Labor Labor Labor is the normal physiologic process defined as uterine contractions resulting in dilatation and effacement of the cervix, which culminates in expulsion of the fetus and the products of conception. Normal and Abnormal Labor is defined as regular Regular Insulin, effective uterine contractions resulting in cervical changes that culminate in expulsion of the fetus and products of conception. Complications may arise during childbirth that necessitate prompt recognition and management by the delivering team. Four important complications/topics related to the moments surrounding delivery include episiotomy and lacerations, operative vaginal deliveries ( forceps Forceps Surgical Instruments and Sutures and vacuum-assisted deliveries), shoulder dystocia, and amniotic fluid Amniotic fluid A clear, yellowish liquid that envelopes the fetus inside the sac of amnion. In the first trimester, it is likely a transudate of maternal or fetal plasma. In the second trimester, amniotic fluid derives primarily from fetal lung and kidney. Cells or substances in this fluid can be removed for prenatal diagnostic tests (amniocentesis). Placenta, Umbilical Cord, and Amniotic Cavity embolism.
Last updated: 18 Oct, 2021
The perineum Perineum The body region lying between the genital area and the anus on the surface of the trunk, and to the shallow compartment lying deep to this area that is inferior to the pelvic diaphragm. The surface area is between the vulva and the anus in the female, and between the scrotum and the anus in the male. Vagina, Vulva, and Pelvic Floor: Anatomy is the space between the vaginal and anal orifices.
Muscular anatomy of the perineum Perineum The body region lying between the genital area and the anus on the surface of the trunk, and to the shallow compartment lying deep to this area that is inferior to the pelvic diaphragm. The surface area is between the vulva and the anus in the female, and between the scrotum and the anus in the male. Vagina, Vulva, and Pelvic Floor: Anatomy and pelvic floor Pelvic floor Soft tissue formed mainly by the pelvic diaphragm, which is composed of the two levator ani and two coccygeus muscles. The pelvic diaphragm lies just below the pelvic aperture (outlet) and separates the pelvic cavity from the perineum. It extends between the pubic bone anteriorly and the coccyx posteriorly. Vagina, Vulva, and Pelvic Floor: Anatomy, external view
Image by BioDigital, edited by LecturioAnorectal anatomy
Image by Lecturio.Lacerations are spontaneous tears that occur due to the trauma of the infant passing through the vaginal canal during delivery.
An episiotomy is an intentional 3–5-cm incision made by the delivering provider to enlarge the vaginal opening at the time of delivery.
Midline versus mediolateral episiotomy
Image: “Medio-lateral-episiotomy” by Jeremykemp. License: Public Domain, edited by Lecturio.Operative vaginal delivery is the use of obstetric forceps Forceps Surgical Instruments and Sutures or a vacuum extractor to effect delivery of a fetus.
Forceps Forceps Surgical Instruments and Sutures and vacuum deliveries
Image by Lecturio.Fetal head position:
Position is determined by the location of the fetal occiput (posterior portion of the head located behind the smaller triangular shaped
fontanelle
Fontanelle
Any of six membrane-covered openings between the cranial sutures in the incompletely ossified skull of the fetus or newborn infant. The fontanelles normally close sometime after birth.
Skull: Anatomy) relative to the maternal
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy (anterior/posterior and right/left). For example, ROA stands for right occiput anterior and means that the fetal occiput is against the right anterior portion of the maternal
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy.
Fetal station
Fetal station
Refers to how high (or low) the presenting fetal part is compared to the maternal ischial spine, reported in centimeters
Normal and Abnormal Labor:
The presenting fetal part is measured in centimeters from the ischial
spine
Spine
The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum.
Vertebral Column: Anatomy. Negative numbers denote a higher
fetal station
Fetal station
Refers to how high (or low) the presenting fetal part is compared to the maternal ischial spine, reported in centimeters
Normal and Abnormal Labor, while positive numbers denote a lower
fetal station
Fetal station
Refers to how high (or low) the presenting fetal part is compared to the maternal ischial spine, reported in centimeters
Normal and Abnormal Labor as the fetus descends in the
birth canal
Birth canal
Pelvis: Anatomy.
CT scan of fetal head demonstrating an
intracranial hemorrhage
Intracranial hemorrhage
Subarachnoid hemorrhage (SAH) is a type of cerebrovascular accident (stroke) resulting from intracranial hemorrhage into the subarachnoid space between the arachnoid and the pia mater layers of the meninges surrounding the brain. Most sahs originate from a saccular aneurysm in the circle of willis but may also occur as a result of trauma, uncontrolled hypertension, vasculitis, anticoagulant use, or stimulant use.
Subarachnoid Hemorrhage:
This is a potential complication of operative vaginal deliveries.
Obstetric forceps Forceps Surgical Instruments and Sutures
Image: “Obstetric forceps” by Wellcome Collection gallery. License: CC BY 4.0Shoulder dystocia is when the baby’s anterior shoulder becomes impacted behind the maternal pubic symphysis Pubic Symphysis A slightly movable cartilaginous joint which occurs between the pubic bones. Vagina, Vulva, and Pelvic Floor: Anatomy, preventing delivery of the fetal body. Shoulder dystocia is a true obstetric emergency.
Shoulder dystocia is an obstetric emergency.
Suprapubic pressure being used to dislodge and internally rotate an impacted shoulder in shoulder dystocia
Image: “Suprapubic-pressureforSD” by Henry Lerner. License: CC BY 4.0McRoberts position with suprapubic pressure
Image: “McRoberts maneuver” by geraldbaeck. License: CC0 1.0Additional maneuvers to attempt if the dystocia persists include:
To remember the management of a shoulder dystocia, remember HELPERR:
Brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region injuries associated with shoulder dystocia
Image by Lecturio.Amniotic fluid Amniotic fluid A clear, yellowish liquid that envelopes the fetus inside the sac of amnion. In the first trimester, it is likely a transudate of maternal or fetal plasma. In the second trimester, amniotic fluid derives primarily from fetal lung and kidney. Cells or substances in this fluid can be removed for prenatal diagnostic tests (amniocentesis). Placenta, Umbilical Cord, and Amniotic Cavity embolism (AFE) is a complication of labor Labor Labor is the normal physiologic process defined as uterine contractions resulting in dilatation and effacement of the cervix, which culminates in expulsion of the fetus and the products of conception. Normal and Abnormal Labor affecting the mother in the immediate postpartum period Postpartum period In females, the period that is shortly after giving birth (parturition). Postpartum Complications.
Amniotic fluid Amniotic fluid A clear, yellowish liquid that envelopes the fetus inside the sac of amnion. In the first trimester, it is likely a transudate of maternal or fetal plasma. In the second trimester, amniotic fluid derives primarily from fetal lung and kidney. Cells or substances in this fluid can be removed for prenatal diagnostic tests (amniocentesis). Placenta, Umbilical Cord, and Amniotic Cavity embolism typically presents dramatically, as sudden onset cardiopulmonary collapse occurring during labor Labor Labor is the normal physiologic process defined as uterine contractions resulting in dilatation and effacement of the cervix, which culminates in expulsion of the fetus and the products of conception. Normal and Abnormal Labor or within 30 minutes after delivery.
Amniotic fluid Amniotic fluid A clear, yellowish liquid that envelopes the fetus inside the sac of amnion. In the first trimester, it is likely a transudate of maternal or fetal plasma. In the second trimester, amniotic fluid derives primarily from fetal lung and kidney. Cells or substances in this fluid can be removed for prenatal diagnostic tests (amniocentesis). Placenta, Umbilical Cord, and Amniotic Cavity embolism is a clinical diagnosis based on presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor.
Chest
x-ray
X-ray
Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source.
Pulmonary Function Tests in a woman with
amniotic fluid
Amniotic fluid
A clear, yellowish liquid that envelopes the fetus inside the sac of amnion. In the first trimester, it is likely a transudate of maternal or fetal plasma. In the second trimester, amniotic fluid derives primarily from fetal lung and kidney. Cells or substances in this fluid can be removed for prenatal diagnostic tests (amniocentesis).
Placenta, Umbilical Cord, and Amniotic Cavity embolism:
Diffuse infiltration is evident throughout the
lungs
Lungs
Lungs are the main organs of the respiratory system. Lungs are paired viscera located in the thoracic cavity and are composed of spongy tissue. The primary function of the lungs is to oxygenate blood and eliminate CO2.
Lungs: Anatomy.
Survival depends on prompt diagnosis and effective resuscitation Resuscitation The restoration to life or consciousness of one apparently dead. . Neonatal Respiratory Distress Syndrome.