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Positive findings = strong predictor of preterm labor or rupture of the membranes w/in 2 weeks of positive testofFN levels are measured with an enzyme immunoassayofFN is present the first half of pregnancyoIs NOT present after 20 weeksoIs found in amniotic fluid (possible ROM)oIs present again near termoFound in cervical area (swab) as well as amniotic fluid (AF)oBecause sexual intercourse within the previous 24 hrs, vaginal creams, and recent vaginal exams can cause false findings, they should be avoided prior to a fetal fibronectin(fFN) test.Percutaneous Umbilical Blood Sampling (PUBS) or Cordocentesis—obtain blood from umbilical cordohelps Dx blood disorders (hemophilias, hemoglobinopathies) and incompatibilities, fetal infections, chromosomes abnormalities, non-immune hydrops, and isoimmune hemolytic disorders. oRisks: bleeding from sampling site, premature ROM, chorioamnionitis, and fetal bradycardia Chapter 22Critical Factors in Labor=4 TQBirth Passageway (R/T type of pelvis)oGynecoid (50%) : “female pelvis” and Anthropoid—favorable to vaginal birth oAndroid (20%) “male pelvis” and platypelloid pelvises—not favorable to vaginal birth; difficult labor
Birth passenger (Fetus)oFetal attitude—refers to the relation of the fetal body parts to one another;posture the fetus assumes as it conforms to the shape of the uterine cavity (usually a flexed position)oFetal lie—the relationship of the long, or cephalocaudal axis (spinal column) of the fetus to the long, or cephalocaudal axis of the mother–Longitudinal=vertical lie cephalocaudal axis of mother and baby are parallel; transverse=horizontal lie; axis are perpendicular oFetal presentation—determine by fetal lie and refers to the body part of the fetus that enter the maternal pelvis first and leads through the birth canal during labor–Presenting part=portion of the fetus that is felt through the cervix on vaginal exam –Cephalic: head first; four types/presenting part: vertex=occiput; sinciput=occipitofrontal diameter; brow=occipitomental diameter; face: submentobregmatic diameter–Breech: lower extremities or buttocksBreech=complete=baby sitting Indian style; footling breech position=onefoot is trying to come down; frank breech=legs are up and butt is down; Can be delivered vaginally, but more dangerous–Shoulder Relationship of Maternal Pelvis and Presenting PartoEngagement—occurs when the largest diameter of presenting part reaches or passes through the pelvic inlet; ex. In cephalic presentation, the biparietal diameter is the largest dimension to pass through the pelvic inlet;; at zero station the baby is engagedoStation—refers to the relationship of the presenting part of an imaginary line drawn between the ischial spines of the maternal pelvis;; in a normal pelvis the ischial spines mark the narrowest diameter through which the fetus must pass–Negative number=presenting part is above the ischial spines–