Normal Labor

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Normal Labor

  1. 1. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat Normal Labor Dr. Rajeev
  2. 2. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat
  3. 3. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat Time of Onset of Labour % of cases At term (EDD) 04% One week on either side 50% 2 weeks earlier & 1 week later 80% At 42 weeks 10% At 43 weeks plus 4% <ul><li>The pain may not be a True Labour pain or it may not be adequate (e.g. Severe Anemia) </li></ul><ul><li>Events in Labour also depend on Age, Stature, health status of the patient, Parity etc. </li></ul><ul><li>A lot of Experience, Knowledge & Skill is required to monitor the progress of Labour. </li></ul><ul><li>Early detection of maternal & fetal Distress helps in anticipation of complications. </li></ul><ul><li>Identifying Complications and appropriate intervention in time, prevent disasters. </li></ul><ul><li>A normal pregnancy may suddenly turn in to a life threatening emergency. </li></ul><ul><li>Every year millions of mothers and infants die due to perinatal complications. </li></ul><ul><li>So, be careful whenever dealing with a case of child birth… </li></ul>
  4. 4. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat
  5. 5. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat
  6. 6. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat
  7. 7. <ul><li>If moving, stop the Ambulance, put EARPHONES on and connect to ERCP… </li></ul><ul><li>Recall and ensure “5C” </li></ul><ul><ul><li>Clean place- use disinfected mackintosh or plastic sheet </li></ul></ul><ul><ul><li>Clean hands wear gloves & provide one to your assistant </li></ul></ul><ul><ul><li>Clean cloth use sterile Gauge and cotton (provided in the DDK) </li></ul></ul><ul><ul><li>Clean blade (provided in the DDK) </li></ul></ul><ul><ul><li>Clean thread (CORD Clamp provided in the DDK) </li></ul></ul><ul><li>Ensure Personal protection (use PPE) </li></ul><ul><li>If the environment temperature is <36*C: Switch OFF the AC (switch Off fans also after Delivery of the BABY unless the mother requests you not to do so). Remember “Neonates Feel Comfortable in the atmosphere we sweat”. </li></ul><ul><li>… and… </li></ul><ul><li>Be guided by the pictures, Proceed according to the flow chart… </li></ul><ul><li>Good luck… </li></ul>06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat
  8. 8. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat 1 6 5 4 3 2 Crowning of the Head Sub-Occipito frontal diameter distending the Vulval Outlet Assisted Delivery of the Head by Extension, exerting an upward pressure to the chin by the right hand placed over the Anococcygeal plane. Head is born by extension Head drops down with the Face close to the anus Restitution
  9. 9. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat 7 8 9 10 External Rotation Assisted Delivery of anterior Shoulder Assisted Delivery of Posterior Shoulder Cutting the Cord
  10. 10. cord clamp applied on the umbilical cord. The clamp should be applied approximately 5 cm distal to the baby’s naval. Kocher’s clamp or an Artery forcep applied approximately 2.5 cm distal to the cord clamp (mother’s end). surgical scissor used to cut the cord. A surgical blade can also be used for this purpose as provided in the DDK (disposable delivery kits) 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat <ul><li>Time of Cord Clamping: </li></ul><ul><li>Delay in clamping for 2-3 minutes or till cessation of cord pulsation facilitates transfer of 80-100ml of blood from a compressed placenta to a baby when placed below the level of uterus. It may be beneficial to a mature baby But has probably has a deleterious effect on the Premature one, due to HYPERVOLEMIA. </li></ul><ul><li>EARLY Cord Clamping is recommended in </li></ul><ul><ul><li>Cases of Rh-incompatibility, </li></ul></ul><ul><ul><li>Babies born asphyxiated </li></ul></ul><ul><ul><li>Premature babies </li></ul></ul><ul><ul><li>Growth retarded </li></ul></ul><ul><ul><li>Babies of DIBETIC MOTHER. </li></ul></ul>
  11. 11. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat 11 12 13 Expression of the Placenta by Fundal pressure Expression of the Placenta by Controlled cord Traction Inspection of Placenta for membranes
  12. 12. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat Keep presenting part of baby off the Cord. Monitor & attempt to maintain the pulse in the cord Position of mother in Cord Prolapse LLP~ left lateral Position (NEVER SUCK THE NOSE FIRST)
  13. 13. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat Uterine massage is performed from the Pubis towards the umbilicus only
  14. 14. 06/06/09 Dr. Rajeev Associate Partner PCR Cell EMRI Gujarat

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