# Delivery events
What does P2002 mean?
2 at full term and 2 living children with no preterm deliveries or abortions. (FPAL)
Rupture of membranes (spontaneous, preterm)
Fetal part over the pelvic inlet (96% cephalic, 3.5% breech and 0.4% shoulder or back)
What are the different types of breech deliveries?
How do you diagnose fetal presentation in physical exam?
Leopold’s maneuvers (feel from the pelvic inlet up to the fundus)
Relation of the long axis of the fetus to the long axis of the mother: Longitudinal fetal lie and transverse fetal lie are shown below.
Reference points for fetal presentation
Occiput, mentum and sacrum.
Difference between false and true labor?
Fase = irregular contractions without cervical dilation and discomfort relieved by sedation. True = regular contractions with cervical dilation and pain not relieved by sedation.
Stages of labor
1st (latent phase = starts dilating to 6cm, active phase = 6cm to pushing) 2nd = pushing to delivery. 3rd = delivery of placenta.
What happens to the cervix during labor?
Softening, dilation, effacement, station, consistency and position.
When is the baby’s head engaged?
0 station = equal with ischial spines
7 cardinal movements of labor
Fetal movements that the mother can’t do: engagement, descent, flexion, internal rotation, extension, external oration and expulsion.
3 essential factors of labor
3 P’s: Passage, Power and Passenger
What are signs of placental separation
Uterine contraction, gush of blood and lengthening of umbilical cord
Normal labor progression in the active phase of the first stage of labor
Nulliparous =1cm/hr. Multiparous = 2c/hr.
Normal labor progression in the second stage of labor
Nulliparous 1-2 hrs w/no epidural, 2-3 hrs with. Multiparous 0-1 hrs w/no epidural and 1-2 hours with.
At what point of the active phase of labor do you consider other options due to arrest?
Arrest of dilation > 6 hrs. Consider oxytocin or C-section.
Arrest of descent
Child gets stuck in vaginal canal.
Risk for vacuum delivery
Indications for C-section
Prior c-section, non reassuring fetal tracing, placenta previa, noncephalic presentation, arrest disorder, pelvic floor dysfunction or elective