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Nageles rule- LMP-3m + 7d derives EDC
Multiple Gestation (1/99 deliveries)
• 2/3 fraternal
– Autosomal recessive in daughters of mothers of twins
• 1/3 identical
– Random occurance
• High prematurity
• Increase incidence of congenital anomalies
– Growth retardation, bacterial infection, hypoglycemia
amnio-afp(fetal tissue breakdown increases this),
bili
(rH incompatability)
creatnine -kidney
mec staining,
cytologic examination
fhr - audible 16-20 wks
quickening
fetal heart beat
nst
st
from placenta
estriol level
ultrasonography
doppler
cordocentesis
Fundal height -cm height relates to weeks gestation
Parturition
•
•
•
•
•
Mediators
ROM
• Progesterone
withdrawl
Cervical Dilation
Uterine Contraction • Estrogen induced
uterine
activity
Placental Separation
•
Oxytocin
&
Uterine Shrinking
prostaglandin
stimulation
fetal scalp - 7.25+
Dystocia – stage 1 & 2 > 20 hrs.
• Uterine dysfunction (hyper or hypotonic)
• Abnormal presentation
– Breech 3.5%
• Complete, footling, frank
– Face, brow, shoulder, transverse
• Excessive fetal size – cephalopelvic disproportion
– Hydrocephalus
– Abnormal size or shape of birth canal
Delivery
• Vertex –95%
• Stations above & below ischial spines
• Tocolysis- terbutaline sulfate, ritodrine,
MgSO4 – not indomethicin
Labor
•
•
•
•
•
•
•
Braxton Hicks
True – 3 contractions in 20 minutes
Cervix <4 cm & 50% effaced
20 – 36 wks gestation
No fetal distress
No disorder contraindicating meds
Informed consent
STAGES of LABOR
stage
occurances
Time
Time
prima
multi
gravida
gravida
1st Onset of regular contractions to 16 – 18 7 – 12
hours
full (10cm) dilitation &effacement hours
2nd Full dilitation & effacement of
the cervix to delivery of fetus
3rd Delivery of the fetus to delivery
of the placenta
1 hr.
20 min.
(up to 2)
3-4 min 4-5min.
(up to 45)
Placenta
• Placenta previa
• Abruptio placentae
–
–
–
–
Maternal mortality 2 – 10%
Fetal mortality 50%
Apparent & concealed hemorrhage
Place mom in lateral lie
Transient Tachypnea of the Newborn
L/S ratio
Lung Transition
• Asphyxia stimulates gasping
• Recoil of thorax draws in air
• Bright loud cold pokey world initiates
crying
Circulatory Transition
• Lung inflation
– Decrease PVR – increase PaO2
• Ductus Venosis – flow stops –DV constricts
• Cord Clamped – UA & UV flow stops
• Ductus Arteriosis – constricts due to
increased PaO2
• Foramen Ovale – closes due to pressure
increase in left atrium
• Umbilical Arteries constrict and close