2. LABOUR
DEFINITION
Series of events that take place
in the genital tract in an effort to
expel the viable products of
conception via the vagina
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3. NORMAL LABOUR
• Spontaneous onset and at term
• Vertex presentation
• Without undue prolongation
• Natural termination with minimal aids
• Without complications to mother &/or baby
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4. STAGES OF LABOUR
• FIRST STAGE
• From onset of true labour pains to full
dilatation of the cervix
• Duration 12 hours in primis
• 6 hours in multis
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5. STAGES OF LABOUR
• Second stage
• From full dilatation of cervix to complete
expulsion of the baby
• Duration 2 hours in primis
• 30 mins. In multis
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6. STAGES OF LABOUR
• Third stage
• From complete expulsion of the baby to
complete expulsion of the placenta and
membranes and the uterus remains
contracted and retracted.
• Duration 15 mins in both primis and
multis
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7. EVENTS IN 1ST STAGE OF
LABOUR
• UTERINE CONTRACTIONS
• CERVICAL DILATATION AND EFFACEMENT
• BAG OF MEMBRANES
• PROGRESSIVE DESCENT OF PRESENTING
PART
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8. EVENTS IN SECOND STAGE
• UTERINE CONTRACTIONS
• ‘BEARING DOWN’
• DELIVERY OF THE FETUS
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9. EVENTS IN THIRD STAGE
• SEPERATION OF PLACENTA
• EXPULSION OF PLACENTA
• UTERUS CONTRACTED & RETRACTED
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10. OCCIPITO ANTERIOR
• DESCENT WITH FLEXION
• INTERNAL ROTATION
• DELIVERY OF HEAD EXTENSION
• RESTITUTION
• INTERNAL ROTATION OF SHOULDERS
• DELIVERY OF SHOULDERS
• DELIVERY OF TRUNK
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11. MANAGEMENT OF LABOUR
• MAXIMAL OBSEVATION WITH MINIMAL
ACTIVE ASSISSTANCE
• ASEPSIS
• SUPPORT
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12. FIRST STAGE OF LABOUR
• GENERAL
• BOWEL
• POSITION OF PATIENT
• DIET
• BLADDER
• PAIN RELIEF
• MONITOR maternal wellbeing
• fetal wellbeing
• progress of labour
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16. SECOND STAGE OF LABOUR
• POSITION OF PATIENT
• BLADDER
• MONITORING
• TOILETING OF EXTERNAL GENITALIA
• EPISIOTOMY
• CONDUCTION OF DELIVERY
• delivery of head
• delivery of shoulders
• delivery of trunk
• IMMEDIATE CARE OF THE NEWBORN
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17. THIRD STAGE OF LABOUR
• ACTIVE MANAGEMENT OF LABOUR
• USE OF OXYTOCICS
• EARLY CLAMPING OF CORD
• DELIVERY OF PLACENTA BY CCT
• UTERINE MASSAGE
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20. DYSTOCIA
• presentation other than vertex
• Having some complications even if vertex
• Modifying the nature of termination
• Adversely affecting maternal&/or fetal
prognosis
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23. COMPLICATIONS IN LABOUR
• FETAL
• HYPOXIA
• INTRAUTERINE INFECTION
• INTRACRANIAL HEMORRHAGE
• STILLBIRTH
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24. PRECIPITATE LABOUR
• When 1st &2nd stages of labour are
combined less than 2 hours
• Prevention
• Hospitalised prior to labour
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25. PROLONGED LABOUR
• WHEN 1ST &2ND STAGES COMBINED ARE
LONGER THAN 18 HOURS
• CAUSES POWER
• PASSENGER
• PASSAGE
• EXCESSIVE SEDATION
• DIAGNOSIS PARTOGRAM
• TREATMENT ARM/OXYTOCIN
• OPERATIVE DELIVERY
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26. Six hours in primigravidae and four hours in multigravidae is considered prolonged.
Primary Dysfunctional Labour
h active phase progresses at the rate of less than 1 cm/hr before normal active slope has
b) Prolonged Deceleration Phase - Three hours or more.
ortion of active-phase dilatation. It is often due to malposition or deflexion of the presenting
itate Labour - Maximum slope of dilatation of 5 cm/hr or more.
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28. OCCIPITO POSTERIOR
• LONGER ENGAGING DIAMETER
• ILLFITTING PRESENTING PART
• LONGER LABOUR
• MORE TRAUMA
• ARREST DISORDERS
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29. OCCIPITO POSTERIOR
• SPONTANEOUS DELIVERY(90%)
• long rotation
• face to pubis
• Arrest disorders
• vacuum
• manual rotation+forceps
• forceps
• cesarean section
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30. BREECH
• LARGER PART COMES LAST
• HEAD IS DELIVERED LAST
• ILLFITTING PRESENTING PART
• ARREST PROBLEMS
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31. BREECH
• ANTENATAL external cephalic version
• ASSISTED BREECH DELIVERY
• 1ST STAGE
• 2ND STAGE delivery of breech
• care of cord
• back to doctor
• delivery of shoulders
• delivery of head forceps/BURNS-
MARSHALL/MAURICEAU-SMELLIE-VEIT
• 3RD STAGE
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32. FACE
• DELAYED ENGAGEMENT
• NO MOULDING
• PROLONGED LABOUR
• ILLFITTING PRESENTING PART
• MENTO POSTERIOR
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40. PREREQUISITES
• PRESENTING PART ENGAGED
• CERVIX FULLY DILATED
• MEMBRANES RUPTURED
• NO CPD
• BLADDER EMPTY
• POSITION SHOULD BE KNOWN
• EXPERTISE
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45. OBSTETRIC FORCEPS
• CLASSIFICATION (ACOG)
• OUTLET FORCEPS SCALP VISIBLE AT INTROITUS
• FETAL HEAD AT PERINEUM
• SAGGITAL SUTURE IN AP DIAMETER
• /ROTATION NOT MORE THAN 45 DEGREES
• LOW FORCEPS FETAL HEAD AT+2CM OR MORE
• ROTATION45 OR MORE DEGREES
• MIDFORCEPS FETAL HEAD ENGAGED
• STATION ABOVE +2 CM.
•
•
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46. OBSTETRIC FORCEPS
• OUTLET FORCEPS OCCIPITO ANTERIOR
•
• OCCIPITO POSTERIOR
• FACE
• AFTER COMING HEAD
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