Pregnancy – L&D | firstconsideration.net

Two Patients

Any time after 24 wks gestation needs assessment/monitoring of fetus as well as the mother
This includes continue monitoring of the fetus

Need sterile exam cervical check to evaluate stage of labor
Presentation – occipital fontanelle has 3 suture lines extending vs anterior fontanelle which has 4
After full dilation (10 cm) probably not ok to transfer b/c delivery imminent in next 20-60 min
Late and variable decels are signs of fetal distress
Feel for cord as the head is delivered and reduce over head if needed
Pull down to deliver anterior shoulder then up to deliver posterior shoulder

Push mom’s legs back to extreme lithotomy (McRoberts)
Suprapubic pressure
Roll to hands and knees position
Rotational maneuvers
- Put fingers behind the anterior shoulder and push forward
Deliver posterior arm
- Get under the posterior arm and sweep it up in front of the face

Let the butt deliver without pulling in order to facilitate dilating the cervix
Rotate body so butt is facing the sky
Put fingers along babies chin/maxilla and control head to not allow neck extension while delivering the body and applying suprapubic pressure
Important thing to avoid is neck hyperextension or flexion

>500 ml in the 1st hr after delivery = PPH
Oxytocin 40 units in 1 L at 500 ml/hr
Misoprostol 800-1000 mcg rectal
TXA – 1 gm over 10 min
Methylergonovine 0.2 mg IM
Carboprost 0.25 mg IM q 15 min to 2 mg max
Can sweep the uterus
Bakri Balloon – Inflate w/ saline start with 250-500 ml but can accomodate up to 800 ml
Blakemore tube – Max volume ~ 500 ml