ObGyn

Abnormal Labor

• 1st stage (painful contractions leading to cervical dilation)
  • Latent Phase (0-6 cm dilation): Protraction of latent phase is defined as greater than 14 hours (multip) or 20 hours (nullip) without change in dilation.
  • Active Phase (6-10 cm dilation): Protraction of active phase is defined as ≤1 cm dilation in 2 hr; manage with Pitocin. Arrest is defined as no change in 4 hours (with adequate contractions) or 6 hours (without adequate contractions); management includes placing an IUPC catheter to determine if contractions are adequate, if yes: C-section, if no: AROM or Pitocin.
• 2nd stage (active pushing)
  • Arrest is defined as no change in fetal station in 1-3 hrs (depending on parity and use of neuraxial anesthesia); management is to reduce epidural rate, give Pitocin, consider C-section or forceps delivery.
• 3rd stage (delivery of the placenta)

Missed Concepts

• Obesity is a risk factor for POP, but weight loss is not an effective management option. Instead consider pessary or surgery.
• Scuba diving is not recommended during pregnancy.
• It's ok to start a new exercise regimen after becoming pregnancy.
• Patient's who are at high risk of preeclampsia (SCD, HTN, nephropathy) should have early 24 hr protein collection to establish baseline.
• Indications for antibiotic ppx in patients who are GBS unknown: < 37 weeks, ROM > 18 hrs, intrapartum fever
• Diagnosis of placenta previa in a patient without prenatal care and with current bleeding: TVUS or speculum exam (these are actually safe because they don't go in the endocervical canal)
• Self breast exams are never recommended.
• POP can cause abnormal uterine bleeding.

Quad Screen Interpretation

Disease	AFP	Estriol	hCG	Inhibin	Mnemonic
Down (trisomy 21)	Low	Low	High	High	HIgh
Turner (45 X,O)	Low	Low	High	High	HIgh
Edward (trisomy 18)	High	Low	Low	High	HE is low
Patau (trisomy 13)	High	Low	Low	Low	AFPatau is High