DELIVERY ======== Bloody show ----------- As the cervix dilates, blood and the cervical mucous plug (from the cervical canal) pass from the vagina. The bloody show is a classic indicator of beginning or progressing labor. Mucus plug ---------- A plug of mucus that fills the cervical canal during pregnancy. Discharge of the plug is usually followed by rupture of the membranes and progressive labor. Effacement ---------- Thinning of the cervix that occurs in preparation for childbirth. The cervical canal shortens from 2 cm to paper thin edges and the canal itself disappears. Only the external opening of the uterus remains of what was the cervix. The edges of the internal opening of the cervix are drawn upward several centimeters to become a part of the lower uterine segment. When the cervix becomes as thin as the adjacent lower uterine segment, it is considered to be completely effaced. Dilation -------- Opening up, enlargement of a tubular structure. This usually refers to the cervical dilation that occurs during labor. The opeining of the cervix must go from essentially 0 centimeters to about 10 centimeters. Engagement ---------- Refers to the point in labor/delivery at which the baby's head, or other presenting part (buttocks in a breech presentation), begins to descend through (engage) the pelvic canal. Crowning -------- The stage in childbirth when the top of the infant's head becomes visible at the vaginal opening. -------------------------------------------------------------------- PREZENTATION ============ Fetal presentation ------------------ The part of the fetus that enters the birth canal first. When the head enters the birth canal it is called a vertex presentation. When the buttocks present first it is called a breech presentation. At or near term 96% of babies are in a vertex position, 3.5% are in a breech presentation, 0.3% in a face presentation, and 0.4% are in a shoulder presentation. About 2/3 of vertex presenting babies are in a left occiput anterior (See Anterior.) and 1/3 are in a right occiput anterior position. Up to 14% of babies are in a breech presentation until the 29th-32nd week of gestation. Many of these babies change to a vertex presentation birth Anterior -------- Means in front of, usually with reference to the front part of the body. Often used in association with the term 'anterior presentation' or 'occiput anterior' (OA). Usually, babies are born with the back of the head or occiput pointed up or slightly to the left or right side. It is as if the child was looking at the floor during emergence from the birth canal. This is the best position in most cases since it allows the child to negotiate more easily the turns required to get through the mother's pelvis and birth canal. If the baby presents in the birth canal with the occiput anterior and to the left it is called an LOA (left occiput anterior) presentation. If the occiput is anterior and to the right, it is called ROA (right occiput anterior). Breech presentation ------------------- When babies are aligned in the uterus to come out buttocks first, as opposed to head first--the way most babies come out of the uterus--it is called a breech presentation. The head is the largest part of a full term baby's body. Therefore, delivery of the buttocks first may not adequately open up the birth canal enough for the head to pass through. The head may then get stuck in the birth canal, leaving the infant and mother in a precarious situation. Most babies with a breech presentation are delivered by cesarean section. On occasion the infant can be turned around so that he is lined up to come out head first. Footling presentation --------------------- Presentation with the feet entering the birth canal ahead of any other part of the body. Vertex ------ A vertex presentation is the most common and desirable. In this position the baby's head enters the birth canal first. External cephalic version ------------------------- Turning the baby so that the head is pointed down toward the pelvic inlet. In most pregnancies, babies orient themselves with the head down toward the pelvis in preparation for labor and delivery by about the 34th week. If the baby is oriented with the head up or lying with the back toward the pelvis, labor is more complicated and a cesarean delivery is more likely. Your doctor may try to turn the baby before delivery- this is called an external version. The doctor will try to turn the baby so that the head is down, pointing toward the pelvis. This is done with pressure on the baby applied through the mother's abdomen. External cephalic version reduces the necessity of a cesarean section, but is not indicated in every case of breech presentation. Ask your doctor more about version to see if this procedure is appropriate for you. There are both risks and benefits from this procedure. --------------------------------------------------------------------------------- INDUCE ====== Induction --------- (Initiation of labor). If labor has not started at an appropriate time or if there are maternal indications for delivery before labor starts naturally, medications may be used to initiate labor. Prostaglandin gel and oxytocin (Pitocin╝) are the most common medications. Rupture of the amniotic membranes may also hasten the onset of active labor. Cervical gel ------------ This usually refers to a prostaglandin medication that is prepared in a gel-like material. It is placed on the cervix to hasten cervical dilatation in preparation for delivery. Amniotomy --------- Amniotomy-Intentional rupturing of the amniotic sac to hasten or induce labor. Pitocin╝ -------- Synthetic formulation of a hormone, oxytocin, that stimulates uterine contractions and is used to induce labor or delivery. Pitocin╝ is a commonly used drug during labor. -------------------------------------------------------------- DIFFICULTIES ============ Cephalopelvic disproportion --------------------------- The most common reason for doing a cesarean section. Sometimes the infant's head is larger than the mother's pelvis, through which the head must pass in a vaginal delivery. Dystocia -------- Literally, it means difficult labor and practically means abnormally slow progress of labor. The most common cause of dystocia is a small bony pelvis and/or insufficiently strong and coordinated uterine contractions. Placenta accreta ---------------- Abnormally deep growth of the placenta into the uterus. Placenta accreta prevents the normal placental separation from the uterus and often causes severe uterine bleeding after delivery. Cord compression ---------------- Prolapsed cord -------------- Positioning of the umbilical cord ahead of the baby's presenting part during labor and delivery. When this occurs, the baby's body puts pressure on the umbilical cord which is caught between the baby and the mother's canal. This pressure can seriously reduce or altogether stop the blood flow through the umbilical cord. Unless the pressure is removed through either delivery of the infant or repositioning of the infant, serious problems occur. Prolapsed umbilical cord occurs more commonly with breech than with vertex presentation. Fetal distress -------------- Problems with the unborn child during labor. Sometimes during labor and delivery the fetus may not get enough oxygen from the placenta and may become "distressed". Bradycardia ----------- An abnormally low heart rate. When referring to the fetal heart rate (FHR) tracing in labor, abnormally low heart rates can signal problems with the fetus before delivery. The FHR is often monitored for abnormalities of the heart rate. Fetal bradycardia episodes are sometimes called FHR decelerations. Some types of FHR decelerations are common during labor. Others suggest fetal stress and demand further evaluation or intervention. Sometimes the FHR not only dips down, it stays down and does not return to its usual level. This is an ominous situation that demands immediate delivery. Caput succedaneum (caput) ------------------------- A spongy swelling and accumulation of fluid in scalp tissues of infants born vaginally. This occurs because the baby's head, in normal presentation, is under much pressure in the birth canal, This pressure on the skin of the scalp causes accumulation of soft tissue fluid. Although it may look serious, it usually disappears within a few days. Episiotomy ---------- A minor surgical procedure which widens the birth canal by cutting the introitus (vaginal opening). Episiotomy is performed to prevent the jagged, less controlled tearing of the introital tissue during the stretching associated with delivery. An episiotomy may be very helpful when forceps or vacuum extraction are used and with breech presentations. Vacuum extraction ----------------- The application of a suction cup to the head for helping deliver the infant. This technique performs a similar function as forceps and helps the baby to descend through the birth canal. The vacuum extractor has a soft plastic cup attached to a tube and suction pump. The cup is inserted into the birth canal and attached to the baby's head by suction. Increasing the suction causes a vacuum and the handle of the cup can be used to pull the baby out of the birth canal. The vacuum extractor is more gentle and less damaging to the mother's soft tissue than forceps. However, there are risks with the vacuum extraction. Excessive suction or traction can cause injury to the mother or baby. There is also a limit on the number of pulls that should be made with the suction device attached. Forceps delivery ---------------- A delivery in which forceps are used to help assist the baby from the birth canal. Forceps are a two-bladed instrument that could be compared to a pair of kitchen tongs in design. Forceps have the additional feature that the two blades are easily taken apart to facilitate placement on the baby within the birth canal. After placing the two blades on the baby's head, the doctor reconnects the two blades and then uses the forceps to apply traction to the infant, assisting delivery. The forceps are not sharp, but they firmly grasp the baby's head. Forceps may be used for several different reasons: to shorten the second stage of labor, end an abnormally long second stage, when the fetal heart rate suggests problems, when the mother suffers from cardiac disease, or whenever the health of the mother and baby are declining and a speedy delivery is required. Although once used often, they are almost never used now. ------------------------------------------------------------------------------------------- BABY ==== Fontanelle ---------- Soft spots found between the cranial bones of the newborn's skull. There are two fontanelles that are usually examined in the newborn period, the anterior and the posterior fontanelles. Umbilical cord -------------- The baby's lifeline from the mother during pregnancy. When the baby is born the cord is about 2 feet long and 1/2 inch thick. The umbilical cord is clamped and cut shortly after birth. It will turn black within the first few days and should protrude about an inch or less. It will fall off within about 2-3 weeks. It is important to care for the umbilical stump to ensure proper healing. Umbilical hernia ---------------- Hernia at the belly button. (see hernia.) The abdominal wall is formed by two sheets of muscle that run along both sides of the abdomen. In normal development, these sheets of muscle fuse together. When the fusion is incomplete or abnormal, part of the bowel can bulge through the space between the muscles at the belly button. As the infant grows, the muscle layers increase and gradually fuse, eliminating the hernia. This is one of the few hernias that often resolves on its own. Occasionally, surgical correction is required. Vernix ------ Also called vernix caseosa. A cheesy, white substance that covers a baby's skin at birth. The vernix is secreted by the sebaceous glands around the 20th week to protect the baby's skin from the amniotic fluid. Without the vernix, the baby would have very wrinkled skin from constant exposure to the watery amniotic fluid. The amount of vernix present decreases toward the end of gestation. Remaining vernix is washed off after birth. The loss of vernix may cause the skin to peel during the first postnatal week. ================================================================= Apgar score ----------- Biophysical profile ------------------- A series of measurements made to evaluate the fetus' condition before delivery. The biophysical profile is similar to the Apgar system, but performed before delivery. Ultrasound observations are made for at least 30 minutes. The score is based on the findings in the table below. Doppler ultrasound ------------------ Electronic fetal monitor ------------------------ An electronic device that is used to monitor the heart rate of the fetus before delivery. There are two types of fetal monitors: 1) external, which are attached to the mother's abdomen and 2) internal, which attach to the infant's scalp inside the uterus. Cervix ------ The lower portion of the uterus. The cervix is the part of the uterus that keeps the fetus from falling out of the uterus. During labor, the cervix thins and dilates to permit passage of the infant out of the uterus and into the vagina. Cord blood banking ------------------ ??? jaundice Premature infant ---------------- Baby born three or more weeks before the due date. Rooming-in ---------- An alternative rooming arrangement in postpartum units. With rooming-in the infant does not stay in the newborn nursery, but in the mother's room during her hospital stay. Small for gestational age (SGA) ------------------------------ Small for gestational age (SGA)-Children whose birth weights are below the 10th percentile (smaller in weight than 90 percent of other infants born at the same gestational age) are considered small for gestational age (SGA). Being small for gestational age has several other names. Some of these follow: Intrauterine growth retardation, Small for dates, Dysmature