Special Tutorial programme Professor Deirdre Murphy Trinity College

Labour & Delivery

Objectives Normal Labour Abnormal Labour Induced Labour

Normal Labour & Delivery

Components of normal labour Powers Passages Passenger

Powers Uterine contractions Maternal effort

Passages Maternal pelvis Inlet Outlet

Pelvic inlet

Pelvic outlet

Passenger Fetal size Fetal presentation Fetal position Moulding

Mechanism of birth Engage in transverse position Rotate in mid-pelvis Flexed descent onto perineum Crowning Extension of neck Restitution Delivery anterior shoulder Delivery posterior shoulder

Student exercise

Diagnosis of labour Stages of labour Partogram Maternal Fetal Progress Pain relief Delivery

Diagnosis of labour Regular painful contractions resulting in progressive change of the cervix +/- show +/- rupture of membranes

Stages of labour First stage Onset of labour until full dilatation of cervix Second stage Full dilation of cervix until delivery of baby Third stage Delivery of baby until complete delivery of placenta and membranes

Partogram - Maternal Name / DOB /Gestation Medical / Obstetrical issues HR / BP/ Temp Urinalysis

Partogram - Fetal Gestational age Fetal heart rate Liquor

Partogram - Progress Uterine contractions Cervical dilatation Descent of presenting part Caput / Moulding Fetal position

Pain relief Support Water Opiates Entonox Epidural Complementary

Partogram - delivery Time of birth Gender of infant Birthweight Apgar scores at 1/5 mins Cord gas Resuscitation Complications

Abnormal Labour & Delivery

What can go wrong? Powers Poor contractions/Maternal effort Passages Small pelvis/Pelvic shape Passenger Big baby/Presentation/Malposition

Abnormal powers Artificial rupture of membranes Oxytocin infusion Change position Encouragement

Passages / Passenger Cannot influence pelvic size / fetal wt Can correct malposition / descent Oxytocin infusion Change position Assisted birth

Primary arrest

Secondary arrest

Arrest in Second Stage

Types of assisted birth Forceps Vacuum / Ventouse Caesarean section

Forceps / Vacuum - Indications Prolonged second stage Suspected fetal compromise Maternal medical conditions

Forceps / Vacuum - Criteria Expertise Consent Analgesia Fully dilated / membranes ruptured Bladder empty Position known Fully engaged spines

Complications Failed attempt Trauma to baby Trauma to mother

Video – vacuum delivery

Induction of labour

Definition Artificial onset of labour

Indications Maternal condition Fetal condition Prolonged pregnancy Prolonged rupture of membranes Hypertensive disorders Fetal growth / well-being Medical disorders Maternal request

Methods Artificial rupture of membranes Prostaglandin

Risks Dates / prematurity Failed induction Long/difficult labour Interventions Neonatal complications

Summary

Covered Normal Labour Abnormal Labour Induced Labour

Practice Assessment