Conduct of vaginal delivery

Pregnancy is a physiologic process that is very competent in numerous regards. Vaginal delivery

1. Conduct of vaginal delivery Henry Osazuwa Consultant Obstetrician

2. Not to teach new things Its is a Doctor’s world We run things here Things should be done our way You guys are under us We know more than you Not to teach new things Things should be done our way Its is a Doctor’s world Its is a Doctor’s world Unified Template

3. Introduction Vaginal delivery is safest way of ending a pregnancy Comparison Complication rates for mother and baby

4. Performed in the second stage of labour What is second of labour? From full cervical (10 cm) dilatation to delivery of the baby. 2 phases – Phase 1 ( Pelvic ) & Phase 2 ( Perineal )

5. Performed in the second stage of labor Stamina │ Courage│ Confidence Three keys Warning! Confidence should be based on competence in providing care

6. Be professional – ALL the time! Stamina │ Courage│ Confidence Three keys Patience is CRUCIAL Be professional – ALL the time!

7. Watch the “ARROWS” Patience is CRUCIAL

8. Signs of second stage Only positive sign – FULL cervical dilatation 1. Uncontrollable urge to push( needs to pass stool ). 2. May hold breath or grunt during contraction. 3. Start to sweat . 4. Mood changes – sleepy or more focused . 5. External genitalia or anus begins to bulge during contractions. 6. Feels the baby’s head begin to move in the vagina .

9. What is crowning !

10. Crowning means the widest part of the baby's head (the crown!) has passed through the bony pelvic outlet. In-between contractions, the protruding foetal head through the vaginal introitus does not recede .

11. Equipments, Instruments & personnel Delivery/Episiotomy pack Personnel Resuscitaire /Radiant warmer – Should be on Drapes Baby blanket Swabs Cord clamp; Scissors Sponge holding forceps Artery forceps Needle holder Dissecting forceps Placenta bowl Episiotomy scissors Stitches Midwives Doctors – Obstetric & Paediatric Care assistance Relatives

12. Monitoring Foetal heart rate monitoring Every 5 minutes During contractions, the Foetal Heart Rate can be as slow as 100/minute Recovers after CONTRACTION!

13. What is the Normal foetal heart rate? 120 – 160 beats/minute

14. Mothers position Encourage her to bear down with each uterine contraction Many ! !! Squirting Sitting Under water Standing Dorsal position with head propped up and hands around the ankles.

15. Guarding & Guiding THE PERINEUM Many techniques have been described. Difficult to define a superior technique. Encourage flexion of the foetal head – done too early may increase the pressure on the perineum. Cup the foetal scalp. Sweep the perineum over the foetal head.

16. Delivery the baby B & C

17. Delivery the baby D & E

18. Delivery of the baby F

19. Delivery of the Placenta 3 RD STAGE OF LABOUR Active and Expectant Management Active – Don’t wait for signs of placenta separation.

20. Delivery of the Placenta Clamp in two place and cut between clams ; close to the perineum Apply CCT with counter pressure on the UTERUS.

21. Oxytocic- Delivery of the anterior shoulder or the foetus. Oxytocin (IV/IM) Ergometrine or Methyl Ergometrine (IV/IM) Risk for PPH: 20 – 40 IU of Oxytocin in 500 ml Dextrose in Water to run 2 HOURS Misoprostol (Rectal/Oral) 10 IU bolus 0.5 mg Ergometrine 0.2 mg Methyl Ergometrine 400 – 800 microgram (2 – 4 tablets)

22. Immediate post-partum care Foetal resuscitation Massage the uterus Examine the placenta Examine the lower genital tract Maternal vital sign monitoring Episiotomy/ perineal tears Encourage breast feeding (First hour)

23. Thank you