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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
• ROM
• Cervical Dilation
• Uterine Contraction
• Placental Separation
• Uterine Shrinking
Mediators
• Progesterone withdrawl
• Estrogen induced uterine activity
• Oxytocin & 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 LABORstage occurances
Time
primagravida
Time
multigravida
1st Onset of regular contractions to full (10cm) dilitation &effacement
16 – 18 hours
7 – 12 hours
2nd Full dilitation & effacement of the cervix to delivery of fetus
1 hr. (up to 2)
20 min.
3rd Delivery of the fetus to delivery of the placenta
3-4 min (up to 45)
4-5min.
Placenta
• Placenta previa
• Abruptio placentae– Maternal mortality 2 – 10%– Fetal mortality 50%– Apparent & concealed hemorrhage– Place mom in lateral lie
Transient Tachypnea of the NewbornL/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