·
Prolonged latent
phase is not associated with increased risk of perinatal morbidity (PNM) or low Apgar
scores and should be treated by therapeutic rest. Protraction
disorders have a higher rate of PNM and low Apgar
scores, but not if spontaneous labor follows the abnormality. Arrest disorders are associated with
significantly higher rates of PNM following either spontaneous or
instrument-assisted delivery.
·
AZT reduces risk by half (from 20% to about 10%). AZT + C-section reduces
transmission rate to 5%.
·
Postpartum blues occur in 50-80% of women, depression in
8-15%, and psychosis in 1-2/1000.
·
Tricyclic
antidepressants and fluoxetine appear safe in
pregnancy, but data about newer SSRIs are limited.
·
Emanuel A. Friedman popularized the use of an
objective measure of labor progression over 30 years ago. Friedman curves plot cervical
dilatation against time passed, with varying expectations for nulliparous and multiparous
patients. Used in conjunction with fetal descent, the curves provide clinical
feedback about the normalcy of the parturient's
progress in labor.
·
Ritgen maneuver:
Moderate upward pressure is
applied to the fetal chin by the operator's posterior hand, which is covered
with a sterile towel, while the vertex is held against the symphysis.
This maneuver allows
control of the delivery of the head and favors extension, so that
the head is delivered with its smallest diameters passing through the introitus and over the perineum
·
Asynclitism is failure of
the vertex to descend with the sagittal suture in the
mid plane between the front and back of the pelvis. It is detected clinically
on examination when either the anterior or posterior parietal bones precede the
sagittal suture.
·
Scanzoni maneuver:
Rotation from OP to OA position
with Kielland forceps, then reapplication of Simpson
forceps for delivery for the OA position.
·
The pain of stage one of labor is visceral,
arising mostly from cervical dilation, and referred to spinal cord levels T10
to L1.
The pain of stage two of labor
is caused by stretching of the birth canal and involves the pudendal
nerve, S2 through S4
·
Epidural anesthesia may increase the length of
the first and second stage of labor, but it does not affect the risk of
cesarean section.
·
Paracervical block
involves the injection of local anesthetics submucosally
into the fornix of the vagina laterally to the cervix (generally at 3 o'clock
and 9 o'clock). The somatic sensory fibers of the perineum are not blocked. Paracervical block is effective only for the first stage of
labor, and is associated with a high incidence of
fetal bradycardia. Its major role is
in providing analgesia for dilation and curettage.
·
The Simpson
forceps are commonly used in low or outlet forceps deliveries. Kielland forceps
are used for midforceps deliveries that
involve rotation of the fetal head. Piper
forceps are designed to deliver the aftercoming head
during a vaginal breech delivery.
·
En Caul Delivery: Delivering the infant without
rupturing the membranes. Since the amniotic fluid cushions the infant, it may
prevent bruising.
·
BF is not C/I in c/o Mastitis. In fact, it is important
to empty the affected breast, so encourage patients to continue breastfeeding
or to use a pump.
·
Postpartum thyroiditis
may involve transient hyperthyroidism followed first by hypothyroidism and then
by a return to euthyroid condition.
·
methods for
converting the fetus to vertex:
1. external version
2. Breech maneuvers use maternal position and gravity
to attempt to facilitate fetal movement into a cephalic presentation. The
mother is advised to perform these maneuvers one or more times each day.
3. Moxibustion is the practice of burning herbs near the
foot to stimulate fetal movement and conversion to cephalic presentation. One
randomized, controlled study found it more effective than placebo.
·
Face presentations can deliver
vaginally if mentum anterior, but brow presentations are unstable and convert either to
face or vertex presentation.
·
An inability to void postpartum often
leads to the diagnosis of a vulvar hematoma. Such hematomas are often large
enough to apply pressure on the urethra. Pain from urethral lacerations is
another reason women have difficulty voiding after delivery. Both general anesthesia, which temporarily disturbs
neural control of the bladder, and oxytocin, which has an antidiuretic effect, can lead to an overdistended
bladder and an inability to void. In this case an indwelling catheter should be
inserted and left in for at least 24 h to allow recovery of normal bladder tone
and sensation. Preeclampsia often leads to
edema, which generally leads to diuresis postpartum.
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