labor and delivery

Labor and DeliverySlide *
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
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Labor
Braxton-Hicks contractions
Do not lead to cervical change
Labor diagnosis usually made in retrospect.
Cause of labor is unknown
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Dilate very slowly
May last days or longer
May be treated with sedation, hydration, ambulation, rest, or pitocin
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Are not comfortable with talking or laughing during their contractions
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Considerable variation.
Effacement (thinning)
Dilatation (opening)
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Descent
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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Internal rotation (fetal head rotates from transverse to anterior
Extension (head extends with crowning)
External rotation (head returns to its’ transverse orientation)
Expulsion (shoulders and torso of the baby are delivered)
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Uterus enlarges, approaching the umbilicus
Normally separates within a few minutes after delivery
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Position of the fetus: vertex, transverse lie, breech
Fetal status: fetal heart rate, EFM
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Cervix
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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
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Palpate vaginally
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Ambulation OK with intact membranes
If in bed, lie on one side or the other…not flat on her back
Check vital signs every 4 hours
NPO except ice chips or small sips of water
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Monitor the Fetal Heart
During early labor, for low risk patients, note the fetal heart rate every 1-2 hours.
During active labor, evaluate the fetal heart every 30 minutes
Normal FHR is 120-160 BPM
Persistent tachycardia (>160) or bradycardia (<120, particularly <100) is of concern
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Continuously records the instantaneous fetal heart rate and uterine contractions
Patterns are of clinical significance.
Use in high-risk patients.
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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
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Tachycardia
Associated with:
Fever, Chorioamnionitis
Maternal hypothyroidism
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Bradycardia
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
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Late Decelerations
Repetive, non-remediable slowings of the fetal heartbeat toward the end of the contraction cycle
Reflect utero-placental insufficiency
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Innocent
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May occur with contractions or between them
Sudden onset/recovery
Increased vagal tone, usually due to some degree of cord compression
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Below 60 BPM for at least 60 seconds
If persistent, can be threatening to fetal well-being, with progressive acidosis
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Episiotomy
Shortens the 2nd Stage Labor
Midline associated with greater risk of rectal lacerations, but heals faster
Many women don’t need them.
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Clamp about an inch from the baby’s abdomen
Use any available instruments or usable material
Check the cord for 3-vessels, 2 small arteries and one larger vein
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Look for missing pieces
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labor and delivery

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