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Quick review

Process of opening and thinning of the


cervix to allow the fetus to be born.

1st : Onset Regular, rhythmic uterine


contractions associated with progressive
cervical dilatation, effacement and fetal
descent until cervix fully dilated.
2nd: Full dilitation of the cervix to birth of
the fetus
3rd: Birth of the newborn to
separation/expulsion of the placenta
4th: First few hours after expulsion of the
placenta, transition time for newborn,
family attachment
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How do you distinguish practice versus


true labor?
Labor results in cervical change
Labor often associated with ROM or bloody
show
Labor doesnt go away with position
change or hydration
Labor get stronger, longer and closer
together
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The 5(6) Ps?


Passenger
Passage
Powers
Position
Psyche
Philosophy of Provider

Lie,
Presentation,
Position,
Attitude,
Station,
Size of head and ability to mold,
Fetal weight

The relationship of the fetal long axis to


the maternal spine

What are the two types of lie?


Longitudinal 99.5%
Transverse .5%
Oblique is a temporary lie that converts
to one of the others

Portion of the fetus that lies over the


pelvic inlet (over the cervix).
What are the 3 main presentations
Cephalic 96%
Breech (Podalic) 3-5%
Shoulder < 1%

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Define: Most dependent fetal part


Cephalic:
Occiput (Vertex)-Flexed
Sinciput Military or deflexed
Bregma (Brow) Extended (.5%)
Mentum (Chin-Face)- Hyperextended .5%
Military and Brow are transient and
convert to occiput or face

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Breech (3-4%) at term. Up to 20%


preterm
Types
Frank= lower extremities flexed at hips,
extended at the knees (highest success
with vaginal birth)
Complete= one or more knees flexed
Incomplete= One or more extremities
extended: Footling, kneeling
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relationship of the denominator of the


presenting part to the four quadrants of
the maternal pelvis
Front of
mother

If breech, then the O is an S for sacrum. If it is a face it is an M for


mentum
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Relationship of fetal parts to each other


Identify the main attitudes (Flexion or
extension)
Universally Flexed OA (9.5 cm diameter)
Flexed OP (11 cm. diameter)
Deflexed (military) (12-12.5 cm diameter)
Extended (Brow) (13-13.5 cm diameter)
Hyperextended (Face) (9.5 cm diameter)
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Suspect Posterior if
maternal abdomen is kidney bean
shaped,
you can feel fetal parts everywhere or
fetal heart is best heard in the flank
Not engaged.
ROP most common. (Left oblique
diameter reduced by the sigmoid colon)

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Presenting part in relation to the ischial spines


Reported in centimeters above (minus
numbers) or below (plus numbers). Some
hospitals use +5 cm. Others use +3 cm. You
need to identify, eg. +2/3 or -3/5
What is engagement?
When the widest portion of the presenting
part has negotiated the pelvic inlet (narrowest
part of the pelvis).
Usually reflects 0 station in a flexed occiput
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Gynecoid (about 50%)


Anthropoid (25-35%)
Android (10-15%)
Platypelloid (<5%)

Important to know most women have the


first two types of pelvis (to ensure the
species goes on)
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Primary (Involuntary)
Secondary (Voluntary) plus resistance of
pelvic muscles and flexion of fetus (2nd
stage only)

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What is the best position for a woman to


assume in latent phase of labor?

What is the best position for active labor?

What is the best position for second


stage

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Discuss psychological factors that may


influence labor
Fear
Personal history
Family history
Culture

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