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Nageles rule-

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Increase incidence of congenital anomalies. Growth ... Dystocia stage 1 & 2 20 hrs. Uterine dysfunction (hyper or hypotonic) Abnormal presentation ... – PowerPoint PPT presentation

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Title: Nageles rule-


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Nageles rule-  LMP-3m 7d  derives EDC
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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

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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
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ultrasonography doppler
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cordocentesis
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Fundal height -cm height relates to weeks
gestation
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Parturition
Mediators
  • ROM
  • Cervical Dilation
  • Uterine Contraction
  • Placental Separation
  • Uterine Shrinking
  • Progesterone withdrawl
  • Estrogen induced uterine activity
  • Oxytocin prostaglandin stimulation

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fetal scalp - 7.25
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Dystocia 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

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Delivery
  • Vertex 95
  • Stations above below ischial spines
  • Tocolysis- terbutaline sulfate, ritodrine, MgSO4
    not indomethicin

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Labor
  • 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

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STAGES 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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Placenta
  • Placenta previa
  • Abruptio placentae
  • Maternal mortality 2 10
  • Fetal mortality 50
  • Apparent concealed hemorrhage
  • Place mom in lateral lie

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Transient Tachypnea of the Newborn L/S ratio
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Lung Transition
  • Asphyxia stimulates gasping
  • Recoil of thorax draws in air
  • Bright loud cold pokey world initiates crying

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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

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