Orientation%20to%20Maternal%20Child%20Health

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Orientation to Maternal Child Health

• June 2009

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Goals

• Remind you of what you already know
• Help you feel more confident approaching your
  first rotation at the birth center

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Methods

• Films
• Normal deliveries, with good and poor head
  control, including water birth
• Episiotomy and repair
• Vacuum technique
• Cases
• To review with a faculty member or resident,
  covering some common findings and some important
  emergencies

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Sarah L.

• Sarah is a 20 yo student, G1 P0 at 38 weeks with
  an uncomplicated pregnancy who presents at
  midnight with uterine contractions x 6 hours, no
  leaking fluid, ucs now q5 minutes.
• BP 110/62, P84, Afeb
• Cervix is FT, 30 effaced, -2 sta

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FHR
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Management?

• What instructions do you give her?

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Call from nurses in APT

• 11 am
•  She is 4 cm, 90 effaced, -1, 120/70, Afeb

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FHR
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• Interpretation?
• Options?
• Is progress adequate?

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1130 am FHR
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The afternoon goes on. . .

• 5 pm 
• 118/62, Afeb
• Anterior rim, completely effaced, 0 sta  

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FHR
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• What is your assessment?
• Plan?

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• 6 pm she is pushing, down to 1 to 2 station

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FHR
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• Concerns?
• Plan?

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630 p.m.

• Baby Brian, 7 lb 4 ounces
• Apgars 8 at one minute, 9 at 5 minutes

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Melissa B.

• 27 yo elementary school teacher
• G2P1 at 40 1/2 weeks
• Presents at 4 am in active labor
• 120/62, P84, Afeb
• 5 cm dilated, 80 effaced, -1 station, leaking
  clear fluid.     GBS neg.

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FHR
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• At 730 am she remains unchanged, but too painful
  to go home.

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FHR
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• Options?

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• At 10 am,   you get called for decelerations in
  fetal heart rate.

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FHR
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• 7 cm dilated, 90, 0sta.
• What do you recommend? 
• Any different monitoring planned?

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• Complete dilation at 1130 am, pushes for 20
  minutes

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FHR
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• Decelerations improve with breathing through some
  contractions without pushing, however at 2
  station. . .

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FHR
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• Intervention?

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Angela G.