What do we know about normal and abnormal labor for nulliparous parturients?

80 Pages·2013·6.36 MB·English

by  Randall Morgan

Nulliparous Parturients
-
What do we know about
normal and abnormal
labor for nulliparous
parturients?
Randall Morgan MD MBA
Goals and objectives
Define-normal 1st stage labor, abnormal 1st stage

labor, failed induction, normal 2nd stage and
abnormal 2nd stage
Discuss opportunities to reduce unintended

circumstances related to the diagnosis and
management of labor
Discuss opportunities for our practice to be

consistent with the available medical literature
I am a
Medical student
1.
50%
PG-1
2.
PG-2
3.
PG-3
4.
PG-4
5.
Attending completed 12% 12%
6.
9% 9%
6%
residency 2001 or after 3%
Attending completed
7. n... G-1 G-2 G-3 G-4 p... p...
e P P P P m m
stud g co g co
residency prior to 2002 cal din din
Medi Atten Atten
The diagnosis of normal and
abnormal labor has not changed
over the past 60 years.
50% 50%
True
1.
False
2.
e e
u s
Tr Fal
Is vaginal birth with a healthy mom and baby
the intended birth mode for women who labor
(excludes preterm labor and women who are
in labor & waiting to have their cesarean)?
83%
Always
1.
Sometimes
2.
17%
Never
3.
0%
ys es er
a m v
Alw meti Ne
o
S
For women whom you induce, is
cesarean section the intended
mode of delivery?
84%
Always
1.
14%
Sometimes
2.
2%
Never
3.
ys es er
a m v
Alw meti Ne
o
S
The active phase of labor begins
at __ cm?
4 cm for nulliparous 67%
1.
women
5 cm for multiparous
2.
women
22%
> 6m for both
3.
11%
multiparous and
0%
nulliparous women
4. Both 1 and 2 4 cm for nulli... 5 cm for multi... > 6m for both ... Both 1 and 2
Friedman’s Curve
Nullipara multipara
Prolonged latent phase >20 hours >14 hours
Average 2nd stage 50 minutes 20 minutes
Prolonged 2nd stage (with >2 hour (>3) > 1 hour (2 hour)
epidural)
Protracted dilation (95th <1.2 cm/hour < 1.5 cm/hour
percentile)
Protracted descent (95th < 1cm/hour < 2cm/hour
percentile)
Arrest of dilation * > 2 hours > 2 hours
Arrest of descent* > 2 hour > 1 hour
Prolonged 3rd stage >30 minutes  30 minute

*adequate contractions > Friedman EA Dec 1955
200 Montevideo unites / 10 Obstet Gynecol 6(6):567-89
minutes for 2 hours
Zhang Contemporary Labor Patterns Dec 2010 AJOBGYN
Fig. 2. Average labor curves by parity in singleton term pregnancies with spontaneous onset
of labor, vaginal delivery, and normal neonatal outcomes. P0, nulliparous women; P1, women
of parity 1; P2+, women of parity 2 or higher.Zhang. Contemporary Labor Patterns. Obstet
Gynecol 2010.