Nageles rule-  LMP-3m + 7d  derives EDC

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

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

ultrasonography doppler

cordocentesis

Fundal height -cm height relates to weeks gestation

Parturition

• ROM

• Cervical Dilation

• Uterine Contraction

• Placental Separation

• Uterine Shrinking

Mediators

• Progesterone withdrawl

• Estrogen induced uterine activity

• Oxytocin & prostaglandin stimulation

fetal scalp - 7.25+

Dystocia – stage 1 & 2 > 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

Delivery

• Vertex –95%

• Stations above & below ischial spines

• Tocolysis- terbutaline sulfate, ritodrine, MgSO4 – not indomethicin

Labor

• Braxton Hicks

• True – 3 contractions in 20 minutes

• Cervix <4 cm & 50% effaced

• 20 – 36 wks gestation

• No fetal distress

• No disorder contraindicating meds

• Informed consent

STAGES of LABORstage occurances

Time

primagravida

Time

multigravida

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.

Placenta

• Placenta previa

• Abruptio placentae– Maternal mortality 2 – 10%– Fetal mortality 50%– Apparent & concealed hemorrhage– Place mom in lateral lie

Transient Tachypnea of the NewbornL/S ratio

Lung Transition

• Asphyxia stimulates gasping

• Recoil of thorax draws in air

• Bright loud cold pokey world initiates crying

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