Normal Labor: Kevin Marcial I. Aralar, MD 1 Year Resident
Normal Labor: Kevin Marcial I. Aralar, MD 1 Year Resident
Normal Labor: Kevin Marcial I. Aralar, MD 1 Year Resident
• Exception
FETAL ORIENTATION
◎ FETAL POSITION:
DIAGNOSIS OF FETAL
PRESENTATION AND
1. LEOPOLD
POSITION
MANEUVERS
2. VAGINAL
EXAMINATION
3. SONOGRAPHY AND
RADIOLOGY
1. LEOPOLD
MANEUVERS
1st - Assess the uterine fundus
• Breech = large, nodular mass
• Head = hard, round, ballotable
3. SONOGRAPHY AND
RADIOGRAPHY
Mechanisms of labor
● the cardinal movements of labor
are engagement, descent, flexion,
internal rotation, extension, external
rotation, and expulsion
▶ When the lowermost portion of the presenting fetal part is at the level of the spines, it is
designated as being at zero (0) station.
▶ If the leading part of the fetal h e a d is at 0 station or below, most often the fetal h e a d has
e n g a g e d — thus, the biparietal plane has passed through the pelvic inlet. I
CERVICAL ASSESSMENT
• A quantifiable method used to predict labor induction
outcomes
• A Bishop score of 9 conveys a high likelihood for a
successful induction.
• A Bishop score of 4 or less identifies an unfavorable cervix
and may be an indication for cervical ripening.
MANAGEMENT OF FIRST
STAGE LABOR
INTRAPARTUM FETAL MONITORING
▶ in the absence of any abnormalities, the fetal heart rate should be
checked immediately after a contraction at least every 30 minutes
every 15 mins 2nd stage
High risk = every 15mins during 1st stage, then 5 mins during the 2nd
MANAGEMENT OF FIRST
STAGE LABOR
• Maternal Vital Signs
▶ Temperature, pulse, and blood pressure are evaluated at
least every 4 hours.
▶ If membranes have been ruptured for many hours
before labor onset or if there is a borderline temperature
elevation, the temperature is checked hourly.
▶ Moreover, with prolonged membrane rupture (> than 18
hours) antimicrobial administration for prevention of group
B streptococcal infections is recommended.
UTERINE CONTRACTIONS
▶ contractions c a n be both quantitatively and
qualitatively evaluated manually.
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