{"id":224,"date":"2020-08-13T16:30:10","date_gmt":"2020-08-13T16:30:10","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=224"},"modified":"2023-09-30T10:32:23","modified_gmt":"2023-09-30T10:32:23","slug":"22-abnormal-labor","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/22-abnormal-labor\/","title":{"rendered":"22. Abnormal Labor"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/KHdausjbBz4\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 11:23<\/p>\n<input type='hidden' bg_collapse_expand='69e9dc20c348b4094132044' value='69e9dc20c348b4094132044'><input type='hidden' id='bg-show-more-text-69e9dc20c348b4094132044' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9dc20c348b4094132044' value='Hide Transcript'><button id='bg-showmore-action-69e9dc20c348b4094132044' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9dc20c348b4094132044' ><\/p>\n<p>Epico educational topic number 22<\/p>\n<p>00:02<\/p>\n<p>abnormal labor you may remember our<\/p>\n<p>00:04<\/p>\n<p>patient labora deliver it from our app<\/p>\n<p>00:06<\/p>\n<p>go video number eleven intrapartum care<\/p>\n<p>00:09<\/p>\n<p>we follow libera through a normal labor<\/p>\n<p>00:11<\/p>\n<p>and delivery course in that video in<\/p>\n<p>00:13<\/p>\n<p>this video labora will experience<\/p>\n<p>00:15<\/p>\n<p>abnormal labor we will discuss how best<\/p>\n<p>00:18<\/p>\n<p>to provide care for labora and her fetus<\/p>\n<p>00:20<\/p>\n<p>to optimize outcomes the objectives of<\/p>\n<p>00:22<\/p>\n<p>this video are to list and describe the<\/p>\n<p>00:24<\/p>\n<p>causes and methods of evaluation of<\/p>\n<p>00:26<\/p>\n<p>abnormal labor patterns discuss fetal<\/p>\n<p>00:28<\/p>\n<p>and maternal complications of abnormal<\/p>\n<p>00:30<\/p>\n<p>labor list indications and<\/p>\n<p>00:32<\/p>\n<p>contraindications for oxytocin<\/p>\n<p>00:34<\/p>\n<p>administration describe risks and<\/p>\n<p>00:36<\/p>\n<p>benefits of trials of labor after<\/p>\n<p>00:38<\/p>\n<p>caesarean delivery and lastly discuss<\/p>\n<p>00:40<\/p>\n<p>strategies for emergency management of<\/p>\n<p>00:42<\/p>\n<p>breech presentation<\/p>\n<p>00:43<\/p>\n<p>shoulder dystocia and cord prolapse here<\/p>\n<p>00:46<\/p>\n<p>is labora entering labor and delivery<\/p>\n<p>00:48<\/p>\n<p>and active labor<\/p>\n<p>00:48<\/p>\n<p>she is dilated to 5 centimeters let&#8217;s<\/p>\n<p>00:51<\/p>\n<p>start by talking about the 3 p&#8217;s that<\/p>\n<p>00:53<\/p>\n<p>contribute to a normal labor the power<\/p>\n<p>00:55<\/p>\n<p>the passenger and the passage the power<\/p>\n<p>00:58<\/p>\n<p>refers to uterine contractions the<\/p>\n<p>01:00<\/p>\n<p>uterus must produce strong frequent<\/p>\n<p>01:02<\/p>\n<p>contractions that will dilate the cervix<\/p>\n<p>01:04<\/p>\n<p>and cause the fetus to descend down<\/p>\n<p>01:06<\/p>\n<p>ideally the uterus should contract three<\/p>\n<p>01:08<\/p>\n<p>times in a 10-minute period here is a<\/p>\n<p>01:10<\/p>\n<p>fetal heart rate tracing and remember<\/p>\n<p>01:12<\/p>\n<p>that the top line is the fetal heart<\/p>\n<p>01:14<\/p>\n<p>rate and the bottom line are the uterine<\/p>\n<p>01:16<\/p>\n<p>contractions this tracing shows ten<\/p>\n<p>01:18<\/p>\n<p>minutes of laborious labor and she has<\/p>\n<p>01:20<\/p>\n<p>three contractions marked by the white<\/p>\n<p>01:22<\/p>\n<p>arrows the uterine contractions are<\/p>\n<p>01:25<\/p>\n<p>usually monitored by an external tool<\/p>\n<p>01:26<\/p>\n<p>commoner which does not give information<\/p>\n<p>01:28<\/p>\n<p>about the strength of the contractions<\/p>\n<p>01:29<\/p>\n<p>just the timing let&#8217;s check back on<\/p>\n<p>01:32<\/p>\n<p>labora she was admitted to labor and<\/p>\n<p>01:33<\/p>\n<p>delivery in active labor at five<\/p>\n<p>01:35<\/p>\n<p>centimeters dilated and she&#8217;s been<\/p>\n<p>01:37<\/p>\n<p>having regular painful contractions for<\/p>\n<p>01:39<\/p>\n<p>two hours since she is a gravity&#8217; one<\/p>\n<p>01:42<\/p>\n<p>pair zero and active labor her cervix is<\/p>\n<p>01:44<\/p>\n<p>expected to dilate at approximately one<\/p>\n<p>01:46<\/p>\n<p>point two centimeters per hour a<\/p>\n<p>01:48<\/p>\n<p>multi-purpose patient and active labour<\/p>\n<p>01:50<\/p>\n<p>should have progression of approximately<\/p>\n<p>01:52<\/p>\n<p>1.5 centimeters per hour after 2 hours<\/p>\n<p>01:55<\/p>\n<p>when we recheck labora cervix it is<\/p>\n<p>01:57<\/p>\n<p>unchanged and it is still 5 centimeters<\/p>\n<p>01:59<\/p>\n<p>dilated<\/p>\n<p>02:00<\/p>\n<p>in order to assess the strength of the<\/p>\n<p>02:02<\/p>\n<p>contractions we place an intrauterine<\/p>\n<p>02:03<\/p>\n<p>pressure catheter or IUP see this<\/p>\n<p>02:06<\/p>\n<p>tracing is from an IUP see the strength<\/p>\n<p>02:09<\/p>\n<p>of the contraction is the amplitude of<\/p>\n<p>02:11<\/p>\n<p>each wave a Montevideo unit<\/p>\n<p>02:13<\/p>\n<p>can be simply calculated by measuring<\/p>\n<p>02:15<\/p>\n<p>the amplitude above the baseline for a<\/p>\n<p>02:17<\/p>\n<p>10-minute period and adding them<\/p>\n<p>02:19<\/p>\n<p>together<\/p>\n<p>02:19<\/p>\n<p>normal labor progress is usually<\/p>\n<p>02:21<\/p>\n<p>associated with a Montevideo unit of<\/p>\n<p>02:23<\/p>\n<p>greater than 200 next let&#8217;s move on to<\/p>\n<p>02:26<\/p>\n<p>the passenger ideally the foetus is not<\/p>\n<p>02:28<\/p>\n<p>too big and is in a good position for<\/p>\n<p>02:30<\/p>\n<p>delivery if the fetus has an estimated<\/p>\n<p>02:32<\/p>\n<p>weight greater than 4,500 grams the risk<\/p>\n<p>02:35<\/p>\n<p>of shoulder dystocia and labour dystocia<\/p>\n<p>02:37<\/p>\n<p>are greater the fetal position is<\/p>\n<p>02:39<\/p>\n<p>important as well for ideally you want<\/p>\n<p>02:41<\/p>\n<p>the fetus positioned in the optimal way<\/p>\n<p>02:43<\/p>\n<p>to be able to fit through the pelvis<\/p>\n<p>02:45<\/p>\n<p>let&#8217;s review the bony landmarks of the<\/p>\n<p>02:47<\/p>\n<p>fetal vertex on vaginal examination the<\/p>\n<p>02:50<\/p>\n<p>diamond-shaped anterior fontanelle and<\/p>\n<p>02:52<\/p>\n<p>the triangular shape posterior<\/p>\n<p>02:54<\/p>\n<p>fontanelle can be palpated as well as<\/p>\n<p>02:56<\/p>\n<p>the sagittal suture this photo has a<\/p>\n<p>02:58<\/p>\n<p>better view of the triangular shaped<\/p>\n<p>03:00<\/p>\n<p>posterior fontanelle we describe the<\/p>\n<p>03:02<\/p>\n<p>fetal position in relationship to the<\/p>\n<p>03:04<\/p>\n<p>fetal occiput and the maternal body here<\/p>\n<p>03:08<\/p>\n<p>is a fetus in the occiput anterior<\/p>\n<p>03:10<\/p>\n<p>position here is the posterior<\/p>\n<p>03:11<\/p>\n<p>fontanelle and the occupant is on the<\/p>\n<p>03:13<\/p>\n<p>anterior part of the maternal body this<\/p>\n<p>03:16<\/p>\n<p>is the optimal position for delivery for<\/p>\n<p>03:18<\/p>\n<p>this as the smallest diameter that has<\/p>\n<p>03:19<\/p>\n<p>to pass through the pelvis this fetus is<\/p>\n<p>03:22<\/p>\n<p>in the occiput posterior position note<\/p>\n<p>03:24<\/p>\n<p>the posterior occiput and the anterior<\/p>\n<p>03:26<\/p>\n<p>fontanelle this fetus is in the occiput<\/p>\n<p>03:29<\/p>\n<p>transverse position both the occiput<\/p>\n<p>03:33<\/p>\n<p>posterior and occiput transverse<\/p>\n<p>03:35<\/p>\n<p>positions have bigger diameters that<\/p>\n<p>03:37<\/p>\n<p>need to fit through the pelvis there are<\/p>\n<p>03:39<\/p>\n<p>other possible presentations such as a<\/p>\n<p>03:40<\/p>\n<p>compound presentation or face<\/p>\n<p>03:42<\/p>\n<p>presentation which could all contribute<\/p>\n<p>03:44<\/p>\n<p>to labor dystocia labor can be stalled<\/p>\n<p>03:47<\/p>\n<p>before she reaches ten centimeters<\/p>\n<p>03:48<\/p>\n<p>dilated known as failure to progress or<\/p>\n<p>03:51<\/p>\n<p>arrest and dilation where the patient<\/p>\n<p>03:53<\/p>\n<p>can reach ten centimeters and the fetus<\/p>\n<p>03:55<\/p>\n<p>does not descend for delivery known as a<\/p>\n<p>03:56<\/p>\n<p>rest of descent the last of the three<\/p>\n<p>03:59<\/p>\n<p>P&#8217;s to discuss is passage maternal<\/p>\n<p>04:02<\/p>\n<p>skeletal or soft tissue issues can<\/p>\n<p>04:03<\/p>\n<p>obstruct the birth canal<\/p>\n<p>04:05<\/p>\n<p>cephalo pelvic disproportion refers to<\/p>\n<p>04:07<\/p>\n<p>the conflict between the fetal head and<\/p>\n<p>04:09<\/p>\n<p>the pelvic size the pelvic bone shape or<\/p>\n<p>04:12<\/p>\n<p>maternal soft tissue most commonly<\/p>\n<p>04:14<\/p>\n<p>excess adipose tissue can contribute to<\/p>\n<p>04:16<\/p>\n<p>labor dystocia let&#8217;s get back to labora<\/p>\n<p>04:19<\/p>\n<p>remember that she was admitted at five<\/p>\n<p>04:21<\/p>\n<p>centimeters dilated in active labor at<\/p>\n<p>04:23<\/p>\n<p>the time of a repeat sterile vaginal<\/p>\n<p>04:25<\/p>\n<p>examination she was still 5 centimeters<\/p>\n<p>04:27<\/p>\n<p>and replaced an intrauterine pressure<\/p>\n<p>04:29<\/p>\n<p>catheter and this demonstrated that her<\/p>\n<p>04:31<\/p>\n<p>contractions were not strong enough<\/p>\n<p>04:33<\/p>\n<p>augmentation refers to stimulation of<\/p>\n<p>04:36<\/p>\n<p>uterine contractions amniotic or<\/p>\n<p>04:38<\/p>\n<p>rupturing of her amniotic membranes can<\/p>\n<p>04:40<\/p>\n<p>enhance progress in the active phase it<\/p>\n<p>04:42<\/p>\n<p>may stimulate release of prostaglandins<\/p>\n<p>04:44<\/p>\n<p>which aid in augmenting the force of<\/p>\n<p>04:46<\/p>\n<p>contractions and also allows for the<\/p>\n<p>04:48<\/p>\n<p>fetal head to be the dilating force<\/p>\n<p>04:51<\/p>\n<p>oxytocin can also be given intravenously<\/p>\n<p>04:53<\/p>\n<p>to strengthen contractions the goal is<\/p>\n<p>04:55<\/p>\n<p>to titrate the oxytocin so that the<\/p>\n<p>04:57<\/p>\n<p>contractions are strong and frequent<\/p>\n<p>04:59<\/p>\n<p>enough to produce cervical change in<\/p>\n<p>05:00<\/p>\n<p>fetal descent but not too strong to<\/p>\n<p>05:03<\/p>\n<p>cause uterine tachy systole uterine<\/p>\n<p>05:05<\/p>\n<p>tachy systole is defined as more than<\/p>\n<p>05:07<\/p>\n<p>five contractions in 10 minutes over a<\/p>\n<p>05:09<\/p>\n<p>30 minute period you perform an an Reata<\/p>\n<p>05:12<\/p>\n<p>me and oxytocin has started for labora<\/p>\n<p>05:14<\/p>\n<p>three hours later you check on her and<\/p>\n<p>05:16<\/p>\n<p>she is happily 10 centimeters dilated<\/p>\n<p>05:17<\/p>\n<p>and she starts pushing her second stage<\/p>\n<p>05:20<\/p>\n<p>is slow but she continues to make<\/p>\n<p>05:22<\/p>\n<p>progress and after 2.5 hours of pushing<\/p>\n<p>05:24<\/p>\n<p>she delivers the fetal head and you<\/p>\n<p>05:26<\/p>\n<p>realize that the anterior shoulder is<\/p>\n<p>05:28<\/p>\n<p>stuck this is a shoulder dystocia let&#8217;s<\/p>\n<p>05:30<\/p>\n<p>now switch gears to discuss shoulder<\/p>\n<p>05:32<\/p>\n<p>dystocia<\/p>\n<p>05:33<\/p>\n<p>shoulder dystocia can be a true<\/p>\n<p>05:35<\/p>\n<p>obstetric &#8216;el emergency the baby&#8217;s<\/p>\n<p>05:38<\/p>\n<p>anterior shoulder is effectively caught<\/p>\n<p>05:40<\/p>\n<p>behind the pubic symphysis which is<\/p>\n<p>05:42<\/p>\n<p>illustrated in white it is important to<\/p>\n<p>05:46<\/p>\n<p>remain calm and to know the steps to<\/p>\n<p>05:48<\/p>\n<p>help deliver the shoulder in general<\/p>\n<p>05:50<\/p>\n<p>there is about 5 minutes to deliver a<\/p>\n<p>05:52<\/p>\n<p>well oxygenated term infant first and<\/p>\n<p>05:54<\/p>\n<p>foremost take steps to make sure that<\/p>\n<p>05:56<\/p>\n<p>you have adequate nursing and obstetric<\/p>\n<p>05:58<\/p>\n<p>&#8216;el staff support start with McRoberts<\/p>\n<p>06:00<\/p>\n<p>maneuver which is hyper flexion and<\/p>\n<p>06:02<\/p>\n<p>abduction of the hips this can open up<\/p>\n<p>06:04<\/p>\n<p>space that will enable the shoulder to<\/p>\n<p>06:06<\/p>\n<p>be reduced the next step is suprapubic<\/p>\n<p>06:09<\/p>\n<p>pressure which is pressure directed<\/p>\n<p>06:10<\/p>\n<p>downward on the anterior shoulder if<\/p>\n<p>06:12<\/p>\n<p>these first two steps do not lead to<\/p>\n<p>06:15<\/p>\n<p>delivery then next try to deliver the<\/p>\n<p>06:17<\/p>\n<p>posterior arm of the fetus an episiotomy<\/p>\n<p>06:20<\/p>\n<p>can be helpful at this point to open up<\/p>\n<p>06:22<\/p>\n<p>space posteriorly additional steps for<\/p>\n<p>06:25<\/p>\n<p>shoulder dystocia include the wood screw<\/p>\n<p>06:26<\/p>\n<p>and Reuben maneuver which are rotation<\/p>\n<p>06:28<\/p>\n<p>of the fetus to reduce the shoulder it<\/p>\n<p>06:30<\/p>\n<p>can also be helpful to move the patient<\/p>\n<p>06:32<\/p>\n<p>onto her hands and knees in severe cases<\/p>\n<p>06:35<\/p>\n<p>intentional clavicular fracture can be<\/p>\n<p>06:37<\/p>\n<p>performed and the last option is to<\/p>\n<p>06:39<\/p>\n<p>perform as a Vannelli<\/p>\n<p>06:40<\/p>\n<p>procedure which requires reversing the<\/p>\n<p>06:42<\/p>\n<p>Cardinal movements to labor and to flex<\/p>\n<p>06:44<\/p>\n<p>the head back into the uterus and to<\/p>\n<p>06:45<\/p>\n<p>perform a cesarean delivery brachial<\/p>\n<p>06:48<\/p>\n<p>plexus injury rates with a shoulder<\/p>\n<p>06:50<\/p>\n<p>dystocia range from four to forty<\/p>\n<p>06:51<\/p>\n<p>percent regardless of the maneuvers used<\/p>\n<p>06:53<\/p>\n<p>to deliver the fetus the second<\/p>\n<p>06:56<\/p>\n<p>obstetrical emergency that we will now<\/p>\n<p>06:57<\/p>\n<p>discuss is cord prolapse this is when<\/p>\n<p>06:59<\/p>\n<p>the umbilical cord descends in advance<\/p>\n<p>07:01<\/p>\n<p>of the fetal presenting part here is the<\/p>\n<p>07:04<\/p>\n<p>fetus and the blue umbilical cord that<\/p>\n<p>07:10<\/p>\n<p>has prolapsed through the cervix cord<\/p>\n<p>07:12<\/p>\n<p>prolapse occurs when one the fetus is<\/p>\n<p>07:14<\/p>\n<p>not vertex or two there are spontaneous<\/p>\n<p>07:16<\/p>\n<p>rupture of membranes before the vertex<\/p>\n<p>07:18<\/p>\n<p>is well engaged or three there is<\/p>\n<p>07:20<\/p>\n<p>iatrogenic artificial rupture of<\/p>\n<p>07:22<\/p>\n<p>membranes before the vertex is well<\/p>\n<p>07:23<\/p>\n<p>engaged cord prolapse is an emergency<\/p>\n<p>07:26<\/p>\n<p>for the blood vessels in the umbilical<\/p>\n<p>07:27<\/p>\n<p>cord are compressed when this is<\/p>\n<p>07:29<\/p>\n<p>recognized the providers hand must push<\/p>\n<p>07:31<\/p>\n<p>the fetal head up so it does not further<\/p>\n<p>07:33<\/p>\n<p>compress the cord and the cord needs to<\/p>\n<p>07:36<\/p>\n<p>be manually reduced back into the<\/p>\n<p>07:37<\/p>\n<p>uterine cavity and the patient needs to<\/p>\n<p>07:39<\/p>\n<p>be brought back to the operating room<\/p>\n<p>07:41<\/p>\n<p>for an immediate caesarean section the<\/p>\n<p>07:43<\/p>\n<p>hand needs to stay in place throughout<\/p>\n<p>07:45<\/p>\n<p>this time until the baby is safely<\/p>\n<p>07:46<\/p>\n<p>delivered the last emergency that we<\/p>\n<p>07:49<\/p>\n<p>will discuss is breech delivery it is<\/p>\n<p>07:51<\/p>\n<p>important to note that singleton breech<\/p>\n<p>07:52<\/p>\n<p>presentations should be delivered by<\/p>\n<p>07:54<\/p>\n<p>cesarean section there may be situations<\/p>\n<p>07:56<\/p>\n<p>however when cesarean section is not<\/p>\n<p>07:57<\/p>\n<p>possible because of precipitous delivery<\/p>\n<p>07:59<\/p>\n<p>or lack of operative resources if this<\/p>\n<p>08:02<\/p>\n<p>situation were to arise the first thing<\/p>\n<p>08:04<\/p>\n<p>is to call for assistance next it&#8217;s<\/p>\n<p>08:07<\/p>\n<p>important to avoid any traction on the<\/p>\n<p>08:09<\/p>\n<p>fetus for the goal is to avoid a fetal<\/p>\n<p>08:11<\/p>\n<p>head extension which can make the<\/p>\n<p>08:12<\/p>\n<p>delivery more difficult wait until the<\/p>\n<p>08:14<\/p>\n<p>maternal efforts have resulted in the<\/p>\n<p>08:16<\/p>\n<p>fetus being delivered to the level of<\/p>\n<p>08:17<\/p>\n<p>the umbilicus suprapubic pressure can<\/p>\n<p>08:20<\/p>\n<p>then be applied to promote flexion and<\/p>\n<p>08:21<\/p>\n<p>descent of the fetal head we will<\/p>\n<p>08:24<\/p>\n<p>conclude laborious journey into the<\/p>\n<p>08:26<\/p>\n<p>world of abnormal labor with a<\/p>\n<p>08:27<\/p>\n<p>discussion about women who have had a<\/p>\n<p>08:28<\/p>\n<p>previous cesarean section what if labore<\/p>\n<p>08:31<\/p>\n<p>had a history with cesarean section with<\/p>\n<p>08:32<\/p>\n<p>their first pregnancy there are three<\/p>\n<p>08:34<\/p>\n<p>primary possible outcomes she could have<\/p>\n<p>08:36<\/p>\n<p>a successful trial of labor after<\/p>\n<p>08:38<\/p>\n<p>cesarean which is a vaginal birth after<\/p>\n<p>08:40<\/p>\n<p>cesarean or VBAC this is the ideal<\/p>\n<p>08:43<\/p>\n<p>option for labora will have decreased<\/p>\n<p>08:44<\/p>\n<p>maternal morbidity and decreased risk of<\/p>\n<p>08:46<\/p>\n<p>complications with future pregnancies at<\/p>\n<p>08:48<\/p>\n<p>a population level more vivax mean there<\/p>\n<p>08:51<\/p>\n<p>is a decreased overall cesarean delivery<\/p>\n<p>08:53<\/p>\n<p>rate<\/p>\n<p>08:53<\/p>\n<p>our next preferred option would be a<\/p>\n<p>08:55<\/p>\n<p>scheduled repeat low transverses Aryan<\/p>\n<p>08:57<\/p>\n<p>section at 39 weeks<\/p>\n<p>08:59<\/p>\n<p>our third preferred option is a failed<\/p>\n<p>09:01<\/p>\n<p>trial of labor after cesarean and she<\/p>\n<p>09:03<\/p>\n<p>still ultimately needs a caesarean<\/p>\n<p>09:04<\/p>\n<p>delivery this option has the highest<\/p>\n<p>09:06<\/p>\n<p>rates of maternal morbidity with higher<\/p>\n<p>09:08<\/p>\n<p>rates of bleeding and infection it is<\/p>\n<p>09:10<\/p>\n<p>important to weigh the risks and<\/p>\n<p>09:12<\/p>\n<p>benefits when making these decisions<\/p>\n<p>09:13<\/p>\n<p>with our patients the benefits of a<\/p>\n<p>09:15<\/p>\n<p>successful trial of labor after<\/p>\n<p>09:17<\/p>\n<p>caesarean delivery are that you avoid<\/p>\n<p>09:18<\/p>\n<p>surgery which needs to lower rates of<\/p>\n<p>09:20<\/p>\n<p>hemorrhage infection and you&#8217;ll have<\/p>\n<p>09:22<\/p>\n<p>shorter recovery periods in addition<\/p>\n<p>09:24<\/p>\n<p>there are decreased future abnormal<\/p>\n<p>09:26<\/p>\n<p>placentation risks such as placenta<\/p>\n<p>09:28<\/p>\n<p>previa or placenta accreta uterine<\/p>\n<p>09:30<\/p>\n<p>rupture is the most feared complication<\/p>\n<p>09:32<\/p>\n<p>of a trial and labor after cesarean with<\/p>\n<p>09:35<\/p>\n<p>a history of one low transverse cesarean<\/p>\n<p>09:37<\/p>\n<p>section the risk of uterine rupture is<\/p>\n<p>09:38<\/p>\n<p>0.7 20.9% with a history of too low<\/p>\n<p>09:42<\/p>\n<p>trans vs. Aaron sections the risk of<\/p>\n<p>09:44<\/p>\n<p>rupture is 0.9 to 1.8% with a history of<\/p>\n<p>09:48<\/p>\n<p>a classical cesarean section the risk of<\/p>\n<p>09:50<\/p>\n<p>uterine rupture is 10% this high rupture<\/p>\n<p>09:53<\/p>\n<p>risk is why these women should have a<\/p>\n<p>09:55<\/p>\n<p>repeat cesarean delivery and not try to<\/p>\n<p>09:57<\/p>\n<p>labor when counseling patients who&#8217;ve<\/p>\n<p>09:59<\/p>\n<p>had a load trans versus Aaron section<\/p>\n<p>10:00<\/p>\n<p>different clinical factors have to be<\/p>\n<p>10:02<\/p>\n<p>taken into account that either increase<\/p>\n<p>10:04<\/p>\n<p>or decrease your probability of a<\/p>\n<p>10:06<\/p>\n<p>successful VBAC having a history of a<\/p>\n<p>10:08<\/p>\n<p>prior vaginal birth or if she presents<\/p>\n<p>10:10<\/p>\n<p>some spontaneous labor both increase<\/p>\n<p>10:12<\/p>\n<p>your probability of a successful VBAC<\/p>\n<p>10:14<\/p>\n<p>factors that increase her chance of a<\/p>\n<p>10:17<\/p>\n<p>failed trailer labor after caesarean<\/p>\n<p>10:18<\/p>\n<p>include increased maternal age non-white<\/p>\n<p>10:20<\/p>\n<p>ethnicity obesity a recurrent indication<\/p>\n<p>10:24<\/p>\n<p>for the initial cesarean delivery such<\/p>\n<p>10:25<\/p>\n<p>as labor dystocia increased neonatal<\/p>\n<p>10:28<\/p>\n<p>birth weight at gestational age greater<\/p>\n<p>10:30<\/p>\n<p>than 40 weeks preeclampsia and a short<\/p>\n<p>10:32<\/p>\n<p>enterprise-e interval ultimately labora<\/p>\n<p>10:35<\/p>\n<p>and her healthcare provider should<\/p>\n<p>10:36<\/p>\n<p>discuss and decide on a delivery plan<\/p>\n<p>10:38<\/p>\n<p>that factors in her individual clinical<\/p>\n<p>10:40<\/p>\n<p>factors as well as the availability of a<\/p>\n<p>10:42<\/p>\n<p>24 hour blood bank continuous electronic<\/p>\n<p>10:44<\/p>\n<p>fetal monitoring and other Hospital<\/p>\n<p>10:46<\/p>\n<p>factors such as in-house anesthesia that<\/p>\n<p>10:48<\/p>\n<p>will enable an expedient cesarean<\/p>\n<p>10:50<\/p>\n<p>delivery to be performed if necessary<\/p>\n<p>10:52<\/p>\n<p>this concludes the Africa video an<\/p>\n<p>10:54<\/p>\n<p>abnormal labor we have discussed the<\/p>\n<p>10:56<\/p>\n<p>three P&#8217;s to consider in evaluating<\/p>\n<p>10:58<\/p>\n<p>labor discuss fetal and maternal<\/p>\n<p>10:59<\/p>\n<p>complications of abnormal labor<\/p>\n<p>11:01<\/p>\n<p>discussed oxytocin and risks and<\/p>\n<p>11:04<\/p>\n<p>benefits of trial of labor after<\/p>\n<p>11:05<\/p>\n<p>caesarean<\/p>\n<p>11:06<\/p>\n<p>disgust management of emergent of<\/p>\n<p>11:08<\/p>\n<p>technical situations<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 11:23<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":46,"menu_order":22,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-224","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/224","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=224"}],"version-history":[{"count":4,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/224\/revisions"}],"predecessor-version":[{"id":1278,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/224\/revisions\/1278"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=224"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}