Case 1: Normal Labor Flashcards
Stages of labor progression
Stage 1 - Latent: 0-4 cm - Active: 5-10 cm Stage 2: 10 cm to baby Stage 3: baby to placenta
Stages of labor timing
Stage 1
- Latent: primi under 20 hrs; multi under 14 hrs
- Active: primi faster than 1.2 cm/hr; multi faster than 1.5 cm/hr; slower progress than expected = protracted active phase; no progress in 4 hrs with normal contractions or 6 hrs with inadequate contains = arrest of active phase
Stage 2: nulli under 2 hrs; multi under 1 hr (must add extra hour to both of epidural)
Stage 3: under 30 min regardless
FHR normal range
110-160
FHR = Fetal Heart Rate
(FHT = Fetal Heart Tones)
3 types of decelerations in FHR
Early
Late
Variable
Early decelerations in FHR caused/characterized by…
- Fetal head compression; benign
- In sync with normal uterine contractions
Late decelerations in FHR caused/characterized by…
- Uteroplacental insufficiency (fetal hypoxia); can progress to fetal acidemia (late decelerations + decreased variability)
- Offset from normal contractions
Variable decelerations in FHR caused/characterized by…
- Cord compression
- Sharp declines that rapidly resolve; usually in sync with contractions
Assessment of labor is based on what?
Cervical change versus time
Accelerations in FHR caused/characterized by…
- Indicates well-being during labor
- Characterized by FHR increases of at least 15 bpm lasting at least 15 sec
Categorization of FHR patterns
Category 1 - reassuring
Category 2 - warrants careful monitoring (e.g. tachy without decelerations)
Category 3 - ominous; high likelihood of severe fetal hypoxia (e.g. persistent brady, late decelerations, variable decelerations)
3 P’s to consider in labor abnormality
Powers, passenger, pelvis
Powers - weak/absent contractions; fix with oxytocin
Passenger - baby too big; fix with CS; “cephalopelvic disproportion”
Pelvis - pelvic outlet too small; fix with CS; “cephalopelvic disproportion”
Course of action for arrest of active phase with adequate uterine contractions
CS
Adequate uterine contractions defined as…
- Pressure greater than 200 Montevideo units measured via internal uterine pressure catheter
- Contractions q 2-3 min lasting 40-60 sec
G3P2 at 39 weeks’ gestation with painful uterine contractions and dark vaginal blood mixed with mucus. Most likely etiology of bleeding?
Bloody show (loss of cervical mucus plug) - sign of impending labor; the presence of mucus gives it away
(antepartum bleeding sans mucus could be placenta previa, placental abruption, vasa previa, etc.; postpartum bleeding could be cervical laceration)
What if a patient requests scheduled delivery (vaginal or CS) at 38 weeks out of convenience?
No, because delivery under 39 weeks associated with increased risk of neonatal complications (so avoid this unless you have a legitimate medical indication)
