Nageles rule-

1
(No Transcript)
2
(No Transcript)
3
(No Transcript)
4
(No Transcript)
5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
Nageles rule-  LMP-3m 7d  derives EDC
10
(No Transcript)
11
(No Transcript)
12
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

13
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
14
ultrasonography doppler
15
cordocentesis
16
Fundal height -cm height relates to weeks
gestation
17
Parturition
Mediators

• ROM
• Cervical Dilation
• Uterine Contraction
• Placental Separation
• Uterine Shrinking

• Progesterone withdrawl
• Estrogen induced uterine activity
• Oxytocin prostaglandin stimulation

18
(No Transcript)
19
fetal scalp - 7.25
20
(No Transcript)
21
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

22
Delivery

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

23
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

24
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.
25
(No Transcript)
26
(No Transcript)
27
Placenta

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

28
Transient Tachypnea of the Newborn L/S ratio
29
(No Transcript)
30
Lung Transition

• Asphyxia stimulates gasping
• Recoil of thorax draws in air
• Bright loud cold pokey world initiates crying

31
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

32
(No Transcript)
33
(No Transcript)