Pelvis

Passenger

Power

What are the 4 types of Pelvis structures:

???

think GAAP

Gynecoid 50%

Android 20%

Anthropoid 25%

Platypelloid 5%

What are these??

obstetric conjugate

transverse diameter

subpubic angle

bituberous diameter

curve & length of sacrum

There are 4 Leopold manuever, which one is this:

determines fetal part lying on fundus

determines the presentation

1st-Fundal grip

2nd-Umbilical grip

3rd-Pawlik's Grip

4th-Pelvic Grip

1st-Fundal grip

2nd-Umbilical grip

3rd-Pawlik's Grip

4th-Pelvic Grip

Which leopold grip is this:

identifies fetal back

determines position

1st-Fundal grip

2nd-Umbilical grip

3rd-Pawlik's Grip

4th-Pelvic Grip

Which leopold manuever is this:

engagement of presenting part

1st-Fundal grip

2nd-Umbilical grip

3rd-Pawlik's Grip

4th-Pelvic Grip

which leopold manuever is this??

determines degree of flexion of fetal head

determines attitude or habitus

Posterior & Anterior Fontanelles

&

Sagittal suture

What are these?

suboccipitobregmatic

occipitfrontal

verticomental

submentobregmatic

Molding is part of what:

Pelvis

Passenger

Power

What is this?

Flexion of head

Military

Brow presentation, partial extension

Face presentation, complete extension

If the baby is in these positions, what should be done?

Complete breech

Frank breech

Footing breech

Kneeling breech

Transverse

What is the frequency of contractions normally?

How long should each contraction last & why?

What is the frequency of contractions normally?

every 2-5 minutes

How long should each contraction last & why?

60 seconds, no more than 90 seconds b/c during the contractions there is no O2 flow to the baby

40 wks post LMP

Preterm <37 wks

What type of labor is this?

Irregular contractions

NO increase in intensity/frequency of contractions

NO blood show

NO change in cervix

NO descent of presenting part

Sedation frequently stops false labor

What type of labor is this?

Contractions regular intervals, increase intensity & frequency

Bloody show

Progressive dilation of cervix

Descent of presenting part

Sedation does not stop true labor, but can slow early labor

What do these terms mean??

Prime

Multi

Essential Prime

Prime:  1st baby

Multi:  2nd baby

Essential Prime:  Had a miscarriage & now delivering

there are 3 stages:

1st

2nd

3rd

Which stage of labor is this?

Onset of labor to complete dilation 10 cm

Prime < 28.5 hrs

Multi < 20 hrs

Which stage of labor is this?

complete dilation to birth of baby

< 2.5 hrs prime

< 1 hr multi

Which stage of labor is this?

birth of baby to deliver of placenta

5-10 average, but up to 30 minute is nl

What stage 1st, 2nd, 3rd???

Latent phase: early labor, irregular ctxs, little change in cervix. Easily confused w/ false labor

                <20 hrs in primes

                <14 hrs in multips

Active phase: (3-7 cm) regular, stronger ctx and progressive dilation. May occur later in primips than multips.

Transition: (7-10 cm) very intense, shaking, vomiting, loss of control common

                <12 hrs in primes

                <6 hrs in multips

What stage 1,2, 3 of labor??

Complete dilation to birth of baby

<2.5 hrs in primes

<1 hr in multips

Urge to bear down

Feeling like need to have BM

Possible increase in bloody show

Various maternal positions for pushing

Delivery part 1,2,3??

Hands off until the last minute!

 Slow, controlled delivery of head crucial for preventing lacerations

 Slower, gentler, briefer pushes when crowning

Keep head flexed and support perineum

Consider suction of mouth w/ bulb 

Allow restitution of head (x when shoulder dystocia suspected)

Delivery part 1,2,3??

Feel for cord around neck (nuchal cord) present in about 20% of births 

Reduce, deliver through or clamp and cut

 Place hands on sides of baby’s head 

Have mother bear down 

Gentle traction downward for anterior shoulder 

Gentle traction up for posterior shoulder 

Avoid excessive traction!

Delivery part 1,2,3

Assess baby:

 Breathing

 Tone

 Color

 Resuscitate as needed 

Delayed vs immediate cord clamping 

Hand baby to rightful owner (mom)! 

Dry and keep warm (skin to skin)

What is this?

Rarely needed! 

Deliver baby quickly 

Perineum will not stretch 

2 types:

midline

mediolateral  

Alternative:

Ritgen maneuver

What stage of labor is this?

Remain vigilant, DELIVER PLACENTA

Signs of placental separation:

gush of blood

lengthening of cord

rise of fundus in abdomen

NO!

Avoid tearing cord off or inverting uterus during delivery of placenta

Must wait 10 minutes

This conditions cause what?

CPD-size of baby does not fit pelvis

Malpresentation or malposition – transverse, breech, military, brow

Inefficient ctxs

Over sedation

Prolonged labor

incidence 1-7% of all births

What is this part of??

Pregnancy hx, medical/surgical hx  (DM, Hx of placenta previa, caesarian, HTN, Seizures)

Social hx, allergies, substance/med use

Prior OB/GYN hx

Ripe cervix:  Ptosin used

labor augmentation

oxytocin, AROM, castor oil,

nipple stim-release natural prostaglandins

Unripe cervix: *must ripen

Mechanically or chemically

supportive

hydration, nutrition, rest

ripen cervix

Oxytocin augmentation if:

    ctxs inadequate

Hydration, nutrition, rest

Maternal position changes

AROM

Hydration, nutrition, rest (?)

Augmentation w/ oxytocin

Maternal position change

Decrease anesthesia

Encouragement

Forceps/vacuum extraction

C/S

What are these indications for??

CPD

Malpresentation/malposition

FTP –failure to progress

Fetal distress unresponsive to interventions-baby not tolerating labor

Placental complications (previa)  Remember baby has to come 1st

Severe maternal disease (eclampsia)  Seizure

Cord prolapse   C-section

Miscellaneous (active HSV outbreak)

What is being looked at with these conditions??

When?

Post dates (41-42 weeks)

Maternal or fetal complications

Prolonged ROM at term (>18 hours)

Chorioamnionitis at any GA

How?

Cervix ripe: oxytocin

Cervix unripe: laminaria, foley bulb, cervidil, cytotec

These are contraindications for what use??

Malpresentation

Placenta previa

Non-reassuring fetal status

Pelvic deformities

Prior classical C/S

Cord prolapse

What type of management is this??

Natural: labor support, mobility, hydration, massage, tub

IV sedation

Epidural