Labour tutorial

Labour tutorial

1. Labour & Delivery

2. Normal Labour & Delivery
Definition of labour:
Physical processes at the end of
pregnancy including opening of the
cervix and contractions of the uterus
that lead to delivery of the fetus

3. Components of normal labour
Powers
Passages
Passenger

4. Powers
Uterine contractions
Maternal effort

6. Passages
Maternal pelvis
Inlet
Outlet

7. Pelvic inlet

8. Pelvic outlet

9. Passenger
Fetal size
Fetal presentation
Fetal position
Moulding

11. Mechanism of birth
Engage in transverse position
Rotate in mid-pelvis
Flexed descent onto perineum
Crowning
Extension of neck
Restitution
Delivery anterior shoulder
Delivery posterior shoulder

13. Diagnosis of labour
Regular painful contractions resulting
in progressive change of the cervix
+/- show
+/- rupture of membranes

14. Stages of labour
First stage
Onset of labour until full dilatation
of cervix
Second stage
Full dilation of cervix until delivery
of baby
Third stage
Delivery of baby until complete
delivery of placenta and membranes

15. Partogram - Maternal
Name / DOB /Gestation
Medical / Obstetrical issues
HR / BP/ Temp
Urinalysis

16. Partogram - Fetal
Gestational age
Fetal heart rate
Liquor

17. Partogram - Progress
Uterine contractions
Cervical dilatation
Descent of presenting part
Caput / Moulding
Fetal position

18. Pain relief
Support
Water
Opiates
Epidural
Complementary

19. Partogram - delivery
Time of birth
Gender of infant
Birthweight
Apgar scores at 1/5 mins
Cord gas
Resuscitation
Complications

20. Abnormal Labour & Delivery

21. What can go wrong?
Powers
Poor contractions/Maternal effort
Passages
Small pelvis/Pelvic shape
Passenger
Big baby/Presentation/Malposition

22. Abnormal powers
Artificial rupture of membranes
Oxytocin infusion
Change position
Encouragement

23. Passages / Passenger
Cannot influence pelvic size / fetal wt
Can correct malposition / descent
Oxytocin infusion
Change position
Assisted birth

24. Primary arrest
0
1
2
3
4
5
6
7
8
9
10
2 4 6 8 1012
Dilatation

25. Secondary arrest
0
1
2
3
4
5
6
7
8
9
10
6 8101214
Dilatation

26. Arrest in Second Stage
0
1
2
3
4
5
6
7
8
9
10
6 810121416
Dilatation

27. Types of assisted birth
Forceps
Vacuum / Ventouse
Caesarean section

31. Forceps / Vacuum - Indications
Prolonged second stage
Suspected fetal compromise
Maternal medical conditions

32. Forceps / Vacuum - Criteria
Expertise
Consent
Analgesia
Fully dilated / membranes ruptured
Bladder empty
Position known
Fully engaged
Station @/below spines

33. Complications
Failed attempt
Trauma to baby
Trauma to mother

36. Induction of labour

37. Definition
Artificial onset of labour

38. Indications
Maternal condition
Fetal condition
Prolonged pregnancy
Prolonged rupture of membranes
Hypertensive disorders
Fetal growth / well-being
Medical disorders
Maternal request

39. Methods
Artificial rupture of membranes
Prostaglandin

40. Risks
Dates / prematurity
Failed induction
Long/difficult labour
Interventions
Neonatal complications