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Operational Obstetrics & Gynecology

Labor and Delivery

Watch a Video Showing a Normal Delivery or Cesarean Section

Labor	Contractions	Electronic Fetal Monitors
Latent Phase Labor	Fetal Heart Rate	Pain Relief
Active Phase Labor	Urine	Second Stage Labor
Progress of Labor	Estimated Fetal Weight	Preparing for Delivery
Delivery of the Baby	Dilatation and Effacement	Managing the Delivery
Delivery of the Placenta	Fetal Orientation	Episiotomy
Managing Labor and Delivery	Leopold's Maneuvers	Anesthesia
Initial Evaluation	Fetal Membranes	Clamp the Cord
History	Blood Count	The Placenta
Risk Factors	Early Labor	Uterine Massage
Vital Signs	Monitor the Fetal Heart	Post Partum Care

Risk Factors

For some women, there is a greater chance of problems during labor than for other women. Various factors have been identified to try to predict those women who will experience problems and those who will not. These are called risk factors. Some are more significant than others. While most women with any of these factors will experience good outcomes, they may benefit from increased surveillance or additional resources.

The following are associated with a moderate increase in risk:

Age < 16 or > 35
2 spontaneous or induced abortions
< 8th grade education
> 5 deliveries
Abnormal presentation
Active TB
Anemia (Hgb <10, Hct <30%)
Chronic pulmonary disease
Cigarette smoking
Endocrinopathy
Epilepsy
Heart disease class I or II
Infertility
Infants > 4,000 gm
Isoimmunization (ABO)
Multiple pregnancy (at term)
Poor weight gain
Post-term pregnancy
Pregnancy without family support
Preterm labor (34-37 weeks)
Previous hemorrhage
Previous pre-eclampsia
Previous preterm or SGA infant
Pyelonephritis
Rh negative
Second pregnancy in 9 months
Small pelvis
Thrombophlebitis
Uterine scar or malformation
Venereal disease

These are associated with a higher increase in risk:

Age >40

Bleeding in the 2nd or 3rd TM

Diabetes

Chronic renal disease

Congenital anomaly

Fetal growth retardation

Heart disease class III or IV

Hemoglobinopathy

Herpes

Hypertension

Incompetent cervix

Isoimmunization (Rh)

Multiple pregnancy (pre-term)

> 2 spontaneous abortions

Polyhydramnios

Premature rupture of membranes

Pre-term labor (<34 weeks)

Prior perinatal death

Prior neurologically damaged infant

Severe pre-eclampsia

Significant social problems

Substance abuse

Home � Introduction � Medical Support of Women in Field Environments � The Prisoner of War Experience � Routine Care � Pap Smears � Human Papilloma Virus � Contraception � Birth Control Pills � Vulvar Disease � Vaginal Discharge � Abnormal Bleeding � Menstrual Problems � Abdominal Pain � Urination Problems � Menopause � Breast Problems � Sexual Assault � Normal Pregnancy � Abnormal Pregnancy � Normal Labor and Delivery � Problems During Labor and Delivery � Care of the Newborn

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Obstetrics & Gynecology - 2nd Edition
The Health Care of Women in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMEDPUB 6300-2C
January 1, 2000

This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates Medical Education Division. It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified.

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