Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Updated: Sep 12 2021

Presentation of Labor

4.7

  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon

(3)

  • Snapshot
    • A 32-year-old G1P2 presents to labor and delivery with contractions. She has been having 1 painful contraction every 20 minutes for the past 2 hours and reports mild spotting on her underwear. A transabdominal ultrasound is performed followed by a pelvic exam. Her cervix is effaced 90% and dilated 5 cm. She is admitted for active labor.
  • Introduction
    • Overview
      • involves spontaneous and regular contractions +/- rupture of membranes
    • Labor
      • true
        • progressive effacement and dilation of uterine cervix resulting from contractions of uterus
      • false
        • Braxton Hicks contraction
          • uterine contractions without effacement and dilation of cervix
          • managed with reassurance and discharge
      • preterm
        • prior to 36 weeks and 6 days
  • Epidemiology
    • 85% of pregnant people undergo spontaneous labor and delivery between 37-42 weeks
  • Presentation
    • Symptoms that require hospital presentation
      • contractions
        • ≥ 4 every 20 minutes or ≥ 8 every 60 minutes
      • rupture of membranes
      • significant bleeding
        • small amount of mucoid bleeding is normal in early labor ("bloody show")
      • decrease in fetal movement
    • Physical exam
      • vital signs
        • blood pressure (BP)
        • heart rate (HR)
        • respiratory rate (RR)
        • temperature
      • auscultation of fetal heart sounds
      • determine fetal position
        • Leopold maneuvers
          • steps taken to palpate the uterus to assess fetal presentation and position
      • vaginal exam to check
        • rupture of membranes (ROM)
        • cervical effacement and dilation
        • fetal station (level of fetus relative to ischial spine)
          • zero station is at the level of the ischial spine
    • Admission for active labor
      • cervial effacement ≥ 80%
      • 4-5 cm dilation
  • Imaging
    • Transabdominal ultrasound
      • indications
        • determine fetal position
        • rule out placenta previa and premature rupture of membranes (PROM)
          • perform prior to digital exam
  • Studies
    • Serum labs
      • complete blood count (CBC)
      • blood type and screen
      • rapid HIV testing
      • hepatitis B
      • syphillis
      • group B streptococcus (GBS)
  • Preterm Labor
    • Definition
      • uterine contractions
        • ≥ 4 every 20 minutes or ≥ 8 every 60 minutes
      • cervical dilation ≥ 3 cm
    • Symptoms
      • menstrual-like cramps
      • low back ache
      • discharge of mucous from vagina
      • spotting
      • contractions
    • Physical exam
      • digital cervical examination (after transabdominal ultrasound (US))
      • speculum exam (after digital exam)
    • Imaging
      • transabdominal US
      • transvaginal US
    • Studies
      • fetal fibronectin testing
      • rectovaginal GBS culture
      • urine culture
      • substance use testing
      • sexually transmitted infection (STI) testing
    • Management
      • gestational ages
        • 34 weeks to 36 weeks and 6 days
          • delivery
            • by induction if necessary
          • penicillin if GBS culture is positive or unknown
        • 32 weeks to 33 weeks and 6 days
          • expectant management unless fetal lungs have reached maturity
          • betamethasone
          • penicillin if GBS culture is positive or unknown
          • antimicrobials if no contractions
        • 24 weeks to 31 weeks and 6 days
          • expectant
          • betamethasone
          • penicillin if GBS culture is positive or unknown
          • tocolytics with indomethacin
          • magnesium sulfate
        • < 24 weeks
          • patient counseling
          • expectant management or induction
Card
1 of 0
Question
1 of 3
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options