-Normal Labor/Delivery-
-Labor is the physiologic process a fetus is expelled from the uterus to the outside world
-Labor involves a sequential, integrated set of changes within the myometrium, decidua, and uterine cervix that occurs gradually over a period of days to weeks and sometimes rapidly over minutes to hours a culminates in delivery of a fetus
-Uterine contractions during active labor serve to dilate the cervix and to push the fetus through the birth canal.
-Successful passage of the fetus is determined on three mechanical variables: uterine contractions, fetus, and pelvis
-Uterine contractions is the force generated by the uterine musculature during contractions. It is thought to be the most optimal of all the 3 mechanical variables
-Many variables with the fetus: fetal size, lie (long axis can be longitudinal, transverse, or oblique), presentation (vertex, breech, shoulder, compound-which is vertex and hand, and funic-umbilical cord), attitude (degree of flexion/extension of head), position (location in the maternal pelvis), number of fetuses, and the presence of fetal abnormalities
-The pelvis is a mechanical variable that is dependent on the size of the bony pelvis, and soft tissues (cervix, and pelvic muscle). Can be assessed clinically or by imaging studies.
-Three stages of labor. First stage of labor has 3 phases (Latent, Active, and Descent Phases)
-Latent Phase is the period between the onset of labor and the point in which a changes in the slope of the rate of cervical dilation is noted
-Active Phase is associated with a faster rate of cervical dilation and usually begins by 2-4 cm of dilation.
-Descent Phase usually coincides with the second stage of labor
-Second stage of labor is the interval between full cervical dilation and delivery of the infant
-Third stage of delivery is the time from delivery of the bay to separation and expulsion of the placenta
-Cardinal movements of labor refers to the change in position of the fetal head during passage through the birth canal
-The seven cardinal movements of labor include: engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion
-Prenatal Diagnosis/Care-
-Prenatal care is meant to ensure the birth of normal baby with minimal risk to the mother
-Many goals of prenatal care include: early accurate estimation of gestation age, identification of patients at risk for complications, ongoing evaluation of the health status of the mother and fetus, anticipation of problems and intervention, and patient education and communication
-Estimated Date of Delivery (EDD)- can be calculated from the first day of the last menstrual period and then subtracting 3 months (Naegele's Rule)
-Should obtain in depth history and obstetrical history
-Physical exam should include blood pressure, weight, and height. BMI should be calculated
-Transvaginal ultrasound can detect fetal cardiac motion by 5.5 weeks
-Doppler measurement can usually be heard at 12 weeks when the fetus ascends out of the pelvis
-Initial routine labs include ABORh, Hemoglobin and Hematocrit, cervical cytology cancer screening, rubella immunity, varicella immunity, urine protein, and urine culture, Syphillis testing, Hepatitis B antigen testing, chlamydia testing, HIV testing, gonorrhea, glucose, toxoplasmosis, and hepatitis C antibodies
-Screenings for cystic fibrosis, Fragile X, Hemoglobinopathies, PKU, Spinal Muscular Atrophy, lead screenings, can be offered in at risk patients.
-Ultrasound examination is beneficial early especially to determine if there is an intrauterine pregnancy
-All pregnant woman should be offered screening for Trisomy 21
-Routine visits should include maternal blood pressure, weight, urine dipstick for protein, measurement of fundal height, documentation of fetal cardiac activity, maternal perception of fetal activity (second and third trimesters) and assessment of fetal presentation in the third trimester
-Between 15-24 weeks assessment of the following should be offered: neural tube defects, Trisomy 21, fetal anomalies, and cervical length
-Between 24-28 weeks assessment for gestational diabetes, RBC antibodies, and Hemoglobin and Hematocrit
-Between 28-36 weeks testing for STD's, group B beta hemolytic streptococcus testing, estimated fetal weight, fetal assessment, and external cephalic vein version
-Between 36-41 weeks need to do patient education and prepare for labor and delivery. Also may want to discuss if planning for breastfeeding and neonatal circumcision
No comments:
Post a Comment