OB Delivery
Medical Obstetric Emergencies Notes
Normal Labour and Delivery
- Normal Labour: Involves contractions leading to the dilation of the cervix, progressing to delivery.
Leopold's Maneuver
- Definition: A method of palpation to determine fetal position and descent into the pelvis.
- Techniques: Involves four different movements to assess fetal position.
Onset of Labour
- Primipara: First-time mothers may experience engagement 2-3 weeks before delivery, often going unnoticed (Prodromal stage).
- Signs:
- Increase in Braxton-Hicks contractions.
- Rupture of membranes (importance of timing to get to the hospital).
True vs False Labour (Assessment Table)
| Parameter | True Labour | False Labour |
|---|---|---|
| Contractions | Regularly spaced | Irregularly spaced |
| Interval between | Gradually shortens | Remains long |
| Intensity | Gradually increases | Do not abolish pain |
| Cervical changes | Progressive effacement and dilation | Stays the same |
Signs of Imminent Delivery
- Indicators:
- Contractions every 2 minutes.
- Patient distressed (states "baby is coming").
- Physical signs such as bearing down or visible head (crowning).
Multiple Births
- Occurrence: About 3% of all pregnancies, increased incidence with fertility drugs.
- Types:
- Dizygotic (Fraternal): Two eggs fertilized separately.
- Monozygotic (Identical): One egg divides.
- Placental configurations:
- Monochorionic-Diamniotic (1 placenta, 2 amniotic sacs).
- Dichorionic-Diamniotic (2 placentas, 2 sacs).
Stages of Labour
- First Stage (Dilation Stage):
- Regular contractions from onset to full dilation (10 cm).
- Duration: May last 8-12 hours for nullipara, 6-8 for multipara.
- Second Stage (Expulsion Stage):
- From full dilation to birth; strong contractions 60-70 seconds every 2 minutes.
- Urge to push conveys delivery is imminent.
- Third Stage (Placenta Stage):
- Delivery of baby to delivery of the placenta (5-20 minutes).
- Observe for mild contractions and gush of blood as indicators.
Meconium Staining
- What is Meconium?: Fetal stool that can cause complications due to aspiration during delivery.
- Types:
- Thin meconium: Less concern; suctioning typically suffices.
- Thick meconium: Prepares for potential airway interventions (intubation/suction).
Fetal Heart Rate Monitoring
- Normal Range: 110-160 beats per minute.
- Actions if decreased: Change positions, administer oxygen, check for cord issues,
- Monitor for prolonged decelerations.
Emergency Procedures
- nuchal cord: If the cord is wrapped around the neck, try to slip it over the baby’s head, otherwise clamp and cut.
- Prolapsed cord: Position in ways to alleviate cord compression (e.g., knee-chest position).
Post-Delivery Care
Newborn Immediate Care
- Vernix: Waxy coating; does not need to be removed immediately.
- APGAR Score: Scored at 1 and 5 minutes; < 7 indicates need for re-evaluation at 10 minutes.
Maternal Post-Delivery Care
- Monitoring: Take vital signs and assess vaginal blood flow.
- Prevent Hypothermia: Cover the mother with blankets post-delivery.
- Post-Partum Hemorrhage (PPH): Can occur from retained placental tissue or uterine atony; treatment involves fundal massage and IV oxytocin.
Complicated Deliveries
- Shoulder Dystocia: Emergency situation needing immediate intervention. Utilizes McRoberts maneuver and suprapubic pressure.
- Delivery of Placenta: Monitor for signs of delivery (globo-spherical uterus and blood loss).
Conclusion
- Every delivery is unique and may require different approaches based on the patient's condition and commitment to care. Understanding and recognizing stages and signs are crucial for successful outcomes.