Orientation to Maternal Child Health June 2009

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

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

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

FHR

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

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

FHR

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

11:30 am FHR

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

FHR Early decels

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

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

FHR Deep variables with pushing

Concerns? Plan? Consider pushing every other contraction

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

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.

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

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

FHR

Options? Augmentation – they need to eventually start Pit

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

FHR

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)

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

FHR

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

FHR

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

Angela G.