Conduct of vaginal delivery

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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

  1. 1. Conduct of vaginal delivery H e n r y Osazuwa C o n s u l t a n t O b s t e t r i c i a n
  2. 2. Its is a Doctor’s world Things should be done our way Not to teach new things U n i f i e d Te m p l a te You guys are under us Its is a Doctor’s world Its is a Doctor’s world
  3. 3. Introduction Vaginal delivery is safest way of ending a pregnancy Comparison C o m p l i c a t i o n r a t e s f o r m o t h e r a n d b a b y
  4. 4. Performed in the second stage of labour What is second of labour? From full cervical (10 cm) dilatation to delivery of 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 )
  5. 5. Performed in the second stage of labor Three keys Stamina │ Courage│ Confidence Warning! Confidence should be based on competence in providing care
  6. 6. Be professional – ALL the time! Patience is CRUCIAL Three keys Stamina │ Courage│ Confidence Be professional – ALL the time!
  7. 7. Watch the “ARROWS” Patience is CRUCIAL
  8. 8. Signs of second stage Only positive sign – FULL cervical dilatation 1. U n c o n t r o l l a b l e u r g e to push(needs to pass stool). 2. May h o l d b r e a t h o r g r u n t during contraction. 3. Start to s w e a t . 4. Mood changes – s l e e p y o r m o r e f o c u s e d . 5. External 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 during contractions. 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 .
  9. 9. What is crowning !
  10. 10. Crowning means the widest part of the baby's head (the crown!) has passed through the bony pelvic outlet. In-between contractions, the protruding foetal head through the vaginal introitus does not recede.
  11. 11. Equipments, Instruments & personnel Delivery/Episiotomy pack Drapes Baby blanket Swabs Cord clamp; Scissors Sponge holding forceps Artery forceps Needle holder Dissecting forceps Placenta bowl Episiotomy scissors Stitches Personnel Midwives Doctors – Obstetric & Paediatric Care assistance Relatives Resuscitaire/Radiant warmer – Should be on
  12. 12. Monitoring Foetal heart rate monitoring Every 5 minutes During contractions, the Foetal Heart Rate can be as slow as 1 0 0 / m i n u t e R e c o v e r s after CONTRACTION!
  13. 13. What is th e Norm al foetal heart rate? 120 – 160 beats/minute
  14. 14. Mothers position M a n y ! !! Squirting Sitting Under water Standing Dorsal position with head propped up and hands around the ankles. Encourage her to bear down with each uterine contraction
  15. 15. Guarding & Guiding THE PERINEUM Many techniques have been described. Difficult to define a superior technique. E n c o u r a g e f l 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. Cup the foetal scalp. Sweep the perineum over the foetal head.
  16. 16. Delivery the baby B & C
  17. 17. Delivery the baby D & E
  18. 18. Delivery of the baby F
  19. 19. Delivery of the Placenta 3 R D S TA G E O F L A B O U R A c t i v e and Expectant Management Active – Don’t wait for signs of placenta separation.
  20. 20. Delivery of the Placenta Clamp in two place and cut between clams; close to the perineum Apply CCT with counter pressure on the UTERUS.
  21. 21. Oxytocic- Delivery of the anterior shoulder o r t h e f o e t u s. O x y t o c i n ( I V/ I M ) E r g o m e t r i n e or Methyl Ergometrine ( I V/ I M ) Misoprostol (Rectal/Oral) 10 0.5 0.2 IU bolus mg Ergometrine mg Methyl Ergometrine 400 – 800 microgram (2 – 4 tablets) Risk for PPH: 20 – 40 IU of Oxytocin in 500 ml Dextrose in Water to run 2 HOURS
  22. 22. Immediate post-partum care Foetal resuscitation Massage the uterus Examine the placenta Examine the lower genital tract Maternal vital sign monitoring Episiotomy/perineal tears Encourage breast feeding (First hour)
  23. 23. Thank you

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