Table Of Contents
IUPC
Cervical changes
Phases of labor
Prolonged Phases of Labor
- Pt is in the latent stage of labor that the head is engaged but the cervix is still not changing plan:
- Pt is in the active phase with no cervical changes for 4 hours plan:
- Patient is fully dilated but the baby does not depend for 3 hrs (null) or 2hrs (multi) plan:
- If the placenta is not delivered within 30mins after birth plan:
Preterm
- Path: Idiopathic
- Pt: + Contraction AND cervical changes, not term
- Dx: Clincal
- Tx:
- Delay Delivery
- MgSulfate
- B agonist
- CCB
- prostaglandins
- Develop Baby – Steroids (L/S <2/1)
- Delay Delivery
- Contraindications:
- Pre Eclampsia
- Fetal demise
- pROM, abruption
Premature rupture of membranes
Preterm premature rupture of membranes
Rupture of membranes
Prolonged rupture of membranes
- Path: Infxn that gets in, not that caused the ROM
- Pt: ROM –> Delivered > 18hrs (Normal delivery <18hr following ROM)
- Dx: Clincal
- Tx:
- f/u: Endometritis/chorioamnitis
Endometritis-Chorioamnionitis
- Path: Baby out (endometritis) chorioamniotiis (baby in), vaginal flora accents
- Pt: Prolonged ROM + Mom gets fever/toxic
- Clinical Presentation:
- – mom presents with PPROM, PROM, Prolonged rupture of membranes and a fever
- – Maternal and/or fetal tachy
- – Fundal/ uterine tenderness
- – Purulent amniotic fluid.
- – Sepsis: fever, leukocytosis, tachycard, tachypnea)
- Dx: rule out other things using UA, CXR, and blood cx
- – NEVER CULTURE: most are vaginal flora = tells us nothing useful.
- Tx: IV Ampicillin + Gentimycin +/- Clindamycin = cover gram – & anaerobes
Post Term:
- Path: Macrosomic, shoulder dystopia, dysmaturity
- Pt:
- >40wks by conception
- > 42 weeks by LMP
- Dx: Clincal
- Tx:
- If you are sure its post term and cervix is favorable then start induction ptocin
- If you are sure its post term and cervix is unfavorable then get c-section
- If you are unsure its post term then you should get a BPP (non-tress + AFI and u/s)
Uterine Atony
Uterine Inversion
- Path: “Births itself”
- Pt: Post partum hemorrage, absent uterus
- Dx: Clinical… speculum
- Tx: Manually…. might need to use tocolytics (oxytocin) to hold into place
Vaginal Lacerations
- Path: Cervix + Vagina, percipitous delivery , macrocosmic baby, episiotomy
- Pt: Post partum hemorrhage + Normal uterus
- Dx: Clinical…. speculum
- Tx:
Retained Placenta
- Path: Burrowed deeply, accessory lobe, placental tear, depth = name (acreta, increta, percreta)
- Pt: Post partum hemorrhage + Firm
- Dx: Placental blood vessels go to the edge
- Tx: D&C —> surgery TAH
- f/u: Beta HCG
Prolonged 1st stage
Prolonged Latent Stage
- Presentation:
- Contraction till Cervix 4cm
- > 20 hrs (primi)
- > 14 hrs (multi)
- Analgesics
- Power, Passenger, Pelvis
- Dx:
- Contraction 3/30 minutes
- Contraction > 40mmHg
- Tx:
- Rest + Wait
- Balloon + Dilation => C section
- Pitocin
Arrest Active
- Presentation:
- Contraction 4cm till 10cm
- > 1.2 cm/hr (primi)
- > 1.5 cm/hr (multi)
- power, pelvis, passenger
- Dx:
- Contraction power + freq
- cervical changes slow (prolonged)
- Cervical changes none (arrested)
- Tx:
- Pitocin
- C section
Prolonged 2nd stage
- Presentation:
- 10 cm till Baby Delivered
- 3hrs (epidural)
- 2hrs (natural)
- Power, pelvis, passenger
- Dx: Contractions freqeuncy, power
- Tx:
- Pitocin
- Station +1/+2 = Vaccuum Forceps
- Station ≤ 0 = C section
Prolonged 3rd stage
- Presentation:
- Power
- Baby delivered till Placenta Delivered
- Tx:
- Massage
- Pitocin
- Manual manipulation