1. Intrapartum Care & Abnormal Labor Francis S. Nuthalapaty, MD Medical Student Lecture Series Department of Obstetrics & Gynecology Greenville Hospital System University Medical Center Greenville, South Carolina
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3. Learning Objectives ET-11 APGO Medical Student Educational Objectives 8 th Ed. 2004 KH Describe the evaluation of common puerperal complications KH Describe the different methods of delivery with the indications and contraindications of each SH Describe the steps of a vaginal delivery KH Describe the three stages of labor and recognize common abnormalities KH List the signs and symptoms of labor Level of Competence Objective
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5. Learning Objectives ET-22 APGO Medical Student Educational Objectives 8 th Ed. 2004 K List indications and contraindications for oxytocin administration K Discuss fetal and maternal complications of abnormal labor K Describe methods of fetal surveillance K List abnormal labor patterns Level of Competence Objective
6. Learning Objectives ET-22 APGO Medical Student Educational Objectives 8 th Ed. 2004 K Discuss strategies for emergency management of breech, shoulder dystocia and cord prolapse K List indications for VBAC Level of Competence Objective
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18. Fetal Presentation Presentation % Incidence Cephalic 96.8 --- Breech 2.7 1:36 Transverse 0.3 1:335 Compound 0.1 1:1000 Face 0.05 1:2000 Brow 0.01 1:10,000 Williams Obstetrics, 21 st Ed. 452.
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20. Cephalic Presenting Diameters FACE SINCIPUT MILITARY BROW VERTEX FLEXED Figure 9-2 Lateral view of the fetal skull showing the prominent landmarks and the anteroposterior diameters.
38. Fetal Station World Health Organization: Managing Complications in Pregnancy and Childbirth www.who.int/reproductivehealth/impac/Clinical_Principles/Normal_labour_C57_C76.html
104. Normal Labor Parameters Source: Modified from Friedman EA. Labor: Clinical Evaluation and Management, 2 nd ed. New York. Appletion-Century-Cronz 1370.43 2.5 h 57 min Second Stage 1.2 cm/h 3.0 cm/h Maximum Slope 3.3 h 54 min Deceleration 11.5 h 4.9 h Active 20.6 h 8.6 h Latent Lower Limit (95%) Mean Nulliparous Labor
105. Normal Labor Parameters Source: Modified from Friedman EA. Labor: Clinical Evaluation and Management, 2 nd ed. New York. Appletion-Century-Cronz 1370.43 50 min 14 min Second Stage 1.5 cm/h 5.7 cm / h Maximum Slope 53 min 14 min Deceleration 5.2 h 2.2 h Active 13.6 h 5.3 h Latent Lower Limit (95%) Mean Multiparous Labor