Transcript Document
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