Nageles rule- LMP-3m + 7d derives EDC

Multiple Gestation (1/99 deliveries ) 2/3 fraternal –Autosomal recessive in daughters of mothers of twins 1/3 identical –Random occurance High prematurity Increase incidence of congenital anomalies –Growth retardation, bacterial infection, hypoglycemia

amnio-afp(fetal tissue breakdown increases this), bili (rH incompatability) creatnine -kidney mec staining, cytologic examination fhr - audible wks quickening fetal heart beat nst st from placenta estriol level

ultrasonography doppler

cordocentesis

Fundal height -cm height relates to weeks gestation

Parturition ROM Cervical Dilation Uterine Contraction Placental Separation Uterine Shrinking Mediators Progesterone withdrawl Estrogen induced uterine activity Oxytocin & prostaglandin stimulation

fetal scalp

Dystocia – stage 1 & 2 > 20 hrs. Uterine dysfunction (hyper or hypotonic) Abnormal presentation –Breech 3.5% Complete, footling, frank –Face, brow, shoulder, transverse Excessive fetal size – cephalopelvic disproportion –Hydrocephalus –Abnormal size or shape of birth canal

Delivery Vertex –95% Stations above & below ischial spines Tocolysis- terbutaline sulfate, ritodrine, MgSO4 – not indomethicin

Labor Braxton Hicks True – 3 contractions in 20 minutes Cervix <4 cm & 50% effaced 20 – 36 wks gestation No fetal distress No disorder contraindicating meds Informed consent

STAGES of LABOR stageoccurances Time prima gravida Time multi gravida 1stOnset of regular contractions to full (10cm) dilitation &effacement 16 – 18 hours 7 – 12 hours 2ndFull dilitation & effacement of the cervix to delivery of fetus 1 hr. (up to 2) 20 min. 3rdDelivery of the fetus to delivery of the placenta 3-4 min (up to 45) 4-5 min.

Placenta Placenta previa Abruptio placentae –Maternal mortality 2 – 10% –Fetal mortality 50% –Apparent & concealed hemorrhage –Place mom in lateral lie

Transient Tachypnea of the Newborn L/S ratio

Lung Transition Asphyxia stimulates gasping Recoil of thorax draws in air Bright loud cold pokey world initiates crying

Circulatory Transition Lung inflation –Decrease PVR – increase PaO2 Ductus Venosis – flow stops –DV constricts Cord Clamped – UA & UV flow stops Ductus Arteriosis – constricts due to increased PaO2 Foramen Ovale – closes due to pressure increase in left atrium Umbilical Arteries constrict and close