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Labor, Delivery, and Changes at Birth

Labor, Delivery, and Changes at Birth. Fred Hill, MA, RRT. Fetus in Uterus. Fetus in Uterus. Events of Birth (Maternal). Rupture of membranes Dilation of cervix Contraction of uterus Separation of the placenta Shrinking of the uterus. Stages of Labor & Delivery.

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Labor, Delivery, and Changes at Birth

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  1. Labor, Delivery, and Changes at Birth Fred Hill, MA, RRT

  2. Fetus in Uterus

  3. Fetus in Uterus

  4. Events of Birth (Maternal) • Rupture of membranes • Dilation of cervix • Contraction of uterus • Separation of the placenta • Shrinking of the uterus

  5. Stages of Labor & Delivery • Stage I: Onset of regular contractions to full dilation and effacement of the cervix • Primigravida: 16 – 18 hours • Multigravida: 7 – 12 hours • Stage II: Full dilation (10 cm) and effacement of the cervix to delivery of the baby • Primigravida: 1 – 2 hours • Multigravida: 20 mins • Stage III: Delivery of the baby to delivery of the placenta • Primigravida: 3 – 4 mins • Multigravida: 4 – 5 mins

  6. Tocolysis • Beta-2 sympathomimetics • Terbutaline sulfate • Ritodrine hydrocholoride • Magnesium sulfate • Indomethacin • Calcium channel blockers

  7. Dystocia • Uterine dysfunction • Abnormal fetal presentation • Cephalopelvic dysproportion • Hydrocephalus • Excessive fetal size (maternal diabetes) • Small pelvic dimensions • Abnormality in shape of birth canal

  8. Abnormal Fetal Presentation • Normal presentation: Vertex ( head first), 95% • Abnormal presentation • Cephalic • Breech (buttocks down) • Face • Brow • Shoulder • Transverse lie

  9. Vertex Presentation

  10. Cephalic Presentation

  11. Face Presentation

  12. Complete Breech

  13. Footling Breech

  14. Frank Breech

  15. Transverse Lie

  16. Other Problems • Prolapse of umbilical cord • Cord wrapping around fetus • Placental abnormalities • Placenta previa: Implantation in lower uterus • Abruptio placentae

  17. Placenta Previa

  18. Abruptio Placentae

  19. Other Risky Deliveries • Cesarean deliveries • Multiple gestations

  20. Changes at Birth • Vaginal squeeze when head presents • Presentation of chest and recoil of chest • First breath: high initial pressures (-100 cm H2O) • Succeeding breaths require less negative pressure • Remaining liquid in lungs • Expelled by coughing and sneezing • Absorption into lung interstitium into lynphatics

  21. Fetal Circulation

  22. Fetal to Adult Circulation • Major changes • First and subsequent breaths • Reduces pulmonary vascular resistance • Air replaces liquid surrounding vasculature • ↑ PaO2 → pulmonary vasodilation • Increase in systemic vascular resistance • Clamping of umbilical cord • R → L Shunting changes to L → R • Foramen ovale closes: mechanical • Ductusarteriosus begins to close due to chemical changes • Cessation of blood flow leads to constriction of: • Ductusvenosus • Umbilical arteries and veins

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