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Slide 1
Labor
Regular, frequent, leading to progressive cervical effacement and dilatation Braxton-Hicks contractions
May be painful and regular, but usually are not Do not lead to cervical change
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Progress of Labor
Lasts about 12-14 hours (first baby) Lasts about 6-8 hours (subsequent babies) Considerable variation. Effacement (thinning) Dilatation (opening) Descent (progress through the birth canal)
Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000 Slide 5
Descent
Fetal head descends through the birth canal Defined relative to the ischial spines 0 station = top of head at the spines (fully engaged) +2 station = 2 cm past (below) the ischial spines
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Watch a Delivery
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Placental Separation
Signs of separation:
Increased bleeding Lengthening of the cord Uterus rises, becoming globular instead of discoid Uterus enlarges, approaching the umbilicus
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Cervix
Dilatation: How far has the cervix opened (in cm) Effacement: How thin is the cervix (in cm or %)
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Status of Membranes
Nitrazine paper turns blue in the presence of alkaline amniotic fluid (nitrazine positive) Vaginal secretions are nitrazine negative (yellow) because of their acidity Pooling of amniotic fluid in the vaginal vault is a reliable sign
Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000 Slide 12
Orientation of Fetus
Vertex, breech or transverse lie Palpate vaginally Leopolds Maneuvers
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Normal Patterns
Normal rate Short term variability (3-5 BPM) Long term variability (15 BPM above baseline, lasting 10-20 seconds or longer) Contractions every 2-3 minutes, lasting about 60 seconds
Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000 Slide 17
Tachycardia
>160 BPM Most are not suggestive of fetal jeopardy Associated with:
Fever, Chorioamnionitis Maternal hypothyroidism Drugs (tocolytics, etc.) Fetal hypoxia Fetal anemia Fetal arrythmia
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Bradycardia
Sustained <120 BPM Most are caused by increased in vagal tone Mild bradycardia (80-90) with retention of variability is common during 2nd stage of labor <80 BPM with loss of BTBV may indicate fetal distress
Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000 Slide 19
Late Decelerations
Repetive, nonremediable slowings of the fetal heartbeat toward the end of the contraction cycle Reflect utero-placental insufficiency
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Early Decelerations
Periodic slowing of the FHR, synchronized with contractions Rarely more than 20-30 BPM below the baseline Innocent Associated with fetal head compression
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Variable Decelerations
Variable in onset, duration and depth May occur with contractions or between them Sudden onset/recovery Increased vagal tone, usually due to some degree of cord compression
Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000 Slide 22
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Prolonged Decelerations
Last > 60 seconds Occur in isolation Associated with:
Maternal hypotension Epidural Paracervical block Tetanic contractions Umbilical cord prolapse
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Pain Relief
Narcotics Continuous Lumbar Epidural Paracervical Block 50/50 nitrous/oxygen Psychoprophylaxis (Lamaze breathing) Hypnosis
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Episiotomy
Avoids lacerations Provides more room for obstetrical maneuvers Shortens the 2nd Stage Labor Midline associated with greater risk of rectal lacerations, but heals faster Many women dont need them.
Operational Obstetrics & Gynecology Bureau of Medicine and Surgery 2000 Slide 27
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