Emergencies in obstetrics
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This consists of basics of management of shoulder dystocia, breech vaginal delivery and management of uterine inversion
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The presentation is on normal labour, stages and mechanisms, physiological basis of labour, abnormal labour, diagnosis and managment
Abnormal uterine action
This document discusses normal and abnormal uterine action during labor. It defines normal labor as having coordinated contractions that gradually increase in frequency and intensity, associated with cervical dilation of at least 1 cm per hour. Abnormal uterine action is any deviation from this pattern and occurs in about 25% of nulliparous and 10% of multiparous women. Types of abnormal action include over-efficient contractions, inefficient contractions like hypotonic and hypertonic inertia, and cervical dystocia. Management involves identifying the type of abnormality and taking appropriate measures like oxytocics to stimulate contractions or cesarean delivery if needed.
Abnormal uterine action
1) Abnormal uterine action refers to any deviation from normal uterine contractions that can affect the progress of labor. It is one of the leading causes of dystocia or difficult labor.
2) Some types of abnormal uterine action include excessive contractions, abnormal polarity, uterine inertia, spastic lower segment, constriction rings, and generalized tonic contractions.
3) Management depends on the specific type but may include oxytocin stimulation of contractions, artificial rupture of membranes, operative vaginal delivery, or caesarean section if needed to deliver the baby safely. Close monitoring of maternal and fetal wellbeing is important.
Lower segment ceasarean section(lscs)
Lower segment caesarean section (LSCS) is a surgical procedure where the fetus is delivered through an incision made in the lower segment of the uterus after 28 weeks of pregnancy. It is indicated when vaginal delivery is not possible due to issues like placenta previa, cephalopelvic disproportion, or fetal distress. The operation involves making incisions through the abdominal wall, uterus, and membranes to deliver the baby and placenta, followed by suturing of the uterine and abdominal layers. Post-operative care includes monitoring for uterine contractions, fluid replacement, and removal of stitches after 5-6 days.
2nd stage obg seminar
The document provides information on the management of the second stage of labor by nurses. It discusses the normal physiology of the second stage, including cervical dilation, fetal descent and rotation, and maternal efforts. It describes the mechanism of labor, including engagement, descent, flexion, internal rotation, crowning, extension, and birth of the shoulders and trunk. Monitoring labor progress and managing the second stage with techniques like the partogram are also summarized.
Physiology and Mangement of 2nd stage labour
This document discusses the physiology and management of the second stage of labor. It defines the second stage as beginning with full cervical dilation and ending with delivery of the fetus. Key points include: the second stage has two phases - propulsive and expulsive; normal duration is 2 hours for primiparous and 30 minutes for multiparous women; physiological changes include descent, uterine contractions, membrane rupture, and soft tissue displacement; management aims for a normal delivery with minimal maternal effects and early detection of abnormalities. Assessment includes monitoring contractions, descent, fetal heart rate, and progressing through the mechanisms of labor.
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This document provides information on the second stage of labour, including its definition, duration, phases, physiology, management, and the cardinal movements involved in normal delivery. Key points include:
- The second stage begins with full cervical dilation and ends with birth of the baby. It typically lasts 2 hours for primiparous women and 30 minutes for multiparous women.
- It involves three phases: latent, active, and transition. Important physiological changes include uterine contraction, soft tissue displacement, and fetal rotation and extension.
- Management includes monitoring the woman's pushing efforts, positioning, preparing for delivery, and potentially applying controlled traction during crowning. Spontaneous delivery of the head is preferred over techniques like
Physiology of labor and pain pathways
The document discusses the physiology of labor and pain pathways. It describes the theories behind the onset of labor, including progesterone withdrawal and estrogen stimulation. It outlines the stages of labor and differences between true and false labor. The passage of the fetus through the birth canal involves changes in position called cardinal movements. Factors that can affect labor include the passenger (fetus), passageway (maternal pelvis), and powers (uterine contractions and maternal efforts). Pain in labor is transmitted via neural pathways and can stimulate various physiological responses.
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Abnormal uterine action
This document discusses normal and abnormal uterine action during labor. It defines normal labor as having coordinated contractions that gradually increase in frequency and intensity, associated with cervical dilation of at least 1 cm per hour. Abnormal uterine action is any deviation from this pattern and occurs in about 25% of nulliparous and 10% of multiparous women. Types of abnormal action include over-efficient contractions, inefficient contractions like hypotonic and hypertonic inertia, and cervical dystocia. Management involves identifying the type of abnormality and taking appropriate measures like oxytocics to stimulate contractions or cesarean delivery if needed.
Abnormal uterine action
1) Abnormal uterine action refers to any deviation from normal uterine contractions that can affect the progress of labor. It is one of the leading causes of dystocia or difficult labor.
2) Some types of abnormal uterine action include excessive contractions, abnormal polarity, uterine inertia, spastic lower segment, constriction rings, and generalized tonic contractions.
3) Management depends on the specific type but may include oxytocin stimulation of contractions, artificial rupture of membranes, operative vaginal delivery, or caesarean section if needed to deliver the baby safely. Close monitoring of maternal and fetal wellbeing is important.
Lower segment ceasarean section(lscs)
Lower segment caesarean section (LSCS) is a surgical procedure where the fetus is delivered through an incision made in the lower segment of the uterus after 28 weeks of pregnancy. It is indicated when vaginal delivery is not possible due to issues like placenta previa, cephalopelvic disproportion, or fetal distress. The operation involves making incisions through the abdominal wall, uterus, and membranes to deliver the baby and placenta, followed by suturing of the uterine and abdominal layers. Post-operative care includes monitoring for uterine contractions, fluid replacement, and removal of stitches after 5-6 days.
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The document provides information on the management of the second stage of labor by nurses. It discusses the normal physiology of the second stage, including cervical dilation, fetal descent and rotation, and maternal efforts. It describes the mechanism of labor, including engagement, descent, flexion, internal rotation, crowning, extension, and birth of the shoulders and trunk. Monitoring labor progress and managing the second stage with techniques like the partogram are also summarized.
Physiology and Mangement of 2nd stage labour
This document discusses the physiology and management of the second stage of labor. It defines the second stage as beginning with full cervical dilation and ending with delivery of the fetus. Key points include: the second stage has two phases - propulsive and expulsive; normal duration is 2 hours for primiparous and 30 minutes for multiparous women; physiological changes include descent, uterine contractions, membrane rupture, and soft tissue displacement; management aims for a normal delivery with minimal maternal effects and early detection of abnormalities. Assessment includes monitoring contractions, descent, fetal heart rate, and progressing through the mechanisms of labor.
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This document provides information on the second stage of labour, including its definition, duration, phases, physiology, management, and the cardinal movements involved in normal delivery. Key points include:
- The second stage begins with full cervical dilation and ends with birth of the baby. It typically lasts 2 hours for primiparous women and 30 minutes for multiparous women.
- It involves three phases: latent, active, and transition. Important physiological changes include uterine contraction, soft tissue displacement, and fetal rotation and extension.
- Management includes monitoring the woman's pushing efforts, positioning, preparing for delivery, and potentially applying controlled traction during crowning. Spontaneous delivery of the head is preferred over techniques like
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The document discusses the physiology of labor and pain pathways. It describes the theories behind the onset of labor, including progesterone withdrawal and estrogen stimulation. It outlines the stages of labor and differences between true and false labor. The passage of the fetus through the birth canal involves changes in position called cardinal movements. Factors that can affect labor include the passenger (fetus), passageway (maternal pelvis), and powers (uterine contractions and maternal efforts). Pain in labor is transmitted via neural pathways and can stimulate various physiological responses.
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The document discusses the structure and function of the myometrium, the muscular layer of the uterine wall, during labor and delivery. It contains three layers of smooth muscle (longitudinal, circular, and oblique) that contract during labor due to hormones like oxytocin and prostaglandins. Calcium entry into uterine muscle cells allows the interaction of actin and myosin fibers to cause contractions. Synchronized contractions of the myometrium expel the fetus through the birth canal in three stages: cervical dilation and effacement in stage one; fetal expulsion in stage two; and placental separation and delivery in stage three.
Stages of labour first and second
1. Labor is the process by which the viable products of conception are expelled from the uterus through the vagina. It involves uterine contractions and cervical dilation.
2. Nursing care during labor involves monitoring the patient, providing comfort measures, and preparing for delivery. The nurse assesses cervical dilation, fetal position, and signs of distress.
3. During the second stage of labor, nurses assist the patient in pushing effectively and maintaining an optimal birthing position. They provide encouragement and help the patient rest between contractions.
Second stage of labor
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
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The document discusses normal labour and delivery. It describes the stages of labour including the first, second, and third stages. It explains the interaction between the powers (uterine contractions), passengers (fetus), and passages (pelvis and birth canal). It discusses assessing cervical dilation, fetal position and station, and monitoring the fetus. It also covers managing each stage of labor, identifying abnormal labour, and addressing complications.
Normal labour
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
Abnormal progress of labor for 4th year med.students
(1) Abnormal progress of labour can include prolonged labour, obstructed labour, or abnormal uterine contractions. Prolonged labour is defined as poor cervical dilation or delayed fetal descent. Obstructed labour occurs when there is a mechanical obstruction preventing delivery.
(2) Factors that can contribute to abnormal labour include uterine dysfunction, fetal issues like large size or malpositioning, and maternal factors like pelvic abnormalities. Complications of prolonged labour include maternal exhaustion and increased C-section rates, as well as risks to the fetus like distress and infection.
(3) Abnormal labour is monitored using a partogram to track cervical dilation, fetal position and heart rate. Management depends on the specific issue,
Common terminologies of obstetrics
Obstetrics deals with pregnancy, childbirth, and the postnatal period. Key terms include gestation, which is the duration of pregnancy, and trimesters, which divide pregnancy into three stages. Complications can include preterm birth before 37 weeks, post-term birth after 42 weeks, and pregnancy-induced high blood pressure conditions like preeclampsia. Delivery methods include normal spontaneous vaginal delivery and Cesarean section.
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The document summarizes the management of the three stages of labour. The first stage involves assessing the patient's history and examining cervical dilation and fetal descent using a partogram. The second stage focuses on monitoring the mother and baby, maintaining an optimal birthing position, and gently guiding the baby's head and shoulders out. Immediate newborn care is also described. The third stage centers on delivering the placenta through controlled cord traction and examining for completeness or anomalies. Perineal tears are repaired to prevent bleeding and infection.
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This document outlines the active management of normal labour in 4 stages: antenatal preparation, first stage (history, exam, procedures), second stage (delivery of baby), third stage (delivery of placenta), and fourth stage (postpartum care of mother and baby). The goal is a healthy delivery with minimal effects. Key procedures include monitoring contractions/fetal heart with a partogram, positioning, nutrition, analgesia, perineal support, and immediate newborn care.
physiology and mecanism of labour
Labour is the process by which the fetus and placenta are expelled from the uterus through the birth canal. It involves involuntary uterine contractions that cause effacement and dilation of the cervix, allowing the fetus to descend and be delivered. Normal labour has three stages - the first stage involves cervical dilation, the second stage is expulsion of the fetus, and the third stage is expulsion of the placenta. Multiple factors influence the progress of labour, including the size and position of the fetus, strength of uterine contractions, and psychological state of the mother.
Prolonged and obstructed labor
The document discusses prolonged and obstructed labor. Prolonged labor is defined as the first and second stages of labor taking more than 18 hours total. Obstructed labor occurs when descent is arrested due to a mechanical obstruction, despite adequate contractions. Causes include cephalopelvic disproportion, malpositions, or large babies. Risks include maternal exhaustion, infection, and fetal distress or death. Treatment involves identifying the obstruction's cause, resuscitating the mother, relieving the obstruction via vaginal operative delivery or C-section, and preventing or treating complications like infection.
Normal Labor in Obstetrics
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A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
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This document discusses normal labour and delivery. It begins with definitions of normal labour and outlines the criteria for a labour to be considered normal. It then discusses the various factors that can influence the progress of labour, including the powers of uterine contractions and maternal pushing, the passenger (fetus), and the passage (maternal pelvis). The stages of labour are described, including the first, second and third stages. Details are provided on the phases of the first stage of labour including the latent and active phases. The document also discusses fetal positioning and descent through the birth canal, as well as monitoring the progress of normal labour.
6.Normal Labor,Delivery And The Puerperium
The document summarizes normal labor, delivery, and the postpartum period. It describes the four main factors that determine labor (contractions, pelvis, fetus, psychology). It then explains the stages of labor and delivery in detail, including first, second and third stages. It discusses management of each stage. It also covers the postpartum period known as the puerperium, including typical uterine bleeding, lactation, and involution over 6 weeks.
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Normal labour, first stage by Yin Moe
The document discusses the stages of normal labor, including:
- The first stage of labor involves cervical dilation from 0-10 cm over 8-12 hours and has latent and active phases.
- The second stage involves pushing and lasts up to 1 hour.
- The third stage involves delivery of the placenta within 30 minutes.
- Labor is diagnosed based on cervical effacement and dilation which are assessed through vaginal examinations every 4 hours in the first stage and hourly in the second stage.
Abnormal uterine action- Clinical Teaching Plan use in OBG submission.
This document summarizes various types of abnormal uterine actions that can occur during labor and delivery, including precipitate labor, excessive uterine contraction/retraction, inefficient uterine action (hypotonic and hypertonic inertia), constriction rings, and cervical dystocia. It defines each condition, discusses their etiology and clinical presentation, and outlines management approaches. Specifically, it provides classifications for abnormal uterine actions, complications of precipitate labor for mother and baby, diagnosis and treatment of pathological retraction rings and constriction rings, and distinguishes organic from functional cervical dystocia and their management.
Labour and Delivery... Stages of labour.pptx
This document provides an overview of gynecology and labor and delivery presented by Sandesh Sharma. It discusses the types of labor as normal or abnormal, the stages of labor including the first, second, third and fourth stages. Each stage is described in detail outlining what occurs and what the mother may experience. Additionally, it covers the mechanism of labor including engagement, descent, flexion, internal rotation, crowning, extension, and external rotation of the fetus through the birth canal. Complications that may occur are also summarized.
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The document summarizes the process of a normal spontaneous vaginal delivery in three stages:
1) Labor - Beginning with early signs and progressing through three stages of cervical dilation.
2) Delivery - Beginning with full dilation and ending with the birth of the baby through contractions and pushing.
3) Placental delivery - Beginning with separation from the uterine wall and ending with expulsion from the vagina.
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The document discusses the structure and function of the myometrium, the muscular layer of the uterine wall, during labor and delivery. It contains three layers of smooth muscle (longitudinal, circular, and oblique) that contract during labor due to hormones like oxytocin and prostaglandins. Calcium entry into uterine muscle cells allows the interaction of actin and myosin fibers to cause contractions. Synchronized contractions of the myometrium expel the fetus through the birth canal in three stages: cervical dilation and effacement in stage one; fetal expulsion in stage two; and placental separation and delivery in stage three.
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1. Labor is the process by which the viable products of conception are expelled from the uterus through the vagina. It involves uterine contractions and cervical dilation.
2. Nursing care during labor involves monitoring the patient, providing comfort measures, and preparing for delivery. The nurse assesses cervical dilation, fetal position, and signs of distress.
3. During the second stage of labor, nurses assist the patient in pushing effectively and maintaining an optimal birthing position. They provide encouragement and help the patient rest between contractions.
Second stage of labor
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
Normal and abnormal labour
The document discusses normal labour and delivery. It describes the stages of labour including the first, second, and third stages. It explains the interaction between the powers (uterine contractions), passengers (fetus), and passages (pelvis and birth canal). It discusses assessing cervical dilation, fetal position and station, and monitoring the fetus. It also covers managing each stage of labor, identifying abnormal labour, and addressing complications.
Normal labour
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
Abnormal progress of labor for 4th year med.students
(1) Abnormal progress of labour can include prolonged labour, obstructed labour, or abnormal uterine contractions. Prolonged labour is defined as poor cervical dilation or delayed fetal descent. Obstructed labour occurs when there is a mechanical obstruction preventing delivery.
(2) Factors that can contribute to abnormal labour include uterine dysfunction, fetal issues like large size or malpositioning, and maternal factors like pelvic abnormalities. Complications of prolonged labour include maternal exhaustion and increased C-section rates, as well as risks to the fetus like distress and infection.
(3) Abnormal labour is monitored using a partogram to track cervical dilation, fetal position and heart rate. Management depends on the specific issue,
Common terminologies of obstetrics
Obstetrics deals with pregnancy, childbirth, and the postnatal period. Key terms include gestation, which is the duration of pregnancy, and trimesters, which divide pregnancy into three stages. Complications can include preterm birth before 37 weeks, post-term birth after 42 weeks, and pregnancy-induced high blood pressure conditions like preeclampsia. Delivery methods include normal spontaneous vaginal delivery and Cesarean section.
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The document summarizes the management of the three stages of labour. The first stage involves assessing the patient's history and examining cervical dilation and fetal descent using a partogram. The second stage focuses on monitoring the mother and baby, maintaining an optimal birthing position, and gently guiding the baby's head and shoulders out. Immediate newborn care is also described. The third stage centers on delivering the placenta through controlled cord traction and examining for completeness or anomalies. Perineal tears are repaired to prevent bleeding and infection.
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This document outlines the active management of normal labour in 4 stages: antenatal preparation, first stage (history, exam, procedures), second stage (delivery of baby), third stage (delivery of placenta), and fourth stage (postpartum care of mother and baby). The goal is a healthy delivery with minimal effects. Key procedures include monitoring contractions/fetal heart with a partogram, positioning, nutrition, analgesia, perineal support, and immediate newborn care.
physiology and mecanism of labour
Labour is the process by which the fetus and placenta are expelled from the uterus through the birth canal. It involves involuntary uterine contractions that cause effacement and dilation of the cervix, allowing the fetus to descend and be delivered. Normal labour has three stages - the first stage involves cervical dilation, the second stage is expulsion of the fetus, and the third stage is expulsion of the placenta. Multiple factors influence the progress of labour, including the size and position of the fetus, strength of uterine contractions, and psychological state of the mother.
Prolonged and obstructed labor
The document discusses prolonged and obstructed labor. Prolonged labor is defined as the first and second stages of labor taking more than 18 hours total. Obstructed labor occurs when descent is arrested due to a mechanical obstruction, despite adequate contractions. Causes include cephalopelvic disproportion, malpositions, or large babies. Risks include maternal exhaustion, infection, and fetal distress or death. Treatment involves identifying the obstruction's cause, resuscitating the mother, relieving the obstruction via vaginal operative delivery or C-section, and preventing or treating complications like infection.
Normal Labor in Obstetrics
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
Normal labour and delivery
This document discusses normal labour and delivery. It begins with definitions of normal labour and outlines the criteria for a labour to be considered normal. It then discusses the various factors that can influence the progress of labour, including the powers of uterine contractions and maternal pushing, the passenger (fetus), and the passage (maternal pelvis). The stages of labour are described, including the first, second and third stages. Details are provided on the phases of the first stage of labour including the latent and active phases. The document also discusses fetal positioning and descent through the birth canal, as well as monitoring the progress of normal labour.
6.Normal Labor,Delivery And The Puerperium
The document summarizes normal labor, delivery, and the postpartum period. It describes the four main factors that determine labor (contractions, pelvis, fetus, psychology). It then explains the stages of labor and delivery in detail, including first, second and third stages. It discusses management of each stage. It also covers the postpartum period known as the puerperium, including typical uterine bleeding, lactation, and involution over 6 weeks.
Management of 2nd stage of labour
The document describes the process of labor and delivery. It begins with defining labor as the series of events that expels the products of conception from the womb through the vagina. It then discusses the stages of labor, including the second stage of expulsion. It provides details on assessing and monitoring the mother and baby throughout labor, managing the delivery, and postpartum care for both.
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The document discusses normal labor and defines its criteria. It describes the stages of labor and nursing care provided in each stage. Key points include defining normal labor as spontaneous delivery of a mature fetus through the birth canal within 24 hours without complications, describing the three stages of labor as dilation, birth of the baby, and delivery of the placenta. Nursing care focuses on comfort measures, monitoring labor progress, and providing pain management.
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This presentation contains details on normal anatomy on female pelvis and fetal head, process of normal labour, abnormal labour, induction of labour and malpresentations.
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The document discusses the stages of normal labor, including:
- The first stage of labor involves cervical dilation from 0-10 cm over 8-12 hours and has latent and active phases.
- The second stage involves pushing and lasts up to 1 hour.
- The third stage involves delivery of the placenta within 30 minutes.
- Labor is diagnosed based on cervical effacement and dilation which are assessed through vaginal examinations every 4 hours in the first stage and hourly in the second stage.
Abnormal uterine action- Clinical Teaching Plan use in OBG submission.
This document summarizes various types of abnormal uterine actions that can occur during labor and delivery, including precipitate labor, excessive uterine contraction/retraction, inefficient uterine action (hypotonic and hypertonic inertia), constriction rings, and cervical dystocia. It defines each condition, discusses their etiology and clinical presentation, and outlines management approaches. Specifically, it provides classifications for abnormal uterine actions, complications of precipitate labor for mother and baby, diagnosis and treatment of pathological retraction rings and constriction rings, and distinguishes organic from functional cervical dystocia and their management.
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This document discusses various complications that can occur during labor and delivery. It defines dystocia as an abnormal, long, or difficult labor or delivery. It identifies the critical factors that can impact labor as the psyche, powers, passenger, and passageway. It then discusses specific complications like uterine dystocia from large babies or overstretching of the uterus. It provides assessments, treatments, and nursing considerations for complications like hypotonic uterine contractions and prolonged labor. Surgical interventions like forceps delivery, vacuum extraction, episiotomy and cesarean delivery are also outlined.
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Labor and delivery
Overview
While it takes nine months to grow a full-term baby, labor and delivery occurs in a matter of days or even hours. However, it’s the process of labor and delivery that tends to occupy the minds of expectant parents the most.
Read on if you have questions and concerns around the signs and length of labor, and how to manage pain.
Signs of labor
Labor has started or is coming soon if you experience symptoms such as:
increased pressure in the uterus
a change of energy levels
a bloody mucus discharge
Real labor has most likely arrived when contractions become regular and are painful.
Braxton Hicks contractions
Many women experience irregular contractions sometime after 20 weeks of pregnancy. Known as Braxton Hicks contractions, they’re typically painless. At most, they’re uncomfortable and are irregular.
Braxton Hicks contractions can sometimes be triggered by an increase in either mother or baby’s activity, or a full bladder. No one fully understands the role Braxton Hicks contractions play in pregnancy.
They may promote blood flow, help maintain uterine health during the pregnancy, or prepare the uterus for childbirth.
Braxton Hicks contractions don’t cause the cervix to dilate. Painful or regular contractions aren’t likely to be Braxton Hicks. Instead, they’re the type of contractions that should lead you to call your doctor.
Second stage of labour
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- 1. Emergencies in Obstetrics Dr. Indunil Piyadigama Consultant Obstetrician and Gynaecologist Pre-intern Progam Ministry of Health, Sri Lanka 4th October 2021
- 2. • Your 1st week at the obstetric unit. You are oncall at the labour ward. 1725 the labour ward nursing sister calls you • 34 year old diabetic mother. Induction of labour at 39 weeks of getation. She was induced with prostaglandin yesterday. ARM done at 0517. Was on syntocinon for augmentation due to slow progress. • Babies head was delivered. But the body has not followed.
- 4. How would you suspect or diagnose? Difficulty with delivery of the face and chin Turtleneck sign or head remaining tightly applied to the vulva Failure of restitution of the head Failure of descend of the shoulders Routine axial traction does not deliver
- 5. What is the problem? • HIE • Injury Fetus • PPH • Tears • Damage to bladder, nerves ect Maternal
- 6. What would you do? H – Call for help E – Evaluate for episiotomy L – Legs in McRobets position P – Suprapubic pressure E – Enter the pelvis R – Roll over R – Record keeping
- 7. Initial steps Stop pushing Call for additional help No fundal pressure
- 11. Records • Medico legal issues • Contemporanous documentation • Times and the intervensions • The anterior and posterior shoulders should be documented
- 13. Breech delivery
- 14. Types of breech presentations
- 16. Steps Lithotomy position Keep your hands off the breech till anatomical landmarks appear Episiotomy – When anterior buttock climbs up the perineum until the anus is visible with a bead of meconium. Breech does not recede with contractions In complete breech maternal effort alone will deliver the legs and lower trunk Extended breech abduction at the hip and flexion at the knee is needed. Attempt the anterolateral limb and then rotate the breech so that other limb is anterolateral and perform the same manoeuver Bring down a loop of cord
- 17. Remainder of the abdomen and lower thorax should deliver with maternal effort alone. At this time fetal head will enter the pelvis causing compression of the umbilical cord. Therefore, rest of the delivery should occur within 2-3 minutes. Once the lower border of the anterior scapula is visible pass 2 finger over the shoulder and along the humerus splinting the arm across the chest Turn 90 degrees and do the same to release the other arm Should grasp the fetus at the thighs with thumbs over the sacrum and index across the iliac crest Let the body partially hang. Assistant should apply suprapubic pressure When the hairline is visible deliver the head
- 18. Important points
- 19. Uterine inversion Folding of the fundus into the uterine cavity 1 in 4000 70% placenta still attached
- 20. Types • 1-4th degree – Cervix, introitus, 4th within the vagina • Acute /Subacute (24hr to 30 days)/Chronic
- 23. How can this happen? Mismanaged 3rd stage – inappropriate traction or too rapid manual removal of placenta Squeezing the uterine fundus to deliver placenta Fundally placed placenta with a short umbilical cord Sudden increase in intra-abdominal pressure with a relaxed uterus Acute tocolysis - anaesthesia Morbidly adhered placenta
- 24. Presentation PPH Mass at the introitus Shock without vaginal bleeding - Neurogenic due to traction on adjacent structures
- 25. Management Manage shock Replace the uterus as soon as possible Manual replacement • With or without GA • May need uterine relaxants • Last part first
- 26. O’Sullivans hydrostatic technique Incising the vaginal ring via a vaginal approach Laparotomy
- 27. Thank you