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Nageles rule-  LMP-3m + 7d  derives EDC

Nageles rule-  LMP-3m + 7d  derives EDC. Multiple Gestation (1/99 deliveries ). 2/3 fraternal Autosomal recessive in daughters of mothers of twins 1/3 identical Random occurance High prematurity Increase incidence of congenital anomalies

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Nageles rule-  LMP-3m + 7d  derives EDC

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  1. Nageles rule-  LMP-3m + 7d  derives EDC

  2. Multiple Gestation (1/99 deliveries) • 2/3 fraternal • Autosomal recessive in daughters of mothers of twins • 1/3 identical • Random occurance • High prematurity • Increase incidence of congenital anomalies • Growth retardation, bacterial infection, hypoglycemia

  3. amnio-afp(fetal tissue breakdown increases this), bili (rH incompatability) creatnine -kidney mec staining, cytologic examination fhr - audible 16-20 wks quickening fetal heart beat nst st from placenta estriol level

  4. ultrasonography doppler

  5. cordocentesis

  6. Fundal height -cm height relates to weeks gestation

  7. Parturition Mediators • ROM • Cervical Dilation • Uterine Contraction • Placental Separation • Uterine Shrinking • Progesterone withdrawl • Estrogen induced uterine activity • Oxytocin & prostaglandin stimulation

  8. fetal scalp - 7.25+

  9. Dystocia – stage 1 & 2 > 20 hrs. • Uterine dysfunction (hyper or hypotonic) • Abnormal presentation • Breech 3.5% • Complete, footling, frank • Face, brow, shoulder, transverse • Excessive fetal size – cephalopelvic disproportion • Hydrocephalus • Abnormal size or shape of birth canal

  10. Delivery • Vertex –95% • Stations above & below ischial spines • Tocolysis- terbutaline sulfate, ritodrine, MgSO4 – not indomethicin

  11. Labor • Braxton Hicks • True – 3 contractions in 20 minutes • Cervix <4 cm & 50% effaced • 20 – 36 wks gestation • No fetal distress • No disorder contraindicating meds • Informed consent

  12. STAGES of LABOR

  13. Placenta • Placenta previa • Abruptio placentae • Maternal mortality 2 – 10% • Fetal mortality 50% • Apparent & concealed hemorrhage • Place mom in lateral lie

  14. Transient Tachypnea of the Newborn L/S ratio

  15. Lung Transition • Asphyxia stimulates gasping • Recoil of thorax draws in air • Bright loud cold pokey world initiates crying

  16. Circulatory Transition • Lung inflation • Decrease PVR – increase PaO2 • Ductus Venosis – flow stops –DV constricts • Cord Clamped – UA & UV flow stops • Ductus Arteriosis – constricts due to increased PaO2 • Foramen Ovale – closes due to pressure increase in left atrium • Umbilical Arteries constrict and close

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