Labour, Delivery & Poostpartum

·         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.

·         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.

·         AZT reduces risk by half (from 20% to about 10%). AZT + C-section reduces transmission rate to 5%.