Normal Labor And Delivery Flashcards
MC fetal lie
Longitudinal
Longitudinal axis of fetus to that of mother
Fetal lie
Portion of fetal body closest or within birth canal
Fetal presentation
MC fetal presentation
Cephalic
Fetal attitude
Fetus bent on itself convex
Flexed head thighs knees
Chin in contact with chest
Arms crossed over thorax
Relationship of fetal presenting part to R/L maternal birth canal
Occiput Anterior L
Leopold’s maneuver
Fundal Grip
Fetal back
Pawlik’s grip engagement
Attitude or habitus, degree of head flexion
Asynclitism
Naegele’s obliquity
Litzman
Ant parietal bone, sagittal suture to sacral promontory
Post parietal bone, symphisis pubis
Regular with shortening intervals and inc intensity
Hypogastric to lumbar
Cervical effacement and dilatation
No effect of sedation
True labor
Clinical signs of labor
Bloody show mucus plug extrusion
Spontaneous ROM
Amniotic Fluid tests to confirm ROM
Pool
Nitrazine blue
Fern crystallization
Parameters of cervical exam
Effacement
Dilation
Consistency
Position
Assesses favorability for successful delivery given cervical status and labor induction
Bishop score
>8 cm
Bishop score
Effacement Dilation Consistency Position Station
Most impt force in expulsion of the fetus
Maternal intra-abdominal pressure
Cardinal movements
Cephalic
Engagement Descent Flexion Internal rotation Extension External rotation Expulsion
Cardinal movements
Breech
Descent Engagement Internal rotation Lateral flexion Delivery Restitution
Cardinal movements
Face
Descent
Internal rotation
Flexion
Accessory ext rotation and expulsion
First stage of labor
Latent phase
Active phase
1-4 cm N20h M14h 4-10 cm N1.2cm/h M1.5 cm/h - acceleration: outcome of labor - max slope 8cm: efficiency - deceleration: fetopelvic relationship
Second stage of labor
Completion of descent and cardinal movements
N50mins M20mins
Third stage of labor
Delivery of placenta
5 mins
Management of first stage
Anesthesia
Stage 1 natural, IM/IV meperidine or morphine, paracervical anesthetic in vaginal fornices, epidural
Stage 2 epidural pudendal nerve block
One hand exerts forward pressure on fetal chin through perineum. Other hand pushes against occiput
Ritgen maneuver
Median episiotomy
More likely to extend to rectum
Mediolateral episiotomy
More difficult repair and healing
More pain and blood loss
Less cosmetic
Less extension to rectum
Signs of placental separation
Calkin globular and firm uterus
Gush of blood
Uterus rises in abdomen
Lengthening of UC
Placental extrusion
Schultze
Duncan
Central glistening amnion
Peripheral maternal surface
Lacerations of birth canal First Second Third Fourth
Fourchette, perineal skin, vaginal mucous membrane
Fascia and perineal muscles
Anal sphincter
Rectal mucosa
