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• Term, GA39.
• Late-term, GA41-41+6.
• Postterm, GA>42.
Confirm GA: Naegele’s rule (EDC = LMP + 7d - 3mo), fundal hight, quickening, lightening, ultrasound .
Physical examination: general examination, Leopold’s maneuver (passenger), uterine contraction (power), pelvic examination
(passenger), auscultation of fetal heart sound.
Leopold’s maneuver: (1) fundal grip, (2) umbilical grip, (3) pawlick’s grip, (4) inguinal grip
Attitude: flexion, extension; vertex (full flexion), sinciput (moderate flexion, military attitude); cephalic subtype:
suboccipitobregmatic (9.5cm), occipitofrontal (12.5cm), occipitomental (13.5cm), submentalbragmatic (9.5+cm)
Clinical pelvimetry: inlet (estimate diagonal conjugate distance from public symphysis to prominence of sacral promontory;
normal ≥11.5cm), mid-pelvis (interischial distance; normal ≥10cm), outlet (biischial diameter (transverse outlet diameter),
pelvic angle; normal: ?)
nulliparous vs multiparous
Position (palpate anterior and posterior fontanelles): transverse, ROP, LOP, ROA, LOA, occipito-anterior
Station: evaluate head engagement, report in cm (eg, station -1) relative to interischial spines
Uterine contraction: can be measured by direct palpation or by external toco ;normal: interval 2-3m, duration 45-60s.
Low risk pregnancy: no complication, spontaneous onset of labor at GA37-42wk, singleton with cephalic presentation,
fetal weight 2500-4000g, normal volume and clear amniotic fluid, no intrapartum bleeding, normal fetal heart rate (normal:
110-160bpm), cervical dilatation progress >1cm/hr
Auscultation of fetal heart: in low risk patient: latent phase q30m active phase q15m; in high risk patient: q15m in both phase
maternal vital sign, observe uterine contraction and fetal heart sound, IV fluid, maternal position, record labor progression
(partograph), analgesic drug
APGAR score (at 1m and 5m): Appearance (0=central cyanosis, 1=peripheral cyanosis, 2=all pink), Pulse (0=none,
1=<100bpm, 2=≥100bpm), Grimace (0=none, 1=grimace, 2=cry), Activity (0=none, 1=some flexion, 2=all movement),
Respiration (0=absent, 1=irregular, 2=cry)
Placental delivery methods: (1) modified Crede’s maneuver (2) Brandt-Andrew maneuver I and II (3) control cord traction
Episiotomy wound assessment and repair: Severity: first degree (vaginal wall tear), second degree (+perineal muscle tear),
third degree (+anal sphincter), fourth degree (+rectum tear). Repair: ?
Postpartum care
Order: One-day: routine postpartum care, observe vaginal bleeding, off IV, intermittent catheter if unable to void within 6h
after delivery. Continuous: regular diet, perineal care, record vital signs q4h, medication: paracetamol, obimin AZ.
10B: Blood pressure, Body temperature, Breathing, Brain, Breast, Bowel, Basket, Bladder, Body discharge, Baby, Blue
Complications
• Antepartum: hemorrhage (placenta previa), premature rupture of membrane.
• Intrapartum: fetal distress, nuchal cord (Mx: Summersault technique), prolapse cord, uterine rupture.
• Postpartum: vulva hemorrhage (Mx: Hot sitz bath + analgesic + amoxycillin/metronidazole ± evacuation), infection (Mx:
Hot sitz bath + analgesic + incision/drainage + amoxycillin/metronidazole or clindamycin±gentamicin or ampicillin/
gentamicin/metronidazole), hematoma.