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Pregnancy is a physiologic process that is very competent in numerous regards. Vaginal delivery
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Conduct of vaginal delivery
H e n r y O s a z u w aC o n s u l t a n t O b s t e t r i c i a n
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 k
now 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
U n i fi e d T e m p l a t e
IntroductionV a g i n a l d e l i v e r y i s s a f e s t w a y o f e n d i n g a p r e g n a n c y
C o m p a r i s o nC o m p l i c a ti o n r a t e s f o r m o t h e r a n d b a b y
Performed in the second stage of labour
W h a t i s s e c o n d o f l a b o u r ?
F r o m f u l l c e r v i c a l ( 1 0 c m ) d i l a t a ti o n t o d e l i v e r y o f
t h e b a b y.
2 phases – Phase 1 (P e l v i c ) & Phase 2 (P e r i n e a l )
Performed in the second stage of labor
S t a m i n a │ C o u r a g e │ C o n fi d e n c e
T h r e e k e y s
W a r n i n g ! Confidence should be based on competence in providing care
Be professional – ALL the time!
S t a m i n a │ C o u r a g e │ C o n fi d e n c e
T h r e e k e y s
Pati ence is C R U C I A L
Be professional – ALL the time!
Watch the “ARROWS”
Pati ence is C R U C I A L
Signs of second stageO n l y p o s i ti v e s i g n – F U L L c e r v i c a l d i l a ta ti o n
1 . U n c o n t r o l l a b l e u r g e t o p u s h ( n e e d s t o p a s s s t o o l ) .
2 . M a y h o l d b r e a t h o r g r u n t d u r i n g c o n t r a c ti o n .
3 . S t a r t t o s w e a t .
4 . M o o d c h a n g e s – s l e e p y o r m o r e f o c u s e d .
5 . E x t e r n a l g e n i t a l i a o r a n u s b e g i n s t o b u l g e d u r i n g
c o n t r a c ti o n s .
6 . F e e l s t h e b a b y ’s h e a d b e g i n t o m o v e i n t h e v a g i n a .
What is crowning !
C r o w n i n g m e a n s t h e w i d e s t p a r t o f t h e b a b y ' s h e a d ( t h e c r o w n ! ) h a s p a s s e d t h r o u g h
t h e b o n y p e l v i c o u t l e t .
I n - b e t w e e n c o n t ra c ti o n s , t h e p r o t r u d i n g fo e t a l h e a d t h ro u g h
t h e va g i n a l i n t ro i t u s d o e s n o t r e c e d e .
Equipments, Instruments & personnel
D e l i v e r y / E p i s i o t o m y p a c k P e r s o n n e l
R e s u s c i t a i r e / R a d i a n t w a r m e r – S h o u l d b e o n
D r a p e sB a b y b l a n k e tS w a b sC o r d c l a m p ; S c i s s o r sS p o n g e h o l d i n g f o r c e p sA r t e r y f o r c e p sN e e d l e h o l d e rD i s s e c ti n g f o r c e p sP l a c e n t a b o w lE p i s i o t o m y s c i s s o r sS ti t c h e s
M i d w i v e sD o c t o r s – O b s t e t r i c & P a e d i a t r i cC a r e a s s i s t a n c eR e l a ti v e s
Monitoring
F o e t a l h e a r t r a t e m o n i t o r i n g
E v e r y 5 m i n u t e s
D u r i n g c o n t r a c ti o n s , t h e F o e t a l H e a r t R a t e c a n b e a s s l o w a s 1 0 0 / m i n u t e
R e c o v e r s a ft e r C O N T R A C T I O N !
What is the Normal foetal
heart rate?1 2 0 – 1 6 0
beats/minute
Mothers position
E n c o u r a g e h e r t o b e a r d o w n w i t h e a c h u t e r i n e c o n t r a c ti o n
M a n y ! !!
Squirting
Sitting
Under water
StandingD o r s a l p o s i ti o n w i t h h e a d p r o p p e d u p a n d
h a n d s a r o u n d t h e a n k l e s .
Guarding & Guiding THE PERINEUM
M a n y t e c h n i q u e s h a v e b e e n d e s c r i b e d .
D i ffi c u l t t o d e fi n e a s u p e r i o r t e c h n i q u e .
E n c o u r a g e fl e x i o n o f t h e f o e t a l h e a d – done too early may increase the pressure on the perineum.
C u p t h e f o e t a l s c a l p .
S w e e p t h e p e r i n e u m o v e r t h e f o e t a l h e a d .
Delivery the baby
B & C
Delivery the baby
D & E
Delivery of the baby
F
Delivery of the Placenta
3 R D S TA G E O F L A B O U R
A c ti v e a n d E x p e c t a n t M a n a g e m e n t
A c ti v e – D o n ’ t w a i t f o r s i g n s o f p l a c e n t a s e p a r a ti o n .
Delivery of the PlacentaC l a m p i n t w o p l a c e a n d
c u t b e t w e e n c l a m s ; c l o s e t o t h e p e r i n e u m
A p p l y C C T w i t h c o u n t e r p r e s s u r e o n t h e U T E R U S .
Oxytocic- Del ivery o f the anter ior shou lder or the foetus .
O x y t o c i n ( I V/ I M )
E r g o m e t r i n e o r M e t h y l E r g o m e t r i n e
( I V/ I M )
R i s k f o r P P H : 2 0 – 4 0 I U o f O x y t o c i n i n 5 0 0 m l D e x t r o s e i n W a t e r t o r u n 2 H O U R S
M i s o p r o s t o l ( R e c t a l / O r a l )
1 0 I U b o l u s
0 . 5 m g E r g o m e t r i n e
0 . 2 m g M e t h y l E r g o m e t r i n e
4 0 0 – 8 0 0 m i c r o g r a m ( 2 – 4 t a b l e t s )
Immediate post-partum careF o e t a l r e s u s c i t a ti o n
M a s s a g e t h e u t e r u s
E x a m i n e t h e p l a c e n t a
E x a m i n e t h e l o w e r g e n i t a l t r a c t
M a t e r n a l v i t a l s i g n m o n i t o r i n g
E p i s i o t o m y / p e r i n e a l t e a r s
E n c o u r a g e b r e a s t f e e d i n g ( F i r s t h o u r )
Thank you