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Labor, Delivery, and Changes at Birth Fred Hill, MA, RRT Fetus in Uterus Fetus in Uterus Events of Birth (Maternal) Rupture of membranes Dilation of cervix Contraction of uterus Separation of the placenta Shrinking of the uterus Stages of Labor & Delivery Stage I: Onset of regular contractions to full dilation and effacement of the cervix Primigravida: 16 – 18 hours Multigravida: 7 – 12 hours Stage II: Full dilation (10 cm) and effacement of the cervix to delivery of the baby Primigravida: 1 – 2 hours Multigravida: 20 mins Stage III: Delivery of the baby to delivery of the placenta Primigravida: 3 – 4 mins Multigravida: 4 – 5 mins Tocolysis Beta-2 sympathomimetics Terbutaline sulfate Ritodrine hydrocholoride Magnesium sulfate Indomethacin Calcium channel blockers Dystocia Uterine dysfunction Abnormal fetal presentation Cephalopelvic dysproportion Hydrocephalus Excessive fetal size (maternal diabetes) Small pelvic dimensions Abnormality in shape of birth canal Abnormal Fetal Presentation Normal presentation: Vertex ( head first), 95% Abnormal presentation Cephalic Breech (buttocks down) Face Brow Shoulder Transverse lie Vertex Presentation Cephalic Presentation Face Presentation Complete Breech Footling Breech Frank Breech Transverse Lie Other Problems Prolapse of umbilical cord Cord wrapping around fetus Placental abnormalities Placenta previa: Implantation in lower uterus Abruptio placentae Placenta Previa Abruptio Placentae Other Risky Deliveries Cesarean deliveries Multiple gestations Changes at Birth Vaginal squeeze when head presents Presentation of chest and recoil of chest First breath: high initial pressures (-100 cm H2O) Succeeding breaths require less negative pressure Remaining liquid in lungs Expelled by coughing and sneezing Absorption into lung interstitium into lynphatics Fetal Circulation Fetal to Adult Circulation Major changes First and subsequent breaths Reduces pulmonary vascular resistance Air replaces liquid surrounding vasculature ↑ PaO2 → pulmonary vasodilation Increase in systemic vascular Clamping of umbilical cord resistance R → L Shunting changes to L → R Foramen ovale closes: mechanical Ductus arteriosus begins to close due to chemical changes Cessation of blood flow leads to constriction of: Ductus venosus Umbilical arteries and veins