniotic fluid is ≥6.5.
C. VAGINAL EXAMINATION Normal vaginal pH ranges from 4.5-5.5.
Can get a lot of information by vaginal examination Arborization or ferning
Note the discharge: Presence of fern-like, salt-like crystals in the amniotic fluid
Watery (seen under microscopes) (Figure 4)
Bloody (scanty or profuse bleeding) Due to high levels of estrogen: increases salt content found in
If profuse, may be an indication of an abnormally located the amniotic fluid. − Salt content induces crystallization
placenta.
Do not perform vaginal examination as it may induce further
bleeding, possibly killing both the fetus and the mother
Contact with anal region is avoided.
This may deliver feces, and thus microbes, into the vagina.
Number of internal examinations
Determined by how far the patient is in labor.
No standard number of vaginal examination is required
Presenting part
Nature of presentation
Vertex Figure 4. Cervical mucus arborization or ferning (Source: Williams Obstetrics,
Face 24th edition).
Footling or breaching
Transverse line Ruptured membranes are significant for:
Position for presenting part Cord prolapse
Occiput of the vertex presentation when the umbilical cord comes ahead of the fetal head
Face for the face presentation It can get in the way of the delivery of the baby
Legs for the footling presentation If the cord is constricted, it can cause hypoxia in the baby
Shoulder if the baby is in the transverse line because of inadequate blood supply
Sacrum for the breech Impending labor
Infection of both mother and fetus (if > 24hrs)
Vaginal flora can go up to the uterus
Can lead to sepsis and death
F. LABORATORY EXAMINATIONS
For possible comparison after delivery
Hemoglobin
Hematocrit
Urinalysis
Blood typing
Figure 9. Measurements using the sub-pubic arch and the bituberous diameter Important in case of hemorrhagic outcome
(Source: https://web.duke.edu) Levels could have changed from pre-natal examination until the
admission
Figure 10. Cervical Planes (Source: Pineda, 2017) Figure 11. Lithotomy: usual position in a lying-in/birthing facility
E. DELIVERY
Delivery of the Head
Crowning
A B Largest head diameter encircled by vulvar ring
Needs assistance to make sure the head popping out does not
cause lacerations on mother’s pelvic floor
Figure 13. Birthing Positions (Pineda, 2018) Assisted using Ritgen Maneuver
Lithotomy (A), squat (B), leaning on pillows (C)
Involves the manual control of the delivery of the head
One hand is wrapped in a towel, the other hand on the
B. MATERNAL EXPULSIVE EFFORTS occiput
Spontaneous Following the contractions, baby is pushed in the direction of
There is a reflex that triggers the urge to push the coccyx towards the fetal chin
Mother will be forced to push (pag-ire) unless anesthesia is Exit of the head is controlled through the occiput facilitating
present the movement of extension preventing perineal trauma to the
Reflexive urge brought about by the impingement of the head on mother
rectal area (Trans 2020)
Push during contraction
Mother is coached to gather enough air then hold her breath
before pushing with all her might
effectively increase the intra-abdominal pressure and contract
the muscles facilitating faster expulsion of the baby
D. EPISIOTOMY
Incision of the pudendum to widen opening for the successful
delivery (especially during nullipara)
Done if the baby is too large for the opening and to shorten the
course of labor
Done for women with too short frenulum of labia minora (fourchette)
Can be:
Median cut
done by those who have proper training in repairing the
rectum
Mediolateral cut
Done at about 45 degrees
Figure 16. Spontaneous Delivery (Pineda, 2018)
Figure 18. Nuchal cord (if there is) should be clamped immediately to prevent
more complications (Pineda, 2018)
QUICK REVIEW
SUMMARY OF TERMS
Figure 21. Manual Separation of Placenta (Pineda, 2018)
Labor: Regular uterine contractions that bring about demonstrable
dilation and effacement of the cervix
Active Management of the 3rd Stage of Labor Onset of Labor: Painful uterine contractions +
Hemostasis Ruptured membranes
Vasoconstriction of placental site Bloody show
Uterotonics Complete cervical effacement
Oxytocin True labor vs. False labor
Anti-diuretic Leopold maneuvers
Ergonovine maleate Leopold maneuver 1 (Fundal Grip)
For contraction of uterus in the treatment or prevention of Leopold Maneuver 2 (Umbilical Grip)
postpartum or post-abortion hemorrhage caused by uterine Leopold Maneuver 3 (Pawlick’s Grip)
atony Leopold Maneuver 4 (Pelvic Grip)
Methylergonovine maleate
REVIEW QUESTIONS
1. The following characterize False labor
a. No cervical dilation
b. Not relieved by sedation
c. Shortened contraction intervals
d. Discomfort in the upper abdomen
2. You must check for the following during the fourth stage of labor:
a. Excessive bleeding
b. Maternal vital signs
c. Clots in the vaginal or lower genital tract area
d. AOTA
e. A and B only
5. Using the Johnson’s rule, if the fundic length of a baby with a vertex
above the ischial spines is 35 cm, what is the weight of the baby?
a. 3720 g
b. 3565 g
c. 3875 g
d. 1550 g