Key Points Prior CD is the most important factor associated with PA, and the risk of PA increases with the number of prior CDs. Suspected PA on prenatal imaging allows planned management of the condition and has been associated with…
Key Points VBAC rates have plummeted from a peak of approximately 30% in 1996 to 5% in 2010. Two-thirds of women with a prior low transverse CD are candidates for TOLAC and should be counseled about and offered this option.…
Key Points In 1970, the CD rate was about 5%. By 2008, it had reached 32.8%, the highest rate ever recorded in the United States. The rates of vaginal births after cesarean delivery have plummeted, from a peak of 28.3%…
Key Points Understanding the hemodynamic changes of pregnancy and the physiologic responses that occur with hemorrhage assists in appropriate management. Clinicians should recognize the four classes of hemorrhage to allow for rapid intervention. Placental abruption is diagnosed primarily by clinical…
Key Points Fetal lie refers to the orientation of the fetal spine relative to that of the mother. Normal fetal lie is longitudinal and by itself does not connote whether the presentation is cephalic or breech. Fetal malpresentation requires timely…
Key Points Analgesia during labor can reduce or prevent potentially adverse stress responses to the pain of labor, including postpartum depression. Parenteral opioids for labor analgesia work primarily by sedation and, except at high doses, result in minimal reduction of…
Key Points The goal of intrapartum FHR monitoring is to assess the adequacy of fetal oxygenation during labor so that timely and appropriate steps can be taken when necessary to avoid fetal hypoxic injury. Fetal oxygenation involves the transfer of…
Key Points Rates of cesarean delivery have risen in the United States, reaching a rate of approximately 25% of all deliveries, whereas rates of forceps deliveries have declined from 17.7% in 1980 to 4% in 2000. Treat the vacuum extractor…
Key Points Labor is a clinical diagnosis defined as uterine contractions that result in progressive cervical effacement and dilation. The most common causes of protraction or arrest disorders are inadequate uterine activity and abnormal positioning of the fetal presenting part.…
Key Points Labor is a clinical diagnosis that includes regular painful uterine contractions and progressive cervical effacement and dilation. Labor has three stages: the first stage is from labor onset until full dilation of the cervix, the second stage is…