22. Stages of delivery. Management of the first and second stage

Question 1

what initial evaluation does every woman admitted in labor should undergo?

Answer 1

• Recording of vital signs (HR, BP, RR, body temp)
• CBC, blood group, Rh status
• Hepatitis B and syphilis screening (if not previously done)
• Group B strep screening (if not previously done)
• Urinalysis, urine culture, urine output
• Review of pregnancy records

Question 2

what is the abdominal examination (Leopold maneuver) for?

Answer 2

determine fetal lie and fetal presentation

Question 3

list the 4 Leopold maneuvers

Answer 3

1. Fundal grip
2. Umbilical grip
3. Pawlik’s grip
4. Pelvic grip

Question 4

Maneuver I Fundal grip

Answer 4

The uterine contour is outlined.
The fundus is palpated with the fingertips of both hands
facing toward the maternal head.
Allows for identification of the fetal parts in the upper pole
(fundus) of the uterus.

Question 5

Maneuver II Umbilical grip

Answer 5

The hands are placed at either side of the maternal abdomen. Allows determination of the location of the fetal back and fetal extremities.

Question 6

Maneuver III Pawlik’s grip

Answer 6

Using one hand, grasp the presenting part between the thumb and fingers (on the lower abdomen, a few cm above the symphysis pubis).

Allows the examiner to develop a further identification of the presenting part and assessment of engagement (if moving parts are felt → the presenting part is not yet engaged).

Question 7

Maneuver IV Pelvic grip

Answer 7

The examiner faces the pelvis of the patient. The palms of both hands are placed on either side of the lower maternal abdomen, with the fingertips facing toward the pelvic inlet. Allows the identification of the fetal parts in the lower pole of the uterus.

Question 8

what is done in the vaginal examination in the first stage of delivery?

Answer 8

1. Determine fetal head position by palpating the fontanelles and sutures
2. Determine if the fetus is in vertex, face, brow, or breech presentation
3. Determine fetal station (extant of descent)
4. Detection of ROM, exclude cord prolapse
5. Evaluate the degree of cervical effacement and dilation

Question 9

how do we assess fetal heart sounds?

Answer 9

Auscultation

may be replaced by CTG monitoring

Question 10

how do we monitor the fetal-well being during 1st stage of delivery?

Answer 10

Cardiotocography (CTG) to assess fetal cardiac function in relation to uterine contraction.

Evaluate every 30 min’ during the active phase of the first stage of labor, and at least every 15 min’ during the second stage of labor.

*For high-risk pregnancies → consider continuous monitoring.

Question 11

what is molding?

Answer 11

the alteration of the relationship of the fetal cranial bones to each other as a result of compressive forces exerted by the bony maternal pelvis. Some molding is normal; if cephalopelvic disproportion is present, the extent of molding will be more pronounced

Question 12

what is Caput succedaneum ?

Answer 12

a localized, edematous swelling of the scalp caused by pressure of the cervix on the presenting portion of the fetal head; resolves spontaneously within 1-3 days

Question 13

when does crowning occur?

Answer 13

when the largest diameter of the fetal head is encircled by the vulvar ring; at this time, the vertex has reached station +5.

Question 14

incision in the perineum (episiotomy) may aid in..?

Answer 14

reducing perineal resistance.

Question 15

characteristics of Midline episiotomy

Answer 15

Simple surgical repair
Rare abnormal healing 
Minimal postoperative pain 
Excellent anatomical result 
Less blood loss
Rare dyspareunia 
Higher risk of 4th degree damage

Question 16

characteristics of mediolateral episiotomy

Answer 16

complex surgical repair
common abnormal healing 
common postoperative pain 
occasionally faulty anatomical result 
more blood loss
more common dyspareunia 
lower risk of 4th degree damage