Title: Nageles rule-
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9Nageles rule- LMP-3m 7d derives EDC
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12Multiple 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
13amnio-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
14ultrasonography doppler
15cordocentesis
16Fundal height -cm height relates to weeks
gestation
17Parturition
Mediators
- ROM
- Cervical Dilation
- Uterine Contraction
- Placental Separation
- Uterine Shrinking
- Progesterone withdrawl
- Estrogen induced uterine activity
- Oxytocin prostaglandin stimulation
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19fetal scalp - 7.25
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21Dystocia stage 1 2 gt 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
22Delivery
- Vertex 95
- Stations above below ischial spines
- Tocolysis- terbutaline sulfate, ritodrine, MgSO4
not indomethicin
23Labor
- Braxton Hicks
- True 3 contractions in 20 minutes
- Cervix lt4 cm 50 effaced
- 20 36 wks gestation
- No fetal distress
- No disorder contraindicating meds
- Informed consent
24STAGES of LABOR
stage occurances Time prima gravida Time multi gravida
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.
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27Placenta
- Placenta previa
- Abruptio placentae
- Maternal mortality 2 10
- Fetal mortality 50
- Apparent concealed hemorrhage
- Place mom in lateral lie
28Transient Tachypnea of the Newborn L/S ratio
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30Lung Transition
- Asphyxia stimulates gasping
- Recoil of thorax draws in air
- Bright loud cold pokey world initiates crying
31Circulatory 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
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