II. Epidemiology

  1. Vaginal Birth accounts for 70% of deliveries in the United States
    1. Of the 4 million births in the U.S. in 2013, three million were vaginal deliveries

III. Contraindications

  1. Complete Placenta Previa
  2. Active genital Herpes Simplex Virus (or prodromal symptoms) at time of labor
  3. Malpresentation
    1. Non-Frank Breech
    2. Transverse Lie
    3. Face Presentation with mentum anterior
  4. Prior uterine surgery that raises risk of labor-induced Uterine Rupture
    1. History of classic uterine incision (vertical uterine incision)
    2. History of significant transfundal uterine surgery
  5. Untreated HIV Infection

IV. Management: Vertical Transmission Prevention

VI. Management: Labor Stage 2

  1. Labor Progression
    1. See Labor Augmentation
    2. See Active Management of Labor
    3. See Labor Coaching
    4. See Fetal Heart Tracing
  2. Assisted Delivery
    1. See Vacuum Assisted Delivery
    2. See Forceps Assisted Delivery
    3. See Manual Rotation in Occipitoposterior Presentation
    4. See Shoulder Dystocia Management
  3. Newborn Care
    1. See Newborn Resuscitation
  4. Other procedures
    1. See Perineal Laceration Repair
  5. Cord Management
    1. Check for nuchal cord as infant's head is delivered
      1. Pull loose nuchal cord's over the infant's head
      2. Tight nuchal cords are associated with increased infant complications
        1. Apply 2 clamps to the nuchal cord and cut the cord between clamps OR
        2. Summersault maneuver
          1. Deliver the anterior and posterior Shoulder
          2. Next, hold infant head by maternal thigh
          3. Next, deliver body by summersault
          4. Remove nuchal cord once body is delivered
    2. Cord clamping
      1. Consider delayed cord clamping in all deliveries not requiring emergent Resuscitation
      2. Wait 1-3 minutes after delivery to clamp cord or until cord stops pulsating
      3. Clamp cord with at least 2-4 cm between the infant and the closest clamp
        1. Allows for umbilical venous catheter
      4. Infant does not need to be below the level of the placenta prior to cord clamping
        1. Vain (2014) Lancet 384(9939): 235-40 [PubMed]
      5. Delayed cord clamping improves infant birth weight, Hemoglobin, iron stores
        1. McDonald (2013) Cochrane Database Syst Rev (7):CD004074 [PubMed]

VII. Management: Labor Stage 3

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Ontology: Normal delivery (C1384485)

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, カンゼンニセイジョウナジョウタイニオケルブンベン, セイジョウブンベン, セイジョウブンベンセイジシュッセイ
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, ケイチツブンベン
Czech Vaginální porod
Hungarian Hüvelyi szülés