![]() ![]() Effacement is measured by estimating the percentage remaining of the length of the thinned cervix compared to the uneffaced cervix. The measurement of cervical dilation is made by locating the external cervical os and spreading one's fingers in a ‘V’ shape, and estimating the distance in centimeters between the two fingers. A sterile gloved exam should be done to determine the degree of cervical dilation and effacement. Amniotic fluid has a pH of 7.0 to 7.5, which is more basic than normal vaginal pH. ![]() If the clinician is unsure whether or not a rupture of membranes has occurred, additional testing such as pH testing, microscopic exam looking for ferning of the fluid, or laboratory testing of the fluid can be the next step. Finally, a history of present illness, review of systems, and physical exam, including a sterile speculum exam, will need to take place.ĭuring the sterile speculum exam, clinicians will look for signs of rupture of membranes such as amniotic fluid pooling in the posterior vaginal canal. The patient's prenatal record, including obstetric history, surgical history, medical history, laboratory, and imaging data, should undergo review. The patient should be placed on continuous cardiotocographic monitoring to ensure fetal wellbeing. When women first present to the labor and delivery unit, vital signs, including temperature, heart rate, oxygen saturation, respiratory rate, and blood pressure, should be obtained and reviewed for any abnormalities. It is up to the clinician to determine if the patient is in labor, defined as regular, clinically significant contractions with an objective change in cervical dilation and/or effacement. Common chief complaints include painful contractions, vaginal bleeding/bloody show, and fluid leakage from the vagina. Women will often self-present to obstetrical triage with concern for the onset of labor. Initial Evaluation and Presentation of Labor Medical professionals use the information they obtain from monitoring and cervical exams to determine the patient's stage of labor and monitor labor progression. Cardiotocography is used to monitor the frequency and adequacy of contractions. Fetal heart monitoring is employed nearly continuously to assess fetal well-being throughout labor. Serial cervical examinations are used to determine cervical dilation, effacement, and fetal position, also known as the station. Clinicians typically use multiple modalities to monitor labor. This triad is classically referred to as the passenger, power, and passage. Successful labor involves three factors: maternal efforts and uterine contractions, fetal characteristics, and pelvic anatomy. The first stage is further divided into two phases. Expulsion: After external rotation (restitution), the top shoulder is delivered under the mother’s pubic bone followed by the bottom shoulder, and then the rest of the baby’s body can be delivered with an upward movement by the healthcare professional.Labor is the process through which a fetus and placenta are delivered from the uterus through the vagina.This movement is also known as restitution. External Rotation/Restitution: Once the baby’s head is born, the baby must rotate from facing head down to either right or left to fit the shoulders around and under the mother’s pubic arch.The baby’s head, face, and chin appear outside the mother. The baby’s head must extend back to accommodate the upward curvature of the birth canal. Extension: Usually, the back of the baby’s head is against the mother’s pubic bone as it passes through the vaginal opening.Usually, the baby faces down toward the mother’s spine, although sometimes the baby faces the mother’s pubic bone. The baby’s head rotates to accommodate these changes in the diameter of the mother’s pelvis. Now, with the baby reaching the mother’s pelvic floor, the widest diameter of the mother’s pelvis is from front to back. Internal Rotation: When the baby’s head enters the mother’s pelvis (engagement), the widest diameter of the mother’s pelvis is from right to left.As the baby’s head meets resistance from the soft tissue of the mother’s pelvis, the baby’s head flexes downward so that the baby’s chin touches the baby’s chest. Flexion: Flexion occurs during descent.Descent: Descent occurs as the baby’s head moves deeper into the mother’s pelvic cavity.Engagement may occur toward the end of pregnancy or during labor. ![]() The entry point of the mother’s pelvis (pelvic inlet) has its widest diameter from right to left. Engagement: Engagement occurs when the widest part of the baby’s head (the biparietal diameter, measured from ear to ear) enters the mother’s pelvis.These movements work to allow the smallest diameter of the baby’s head to pass through the mother’s pelvis. There are seven cardinal movements a baby makes while attempting to get into the best position for birth. ![]()
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