Abstract
Family physicians must be well prepared to anticipate and respond to problems that can arise during labor and delivery. Most pregnancies end with a healthy infant, particularly if there are few or no unnecessary interventions. As an example, the widespread use of continuous electronic fetal monitoring since the 1970s not only did not improve neonatal morbidity and mortality outcomes, it increased cesarean section rates in the United States.1 This chapter explores common intrapartum complications in such a manner as to sharpen family practitioners’ clinical skills to more accurately know when and how to intervene with a given complication. The corollary to this approach is that practitioners will further develop the ability to know when “watchful waiting” is indicated because of an improved ability to assess and improve the health of the mother and fetus.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Sandmire HF. Whither electronic fetal monitoring? Obstet Gynecol 1990;76:1130–4.
Lagrew DC, Freeman FK. Management of postdate pregnancy. Am J Obstet Gynecol 1986;154:13–18.
Boyce A, Mayaux MJ, Schwartz D. Classical and ‘true’ gestational postmaturity. Am J Obstet Gynecol 1976;125:911–14.
McClure-Brown JC. Postmaturity. Am J Obstet Gynecol 1963;85: 573–82.
Crowley P. Elective induction of labour at 41+ weeks gestation. In: Chalmers I, editor. Oxford database of perinatal trials. Version 1.2, disk issue 5, record 4144. Oxford: Oxford University Press, 1991.
Hoskins IA, Frieden FJ, Young BK. Variable decelerations in reactive nonstress tests with decreased amniotic fluid index predict fetal compromise. Am J Obstet Gynecol 1991; 165:1094.
Sarno AP, Ahn MO, Phelan JP. Intrapartum amniotic fluid volume at term: association of ruptured membranes, oligohydramnios, and increased fetal risk. J Reprod Med 1990;35:719–23.
Rayburn WF. Prostaglandin E2 gel for cervical ripening and induction of labor: a critical analysis. Am J Obstet Gynecol 1989; 160: 529–34.
Hannah ME, Hannah WJ, Hellmann J, Hewson S, Milner R. Induction of labor as compared with serial antenatal monitoring in port-term pregnancy. N Engl J Med 1992;326:1587–92.
Witter FR, Weitz CM. A randomized trial of induction at 42 weeks’ gestation versus expectant management for postdate pregnancies. Am J Perinatol 1987;4:206–11.
Arias F. Predictability of complications associated with prolongation of pregnancy. Obstet Gynecol 1987;70:101–6.
Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference? Pediatrics 1990;85:715–21.
Katz VL, Bowes WA. Meconium aspiration syndrome: reflections on a murky subject. Am J Obstet Gynecol 1992;166:171–81.
Leveno KJ, Quirk JG, Cunningham FG, et al. Prolonged pregnancy. I. Observations concerning the causes of fetal distress. Am J Obstet Gynecol 1984;150:465–73.
Benedetti TJ, Gabbe S. Shoulder dystocia: a complication of fetal macrosomia and prolonged second stage of labor with midpelvic delivery. Obstet Gynecol 1978;52:526–32.
Cunningham FG, MacDonald PC, Gant NF. Williams Obstetrics. 18th ed. Norwalk, CT: Appleton & Lange, 1989.
Friedman EA. The graphic analysis of labor. Am J Obstet Gynecol 1954;68:1568–75.
Friedman EA. Labor: clinical evaluation and management. 2nd ed. Norwalk, CT: Appleton-Century-Crofts, 1978.
Johnson JWC, Daikoku NH, Niebyl JR, Johnson TRB, Khouzami VA, Witter RF. Premature rupture of the membranes and prolonged latency. Obstet Gynecol 1981;57:547–56.
Conway DK, Prendiville WJ, Morris A, Speller DCE, Stirrat GM. Management of spontaneous rupture of the membranes in the absence of labor in primigravid women at term. Am J Obstet Gyncol 1984;150:947–51.
Grant J, Keirse MJNC. Prelabour rupture of the membranes at term. In: Chalmers I, Enkin M, Keirse MJNC, editors. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989:1112–17.
O’Driscoll K, Foley M, MacDonald D. Active management of labor as an alternative to cesarean section for dystocia. Obstet Gynecol 1984;63:485–90.
Akoury HA, Brodie G, Caddick R, McLaughin VD, Pugh PA. Active management of labor and operative delivery in nulliparous women. Am J Obstet Gynecol 1988;158:255–8.
Turner MJ, Brassil M, Gordon H. Active management of labor associated with a decrease in the cesarean section rate in nulli-paras. Obstet Gynecol 1988;71:150–4.
Lopez-Zeno JA, Peaceman AM, Adeshek JA, Socol ML. A controlled trial of a program for the active management of labor. N Engl J Med 1992;326:450–4.
American College of Obstetricians and Gynecologists. Induction and augmentation of labor. Technical bulletin 157. Washington, DC:ACOG, 1991.
Clark SL, Eglinton GS, Beall M, et al. Effect of indication for previous cesarean section on subsequent delivery outcome in patients undergoing a trial of labor. J Reprod Med 1984;29:22–25.
Turner MJ, Rasmussen MJ, Boylan PC, MacDonald D, Stronge JM. The influence of birth weight on labor in nulliparas. Obstet Gynecol 1990;76:159–63.
McKay S, Mahan CS. Maternal position and movement during labor and birth. Contemp Obstet Gynecol 1984;24:90–119.
Dyson DC, Ferguson JE II, Hensleigh P. Antepartum external cephalic version under tocolysis. Obstet Gynecol 1986;67:63–68.
Bowles WA. Clinical aspects of normal and abnormal labor. In: Creasy RK, Resnik R, editors. Maternal-fetal medicine: principles and practice. Philadelphia: Saunders, 1989.
Robson SC, Crawford RA, Spencer JAD, Lee A. Intrapartum amniotic fluid index and its relationship to fetal distress. Am J Obstet Gynecol 1992;166:78–82.
Sarna AP, Ahn MO, Brar HS, Phelan JP, Platt LD. Intrapartum doppler velocimetry, amniotic fluid volume, and fetal heart rate as predictors of subsequent fetal distress. I. An initial report. Am J Obstet Gynecol 1989;161:1508–14.
MacDonald D, Grant A, Sheridan-Pereira M, Boylan P, Chalmers I. The Dublin randomized trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynecol 1985;152:524–39.
Grant A. Monitoring the fetus during labour. In: Chalmers I, Enkin M, Keirse MJNC, editors. Effective care in pregnancy and childbirth. Oxford: Oxford University Press 1989:846–82.
Cohen AR, Klalpholz H, Thompson MS. Electronic fetal monitoring and clinical practice—a survey of obstetric opinion. Med Decis Making 1982;2:79–85.
Clark SL, Paul RH. Intrapartum fetal surveillance: the role of fetal scalp blood sampling. Am J Obstet Gynecol 1985;153:717–22.
Smith CV, Nguyen HN, Phelan JP. Intrapartum assessment of fetal well-being: a comparison of fetal acoustic stimulation with acid-base determinations. Am J Obstet Gynecol 1986;155:726–32.
Polzin GB, Blakemore KJ, Petrie RH, Amon E. Fetal vibroacoustic stimulation: magnitude and duration of fetal heart rate accelerations as a marker of fetal health. Obstet Gynecol 1988;72:621–25.
Phelan JP, Platt LD, Yeh S, Broussard P, Paul RH. The role of ultrasound assessment of amniotic fluid volume in the management of the postdate pregnancy. Am J Obstet Gynecol 1985;151:304–8.
Miyazaki FS, Nevarez F. Saline amnioinfusion for relief of repetitive variable decelerations: a prospective randomized study. Am J Obstet Gynecol 1985;153:301–6.
Owen J, Henson BV, Hauth JC. A prospective randomized study of saline solution amnioinfusion. Am J Obstet Gynecol 1990; 162: 1146–9.
Strong TH, Hetzler G, Sarno AP, Paul RH. Prophylactic intrapartum amnioinfusion: a randomized clinical trial. Am J Obstet Gynecol 1990;162:1370–5.
Wenstrom DK, Parsons MT. The prevention of meconium aspiration in labor using amnioinfusion. Obstet Gynecol 1989;73:647–51.
Lowe TW, Cunningham FG. Placental abruption. Clin Obstet Gynecol 1990;33:406–13.
Fleming AD. Abruptio placentae. Crit Care Clin 1991;7:865–75.
Lavery JP. Placenta previa. Clin Obstet Gynecol 1990;33:414–21.
Rose GL, Chapman MG. Aetiological factors in placenta praevia—a case controlled study. Br J Obstet Gynaecol 1986;93:586–8.
Langlois SP, Miller AG. Placenta praevia—a review with emphasis on the role of ultrasound. Aust NZ J Obstet Gynaecol 1989; 19: 110–16.
Gilstrap LC, Cox SM. Acute chorioamnionitis. Obstet Gynecol Clin North Am 1989;16:373–9.
Boyer KM, Gotoff SP. Prevention of early-onset neonatal group B streptococcal disease selective intrapartum chemoprophylaxis. N Engl J Med 1986;314:1665–9.
Gibbs RS, Dinsmoor MJ, Newton ER, et al. A randomized trial of intrapartum versus immediate postpartum treatment of women with intra-amniotic infection. Obstet Gynecol 1988;72:823–8.
Gilstrap LC, Leveno KJ, Cox SM, et al. Intrapartum treatment of acute chorioamnionitis: impact on neonatal sepsis. Am J Obstet Gynecol 1988;159:579–83.
Kochenour NK. Intrapartum obstetric emergencies. Crit Care Clin 1991;7:851–64.
Carlan SJ, Angel JL, Knuppel RA. Shoulder dystocia. Am Fam Physician 1991;43:1307–11.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1994 Springer Science+Business Media New York
About this chapter
Cite this chapter
Ratcliffe, S.D. (1994). Problems During Labor and Delivery. In: Taylor, R.B. (eds) Family Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-4005-9_12
Download citation
DOI: https://doi.org/10.1007/978-1-4757-4005-9_12
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4757-4007-3
Online ISBN: 978-1-4757-4005-9
eBook Packages: Springer Book Archive