1. Orientation to Maternal Child Health
June 2009

2. Goals: Remind you of what you already know
Help you feel more confident approaching your first rotation at the birth center

3. Methods
Films
Normal deliveries, with good and poor head control, including water birth
Episiotomy and repair
Vacuum technique
Cases
To review with a faculty member or resident, covering some common findings and some important emergencies

4. Sarah L.
Sarah is a 20 yo student, G1 P0 at 38 weeks with an uncomplicated pregnancy who presents at midnight with uterine contractions x 6 hours, no leaking fluid, uc’s now q5 minutes.
BP 110/62, P84, Afeb
Cervix is FT, 30% effaced, -2 sta

5. FHR

6. Management? What instructions do you give her?
Observe x 1-2 hours or send home initially (Prodromal labor)

7. Call from nurses in APT 11 am:
 She is 4 cm, 90% effaced, -1, 120/70, Afeb

8. FHR

9. Interpretation? Options? Is progress adequate? Sleep cycle
Talk about expectations for latent phase labor

10. 11:30 am FHR

11. The afternoon goes on. . . 5 pm 118/62, Afeb
Anterior rim, completely effaced, 0 sta  

12. FHR
Early decels

13. What is your assessment? Plan?
Early decels are normal – no change in plans

14. 6 pm she is pushing, down to +1 to +2 station

15. FHR
Deep variables with pushing

16. Concerns?
Plan?
Consider pushing every other contraction

17. 6:30 p.m. Baby Brian, 7 lb 4 ounces
Apgars 8 at one minute, 9 at 5 minutes

18. Melissa B. 27 yo elementary school teacher G2P1 at 40 1/2 weeks
Presents at 4 am in active labor
120/62, P84, Afeb
5 cm dilated, 80% effaced, -1 station, leaking clear fluid.     GBS neg.

19. FHR
Ignore that this is FSE – note frequency of UC’s

20. At 7:30 am she remains unchanged, but too painful to go home.

21. FHR

22. Options?
Augmentation – they need to eventually start Pit

23. At 10 am,   you get called for decelerations in fetal heart rate.

24. FHR

25. Any different monitoring planned?
7 cm dilated, 90%, 0sta.
What do you recommend? 
Any different monitoring planned?
Note hyperstim – turn down the pit, consider terb. Consider internal monitors (and review their placement at this point)

26. Complete dilation at 11:30 am, pushes for 20 minutes

27. FHR

28. Decelerations improve with breathing through some contractions without pushing, however at +2 station. . .

29. FHR

30. Intervention?
Discuss vacuum extraction – preparation, indications, etc.

31. Angela G.