II. Epidemiology
- Vaginal Birth accounts for 70% of deliveries in the United States
- Of the 4 million births in the U.S. in 2013, three million were vaginal deliveries
III. Contraindications
- Complete Placenta Previa
- Active genital Herpes Simplex Virus (or prodromal symptoms) at time of labor
- Malpresentation
- Non-Frank Breech
- Transverse Lie
- Face Presentation with mentum anterior
- Prior uterine surgery that raises risk of labor-induced Uterine Rupture
- History of classic uterine incision (vertical uterine incision)
- History of significant transfundal uterine surgery
- Untreated HIV Infection
IV. Management: Vertical Transmission Prevention
V. Management: Labor Stage 1
- See First Stage of Labor
- See Fetal Heart Tracing
- Labor Progression
- Pain management
VI. Management: Labor Stage 2
- Labor Progression
- Assisted Delivery
- Newborn Care
- Other procedures
- Cord Management
- Check for nuchal cord as infant's head is delivered
- Pull loose nuchal cord's over the infant's head
- Tight nuchal cords are associated with increased infant complications
- Apply 2 clamps to the nuchal cord and cut the cord between clamps OR
- Summersault maneuver
- Deliver the anterior and posterior Shoulder
- Next, hold infant head by maternal thigh
- Next, deliver body by summersault
- Remove nuchal cord once body is delivered
- Cord clamping
- Consider delayed cord clamping in all deliveries not requiring emergent Resuscitation
- Wait 1-3 minutes after delivery to clamp cord or until cord stops pulsating
- Clamp cord with at least 2-4 cm between the infant and the closest clamp
- Allows for umbilical venous catheter
- Infant does not need to be below the level of the placenta prior to cord clamping
- Delayed cord clamping improves infant birth weight, Hemoglobin, iron stores
- Check for nuchal cord as infant's head is delivered
VII. Management: Labor Stage 3
- See Third Stage of Labor
- See Postpartum Hemorrhage
- See Retained Placenta
- See Uterine Inversion
VIII. References
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| Definition (NCI) | Birth of the fetus through the vagina without the application of vacuum or forceps or any other instrument. (adapted from reVITALize)(NICHD) |
| Concepts | Finding (T033) |
| ICD9 | 650 |
| SnomedCT | 48782003, 267325009, 267353009, 281686002, 200477006, 199313007 |
| English | FTND - Full term norm delivery, SVD - Spont vaginal delivery, Spontaneous vaginal delivery, ND - Normal delivery, Normal delivery (live child), Delivery in a completely normal case, Delivery of fetus, completely normal case, normal delivery (diagnosis), normal delivery, Normal Spontaneous Vaginal Delivery, Normal delivery in normal case, Normal pregnancy &/or delivery (& [spontaneous vaginal delivery]) (disorder), Delivery - normal, Normal delivery in a completely normal case, Normal pregnancy &/or delivery (& [spontaneous vaginal delivery]), Normal pregnancy+deliv., Delivery: [normal in a completely normal case] or [spontaneous vaginal], Delivery: [normal in a completely normal case] or [spontaneous vaginal] (disorder), Normal foaling, Parturition normal, Normal Delivery, NSVD, FTND - Full term normal delivery, SVD - Spontaneous vaginal delivery, Delivery normal, delivery; normal, normal; delivery, Normal delivery, Delivery normal (disorder), Delivery normal (finding) |
| Spanish | parto normal (hallazgo), parto normal (trastorno), Parto en un caso completamente normal, Fase expulsiva del parto normal, Parto normal (niño vivo), parto normal de término, alumbramiento del feto, caso completamente normal (trastorno), alumbramiento del feto, caso completamente normal, parto vaginal espontáneo |
| French | Accouchement normal (enfant vivant), Accouchement normal, Accouchement dans un cas complètement normal |
| Dutch | bevalling volledig normaal, normale bevalling, bevalling normaal (levendgeborene), bevalling; normaal, normaal; bevalling |
| Portuguese | Dequitadura normal, Expulsão normal (nado-vivo), Expulsão num caso completamente normal |
| German | Entbindung in einem ganz normalen Fall, normale Entbindung, normale Geburt (Lebendgeburt) |
| Italian | Parto normale (bambino vivo), Parto normale, Parto in caso completamente normale |
| Japanese | 正常分娩（生児出生）, 正常分娩, 完全に正常な状態における分娩, ｶﾝｾﾞﾝﾆｾｲｼﾞｮｳﾅｼﾞｮｳﾀｲﾆｵｹﾙﾌﾞﾝﾍﾞﾝ, ｾｲｼﾞｮｳﾌﾞﾝﾍﾞﾝ, ｾｲｼﾞｮｳﾌﾞﾝﾍﾞﾝｾｲｼﾞｼｭｯｾｲ |
| Czech | Normální porod, Porod ve zcela normálním případě, Normální porod (živé dítě) |
| Hungarian | Normális szülés, Normális szülés (élő gyermek), Szülés teljesen normális esetben |
Ontology: Vaginal delivery procedure (C1541822)
| Definition (NCI) | Birth of the fetus through the vagina.(NICHD) |
| Concepts | Therapeutic or Preventive Procedure (T061) |
| CPT | 59409, 59410, 59614, 59612 |
| English | Vaginal delivery, Vaginal Delivery, Vaginal delivery procedure |
| Spanish | Parto vaginal |
| French | Accouchement vaginal |
| Dutch | vaginale bevalling |
| Portuguese | Parto vaginal |
| German | vaginale Entbindung |
| Italian | Parto vaginale |
| Japanese | 経腟分娩, ｹｲﾁﾂﾌﾞﾝﾍﾞﾝ |
| Czech | Vaginální porod |
| Hungarian | Hüvelyi szülés |
