Normal vs assisted delivery Flashcards
Normal delivery definition
Spontaneous in onset, low risk throughout pregnancy and delivery
Infant is born in the vertex position and between 37-42 weeks gestation
After birth, mother and infant must be in good condition
Assisted delivery definition
Use of vacuum or forceps to extract the fetus from the whomb
Cardinal movements of labor
1) Engagement
2) descent
3) Flexion of neck to the chest
4) internal rotation
5) extension through the cervix And vagina
6) external rotation
7) expulsion
3 stages of labor
1) from onset of contractions -> 10 cm dilated
* *1a) = latent phase 0->6cm dilation
* *1b) = active phase 6-> 10cm dilation
2) from 10cm dilation -> delivery of the fetus
3) from delivery of the fetus -> delivery of the placenta
- *many patients require admission prior to active phase of the labor**
- nullpartum is admitted later than multipartum (multiple pregnancies make future incidences go quicker usually)
Inital exam of the 1st stage of labor
Are membranes intact or ruptured
If bleeding is it excessive or not?
Get cervical dilation and effacement measurements
- null = will efface first
- multi = will efface and dilate at the same time
Measure:
- fetal station
- fetal lie
- fetal presentation
- fetal position
- fetal size and maternal pelvis
- fetal and maternal well-being
Crowning
“Ring of fire” = if they dont have anesthesia at this point this gonna hurt
episootomy should NOT be routine during birth, however if you have to do it the last time to do it is when crowning is occurring
When the baby is crowing, apply warm compresses and massage the perineum to help it stretch and reduce risk of tearing or need for episiotomy. Also minimize trauma to infant
Cord clamping
It is recommended to delay cord cutting and clamping for at least 30-60 seconds
- especially in preterm and vigorous term babies
there is no difference of the position of the baby with cord clamping through
Advantages and disadvantages of cord clamping delay
Advantages
- increase hemoglobin levels at birth
- higher iron stores first several months of life
- facilitates transfer of Igs and stem cells
- significant neonatal benefits in preterm infants
- benefits of transfusion of additional blood volume at birth exceed banking
- lower incidence of necrotizing enterocolitis and intraventricular hemorrhage
Disadvantages
- small increase in jaundice (may require phototherapy)
- polycythemia can occur in small infants
- reduces cord blood volume for cord samples (blood gases, ABO, Rh testing, stem cells, etc.)
- may compromise cord blood gas measurements if done after delivery of placenta
When to NOT delay cord clamping
Will interfere with time care of newborn
Either mother and/or fetus are unstable
If there is placenta abruption or previa
If there is cord avulsion
In any newborn that is shown IUGR with abnormal umbilical artery doppler
Cord milking
Generally not recommended as an unknown volume of blood can be transfused to an infant in a non controlled way which could cause harm
there are higher incidence of intraventricular hemorrhages in preterm newborns with this occurring
Placenta delivery
Usually minutes after infant birth a gush of blood and slight lengthening of the cord will occur indicating placental Separation
The uterus moves cephalad and becomes firm/globular as the placenta separates
Must apply gentile cord traction and uterine massage to delivery the placenta (DONT pull too hard)
Examine placenta for any abnormalities and to make sure you got all of it
Massage uterus and fundus to encourage contraction and minimize bleeding
Repair any lacerations with absorbable sutures as needed
Three components of active management of the 3rd stage of labor
1) administration of oxytocin (uterotonic) immediately after delivery of baby
2) controlled cord traction to deliver the placenta
3) fundal or biannual uterine massage following delivery of the placenta
**all are done to minimize risk of hemorrhage
3rd stage of labor
Usually is only 6 minutes
Prolonged = > 30 minutes
- risks of postpartum hemorrhage, need for transfusion and D/C maneuvers are increased once past 30 minutes
Risk factors of prolonged 3rd stage
- preterm delivery
- delivery in a labor bed
- preeclampsia
- augmented labor
- multiparty
After delivery
< 500 cc blood loss for vaginal delivery’s, >1000 cc for C-section is average
vaginal delivery with > 500cc blood loss is postpartum hemorrhage
Should you encourage early breastfeeding?
YES
Increases maternal-newborn connection and has shown to be beneficial in reducing neonatal mortality and morbidity
