Special Tutorial programme

Professor Deirdre MurphyTrinity College

Labour & Delivery

Objectives

Normal Labour

Abnormal Labour

Induced Labour

Normal Labour & Delivery

Components of normal labour

Powers

Passages

Passenger

Powers

Uterine contractions

Maternal effort

Passages

Maternal pelvis

Inlet

Outlet

Pelvic inlet

Pelvic outlet

Passenger

Fetal size

Fetal presentation

Fetal position

Moulding

Mechanism of birth

Engage in transverse positionRotate in mid-pelvisFlexed descent onto perineumCrowning Extension of neckRestitutionDelivery anterior shoulderDelivery posterior shoulder

Student exercise

Student exercise

Diagnosis of labourStages of labourPartogram

Maternal FetalProgressPain relief

Delivery

Diagnosis of labour

Regular painful contractions resultingin progressive change of the cervix

+/- show+/- rupture of membranes

Stages of labour

First stageOnset of labour until full dilatation of cervix

Second stageFull dilation of cervix until delivery of baby

Third stageDelivery of baby until complete delivery of placenta and membranes

Partogram - Maternal

Name / DOB /Gestation

Medical / Obstetrical issues

HR / BP/ Temp

Urinalysis

Partogram - Fetal

Gestational age

Fetal heart rate

Liquor

Partogram - Progress

Uterine contractionsCervical dilatationDescent of presenting partCaput / MouldingFetal position

Pain relief

SupportWaterOpiatesEntonoxEpiduralComplementary

Partogram - delivery

Time of birthGender of infantBirthweightApgar scores at 1/5 minsCord gasResuscitationComplications

Abnormal Labour & Delivery

What can go wrong?

Powers Poor contractions/Maternal effort

Passages Small pelvis/Pelvic shape

PassengerBig baby/Presentation/Malposition

Abnormal powers

Artificial rupture of membranesOxytocin infusion

Change positionEncouragement

Passages / Passenger

Cannot influence pelvic size / fetal wtCan correct malposition / descent

Oxytocin infusionChange positionAssisted birth

Primary arrest

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2 4 6 8 10 12

Dilatation

Secondary arrest

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6 8 10 12 14

Dilatation

Arrest in Second Stage

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6 8 10 12 14 16

Dilatation

Types of assisted birth

Forceps

Vacuum / Ventouse

Caesarean section

Forceps / Vacuum - Indications

Prolonged second stage

Suspected fetal compromise

Maternal medical conditions

Forceps / Vacuum - Criteria

ExpertiseConsent AnalgesiaFully dilated / membranes rupturedBladder emptyPosition knownFully engagedStation @/below spines

Complications

Failed attempt

Trauma to baby

Trauma to mother

Video – vacuum delivery

Induction of labour

Definition

Artificial onset of labour

Indications

Maternal conditionFetal condition

Prolonged pregnancyProlonged rupture of membranesHypertensive disordersFetal growth / well-beingMedical disordersMaternal request

Methods

Artificial rupture of membranes

Prostaglandin

Risks

Dates / prematurity

Failed induction

Long/difficult labour

Interventions

Neonatal complications

Summary

Covered

Normal Labour

Abnormal Labour

Induced Labour

Practice Assessment