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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Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
Series of events that takes place in the genital organ in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour.
there are four stages of labour.
This presentation contains details on normal anatomy on female pelvis and fetal head, process of normal labour, abnormal labour, induction of labour and malpresentations.
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
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.
Normal labor usually begins within 2 weeks (before or after) the estimated delivery date. In a first pregnancy, labor usually lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours.
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WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
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In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
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Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
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4. MECHANISMS OF NORMAL LABOUR
• The following criteria should be present to call it normal labour
Spontaneous expulsion,
of a single,
mature fetus (37 completed weeks – 42 weeks),
presented by vertex,
through the birth canal (i.e. vaginal delivery),
within a reasonable time (not less than 3 hours or more than 18 hours),
without complications to the mother,
or the fetus
5. What are the stages of labour?
The first stage:
begins when start having contractions that cause progressive changes in
the cervix and ends when the cervix is fully dilated. This stage is divided
into two phases:
Latent phase (~8H): Point at which woman perceives regular uterine
contractions until 4cm dilatation. Prolonged if >20H in a nulliparous;
>16H if multipara.
Active phase (~8H nullipara, 6H multipara): 4cm dilatation to fully dilated
and regular contractions. Rate of dilatation should be >1cm per hour if
nulliparous; >1.5cm per hour if multipara.
6. • The second stage of labor begins when the cervix is fully
dilated and ends with the birth of the baby. This is
sometimes referred to as the "pushing" stage.
• The third stage: begins right after the birth of the baby
and ends with the delivery of the placenta. This is the
shortest stage, lasting up to 30 minutes, with an average
length of 5 to 10 minutes. There is no difference in
duration for nulliparous and parous.
8. Aims in the management of labour
To achieve delivery of a normal healthy child
To anticipate, recognize and treat potential abnormal conditions
before significant hazard develops for the mother or the fetus.
9. MANAGEMENT Of 1st STAGE OF LABOUR
I. Assessment
II. Preparation and care
III. Partogram
10. • I. Assessment
1. History:
• 1. Woman’s antenatal record is reviewed 2. No records
of antenatal care: complete history .
2. Examination
General
Pallor, edema, abdominal scar
Vital signs: BP, pulse, RR and Temp.
Abdominal examination:
• a. Presentation and position and engagement
• b. Auscultate the fetal heart
• c. Evaluate the uterine contraction
11. Vaginal examination
• Presentation, Engagement, Position
• Membranes: Intact or absent: exclude cord prolapse after ROM
• Cervix: Consistency, position Dilatation Effacement,
• Assess the adequacy of the pelvis.
• 3. Investigation
Urine: Protein, Sugar, ketones
Blood: CBC ,RBS, Grouping ,cross match for high risk
patients.
12. • II. Preparation and care
1. Bowel preparation: Indicated when there is
No bowel action for 24 h or Rectum feels loaded on vaginal
examination .
2. Bladder care: Encourage to empty bladder1½ - 2 h. (A full
bladder: prevent the fetal head from entering the pelvic brim impede
descent of the fetal head. inhibit effective uterine action).
The quantity of urine should be measured and recorded and a
specimen obtained for testing.
3. Nutrition : No food is permitted after labour is established
{prevent regurgitation and aspiration} , Small amount of clear fluid or
frozen pineapple, Ice chips to moisten the mouth , Maintain adequate
hydration via intravenous routes
13. 4.Position of labouring mother:
As long as the patient is healthy, the presentation normal, the
presenting part engaged, and the fetus in good condition, the patient may
walk about or may be in bed, as she wishes.
5. Pain relief :for Severe pain :
Opiate drugs: e.g. Pethidine IM/4 h
Inhalational analgesia: e.g. Entonox
Epidural analagesia .
III. Monitoring the progress of labour :
Once labour has become established, all events during labour should be
recorded on a partogram.
a) fetal Well-being. b) maternal Well-being. c) Progress of the labour .
16. How To Monitor The Fetal Heart Rate?
Auscultation methods
Electronic monitoring ~ CTG }=== To detect fetal hypoxia
17. Progress of labour
I. Cervical dilatation (cm).every vaginal examination.
Causes of cervical dilatation:
Contraction and retraction of uterine musculature.
Mechanical pressure by the bulging membrane .
The descend of the presenting part.
Phases of cervical dilatation
Latent phase – the first 3 cm of dilatation; a slow process (8 hours in nulliparous and 3 hours in multiparous
Active phase – this is active process of cervical dilatation; the normal rate is 1 cm/hour
II. Descend:
• every vaginal examination (amount of head palpable above pelvic brim).
20. MANAGEMENT 2nd STAGE OF LABOUR
I. Preparation
II.Observation
III.Conduct of delivery
21. I. Preparation
1. Maternal position:
With the exception of avoiding supine position, the mother may
assume any comfortable position for effective bearing down.
Semi-recumbent or
Supported sitting position, with the thighs abducted
2. PERINEAL CLEANSING
When delivery is imminent skin over the lower abdomen, vulva, anus
and upper thigh is cleansed with antiseptic solution.
22. PERINEAL CLEANSING
Need 6 swab balls
Clean sequentially as shown by the numbers
Clean according to the direction shown by the
Arrows
23. II. Observation
1.Maternal conditions
• Emotional condition
• pulse quarter-hourly
• bloods pressure hourly
2.Fetal conditions
FHR: either continuously or after each contraction.
Liquor: meconium staining.
3.Uterine contractions: Strength, Duration, Frequency, assessed continuously.
4.The progress of descent: every 30 minutes
24. III. CONDUCTING THE DELIVERY
• 1. DELIVERY OF THE HEAD
Control the delivery of the head to prevent laceration that occur
when the head born suddenly,& the head must be flexed until the
largest diameter has passed vulval outlet.
Once the head has crowned , the women should be discouraged
from bearing down by telling her to take shallow breaths.
The head now delivered by pressure through perineum on to the
forehead , the fingers & thumb placed on each side of the anus ,
pushing the head forward slowly before it is allowed to extend and
complete its delivery, & control the rate of escape with the other
hand.
25. place the fingers of one hand against the baby’s head to keep it flexed (bent),
Continue to gently support the perineum as the baby’s head delivers
26. • •Instruct the mother to focus on her breathing. Have
her “breathe heavily” to help her stop pushing and
prevent a forceful birth.
27. Once the baby’s head delivers, ask the woman not to push
Suction the baby’s mouth and nose
28. CORD AROUND THE NECK
Feel around the baby’s neck for the umbilical cord..
If the cord is around the neck, attempt to slip it over
the baby’s head
If the cord is tight around the neck, doubly clamp
and cut it before unwinding it from around the neck
29.
30. As the head emerges, the baby will turn to one side (for
easier passage of shoulders through birth canal)
Note the time, if possible
31. Allow the baby’s head to turn spontaneously.
•After the head turns, place a hand on each side of the
baby’s head.
•Tell the woman to push gently with the next contraction.
•Reduce tears by delivering one shoulder at a time
36. 4. DELIVERY OF THE TRUNK
After the delivery of the shoulders the baby is grasped around
the chest to aid the birth of the trunk.
Finally, the body is slowly extracted by traction on the
shoulders and lifts the baby towards the mother’s abdomen.
The time of delivery is noted.
37.
38. 5. CLAMING AND CUTTING THE UMBILICAL CORD
After delivery .. wait 15 to 20 seconds before clamping
and cutting the umbilical cord.
After cutting the cord a plastic crushing clamp is placed
on the cord 1 to 2 cm from the umbilicus and the cord
is cut again 1 cm beyond the clamp.
41. EPISIOTOMY
Surgical incision into the perineum to enlarge the
diameter of vulval outlet & assist childbirth.
Benefits:
1.Speed up the birth
2.Prevent Tearing
3.Protects against incontinence
4.Protects against pelvic floor relaxation
5.Heals easier than tears
43. Indications :
1. Sizeable babies with anticipation of shoulder dystocia.
2. Shoulder dystocia.
3. Instrumental delivery (according to judgement)
4. Breech
5. Scarring from female genital mutilation or poorly healed third or
fourth degree tears
6. Fetal distress.
7.Prevent perineal tear or excessive stretching of muscles ,tear may
involve anal sphincter and stretching may lead to prolapse in later
years
8.Prevent damage from abnormal presenting part e.g face
presentation .
47. IMMEDIATE CARE OF THE NEW BORN
Once the baby is breathing normally he should be dried and warmly
wrapped to prevent cooling and handle to the mother to hold, cuddle
and enjoy.
If spontaneous respiration is not established soon after birth,
resuscitation is the immediate priority.
The Apgar’s score of the baby should be noted and recorded.
48. MANAGEMENT 3nd STAGE OF LABOUR
I. Delivery of placenta
II. Examination of placenta
& perineum
III. Repair of episiotomy
49. I. Delivery OF THE PLACENTA :
two stages:
1) Separation of the placenta from the wall of the uterus and into the lower uterine
segment and/or the vagina, and
2) Actual expulsion of the placenta out of the birth canal.
MECHANISM OF PLACENTA SEPARATION:
1-Mathews-Duncan mechanism
The leading edge of the placenta separates first and the placenta is delivered with its raw
surface exposed.
2- Schultz mechanism :
If the placenta is inserted at the fundus and central area separates first, the placenta
inverts and draws the membranes after it, covering the raw surface (inverted umbrella)
50. • SIGNS OF PLACENTAL SEPARATION
• within 5 minutes after the delivery of the infant.
1. The uterus becomes globular and hard. =earliest to appear.
2. Sudden gush of blood
3. The uterus rises in the abdomen because the placenta, having separated
passes down into the lower segment and vagina, where its bulk pushes the uterus
upward.
4. Cord lengthening. =most reliable clinically.
51. ACTIVE MANAGEMENT OF THE THIRD STAGE
• Helps prevent postpartum haemorrhage. includes:
1. use of oxytocin
2. controlled cord traction,
3. uterine massage.
• Once the signs of placental separation have occurred the obstetrician
assists delivery of the placenta by controlled cord traction as
described by Brandt- Andrews’ method. If the patient is awake, she is
asked to bear down while gentle traction is made on the umbilical
cord.
52. • II. EXAMINATION
• 1. OF THE PLACENTA : The placenta, membranes, and umbilical cord
should be examined for completeness and for anomalies.
• 2. OF THE PERINEUM :At the same time, the perineal region, vulva
outlet, vaginal canal, and the cervix should be carefully examined for
lacerations.
• If the perineum has been torn or an episiotomy made, tear or
incision should be repaired immediately.
• III. REPAIR OF EPISIOTOMY
• Suture as soon as possible after delivery to avoid bleeding and
infection.