L&D

=Labor & Delivery =  **Vaccines**  Varicella, rubella, measles, mumps, and polio vaccines consist of attenuated live viruses and should not be administered during pregnancy because of a theoretic risk to the fetus.toc

**Biophysical profile** BPP is based on FHR monitoring (generally NST) in addition to four parameters observed on real-time ultrasonography:
 * amniotic fluid volume
 * fetal breathing
 * fetal body movements
 * fetal body tones.

Each parameter gets a score of 0 to 2. A score of 8 to 10 is considered normal, a score of 6 is equivocal, and a score of 4 or less is abnormal and prompts delivery. 
 * Bishop Score**
 * || <span style="background-color: transparent; color: #ffffff; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**0** || <span style="background-color: transparent; color: #ffffff; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**1** || <span style="background-color: transparent; color: #ffffff; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**2** || <span style="background-color: transparent; color: #ffffff; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**3** ||
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Position** || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Posterior || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Intermediate || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Anterior || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">- ||
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Consistency** || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Firm || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Intermediate || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Soft || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">- ||
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Effacement** || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">0-30% || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">31-50% || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">51-80% || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">>80% ||
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Dilation** || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">0 cm || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1-2 cm || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">3-4 cm || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">>5 cm ||
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Fetal station** || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">-3 || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">-2 || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">-1, 0 || <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">+1, +2 ||

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Bishop score of >8 is good.

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Montevideo Unit** <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Variation of intrauterine pressure (IUP) from baseline times # contractions in 10 min period 200+ is adequate

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Definitions** <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">__Labor__ <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: contractions causing cervical change <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">__Lie__ <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: orientation of fetus in uterus (assessed with Leopold maneuver). Ex. transverse <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">__Presentation__ <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: breech/vertex <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">__Position__ <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: anything but OA can lead to prolonged labor/ increased rate of CS. Palpate sutures to detect. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> ==<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Cardinal movements of labor** == ==<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Rupture of membranes** == ==<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Pelvic girdle orientations** == ==<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Obstetric conjugate: sacroiliac notch to pubic sympysis <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">**Augmentation/induction** ==
 * Stages of labor**
 * 1) <span style="background-color: transparent; color: #000000; font-family: 'Times New Roman'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Onset to complete dilation (10-12 hours in primigravida, 6-8 in multiparous)
 * 2) <span style="background-color: transparent; color: #000000; font-family: 'Times New Roman'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Latent phase: 0-3cm (slow)
 * 3) <span style="background-color: transparent; color: #000000; font-family: 'Times New Roman'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Active phase: 3-9cm (fast). 1.0cm/hr is 5 <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 6pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: super; white-space: pre-wrap;">th <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> percentile
 * 4) <span style="background-color: transparent; color: #000000; font-family: 'Times New Roman'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: lower-roman; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Active phase arrest: no change in cervix for 2 hours with adequate ctx
 * 5) <span style="background-color: transparent; color: #000000; font-family: 'Times New Roman'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Completely dilated cervix to delivery of infant
 * 6) <span style="background-color: transparent; color: #000000; font-family: 'Times New Roman'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Infant delivery to delivery of placenta
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Engagement
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Descent
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Flexion
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Internal rotation
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Extension
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">External rotation
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SROM/AROM = spontaneous/artificial
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PROM: premature – before labor has begun (give ampicillin)
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PPROM: preterm premature
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Prolonged PROM- 18+ hours before the onset of labor
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Diagnosis
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pool test - check for fluid in vagina
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Nitrazine blue: detects base in the vaginal fluid. Amniotic fluid is basic
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fern test
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Oligohydramnios in previously normal fluid level
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indigo dye in amniocentesis checked with tampon
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indications
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Deliver if 36+ weeks
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Don’t deliver if less than 32 weeks
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;">**<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Gynecoid: ideal **
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;">**<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Android: ideal brim, but ischial spines narrow **
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;">**<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Anthropoid: oblong **
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;">**<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pladypoid: wide **
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indications:
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Postterm (42+weeks)
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Preeclampsia
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PROM
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Nonreassuring FHTs
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">IUGR
 * <span style="background-color: transparent; color: #000000; font-family: 'Trebuchet MS'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Agents
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PGE2 gel or pessary (Cervadil)
 * <span style="background-color: transparent; color: #000000; font-family: Verdana; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: square; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Contraindicated w/maternal asthma/glaucoma
 * <span style="background-color: transparent; color: #000000; font-family: Verdana; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: square; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Contraindicated if >1 prior CS
 * <span style="background-color: transparent; color: #000000; font-family: Verdana; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: square; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Can’t be immediately turned off like pitocin, bad if tetany occurs
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Misoprostol - Ctx only no ripening(?)
 * <span style="background-color: transparent; color: #000000; font-family: 'Courier New'; font-size: 10pt; font-style: normal; font-weight: normal; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 10pt; font-style: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mechanical: Foley bulb