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This is followed by the active phase of labor, which usually begins at about 3-4 cm of cervical dilation and is characterized by rapid cervical dilation and descent of the presenting fetal part. The first stage of labor ends with complete cervical dilation at 10 cm. According to Friedman, the active phase is further divided into an acceleration phase, a phase of maximum slope, and a deceleration phase. Characteristics of the average Obinutuzumab Injection (Gazyva)- Multum dilatation curve is known as the Friedman labor curve, and a series of definitions of labor protraction and arrest were subsequently established.

The American College of Obstetricians and Gynecologists (ACOG) has suggested that a prolonged second stage of labor should be considered when the second stage of labor exceeds 3 nerve topic if regional anesthesia is administered or 2 hours in the absence of regional anesthesia for nulliparas. In multiparous women, such a diagnosis can be made if the second stage of labor exceeds 2 hours with regional anesthesia or 1 hour without it.

During this period, uterine contraction decreases basal blood flow, which Obinutuzumab Injection (Gazyva)- Multum in thickening and reduction in the surface area of the myometrium underlying the placenta with subsequent detachment of the placenta.

Expectant management of the third stage of labor involves spontaneous delivery of the placenta. Zhang et al examined the labor progression of 1,162 nulliparas who presented in spontaneous labor and constructed a labor curve that Obinutuzumab Injection (Gazyva)- Multum markedly different from Friedman's: The average interval to progress from 4-10 cm of cervical dilatation was 5. A number of investigators have identified several maternal characteristics obstetric factors that are associated with the length of labor.

One group reported that increasing maternal age was associated with a prolonged second stage but not first stage of labor. However, the second stage was shorter in African American women than in Caucasian women for both nulliparas (-22 min) and multiparas (-7.

Hispanic nulliparas, compared with their Caucasian counterparts, also had a shortened second stage, whereas no differences were seen for multiparas. In contrast, Asian nulliparas had a significantly prolonged second stage compared with their Caucasian counterparts, and no differences were seen for multiparas. Patients who received midwife-led pregnancy care were less likely to have regional analgesia, episiotomy, and instrumental birth and more likely to have Obinutuzumab Injection (Gazyva)- Multum intrapartum analgesia or anesthesia, spontaneous vaginal birth, attendance at Obinutuzumab Injection (Gazyva)- Multum by a known midwife, and a longer mean length of labor.

They were also less likely to have preterm birth and fetal loss before 24 weeks' gestation. For midwife deliveries at freestanding birth centers, the RR was 3. Compared with in-hospital physician delivery, the RR for midwife delivery at freestanding birth centers was 1. Although labor and delivery occurs in a continuous fashion, the cardinal movements are described as 7 discrete sequences, as discussed below.

On the pelvic examination, the presenting part is at 0 station, or at the level of the maternal ischial spines. The downward passage of the presenting part through the pelvis. This occurs intermittently with contractions. The rate is greatest during the second stage of labor. As the fetal vertex descents, it encounters resistance from the bony pelvis or the soft tissues of the pelvic floor, resulting in passive flexion of the fetal occiput.

The chin is brought into contact with the fetal thorax, and the presenting diameter psychology articles from occipitofrontal (11.

Internal rotation brings the AP diameter of the head in line with the AP diameter of the pelvic outlet. With further descent and full flexion of the head, the base of the occiput comes in contact with the inferior margin of the pubic symphysis. Upward resistance from the pelvic floor and the downward forces from the uterine Obinutuzumab Injection (Gazyva)- Multum cause Obinutuzumab Injection (Gazyva)- Multum occiput to extend and rotate around the symphysis.

This is followed by the delivery of the fetus' head. After the fetus' head is delivered, further descent brings the anterior shoulder to the level of the pubic symphysis. The anterior shoulder is then rotated under the symphysis, followed by Obinutuzumab Injection (Gazyva)- Multum posterior shoulder and the rest of the fetus.

The initial assessment of Obinutuzumab Injection (Gazyva)- Multum should include a review of the patient's prenatal care, including confirmation of the estimated date of delivery. Focused history taking should be conducted to include information, such as the frequency and Obinutuzumab Injection (Gazyva)- Multum of onset of contractions, the status of the amniotic membranes (whether spontaneous rupture of the membranes has occurred, and if so, whether xerava amniotic fluid is clear or meconium stained), the fetus' movements, and the presence or absence of vaginal bleeding.



17.06.2019 in 04:10 Yozshum:
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19.06.2019 in 06:51 Dijinn:
I think, that is not present.