1. Special Tutorial programme Professor Deirdre Murphy Trinity College

2. Labour & Delivery

3. Objectives Normal Labour Abnormal Labour Induced Labour

4. Normal Labour & Delivery

5. Components of normal labour Powers Passages Passenger

6. Powers Uterine contractions Maternal effort

8. Passages Maternal pelvis Inlet Outlet

9. Pelvic inlet

10. Pelvic outlet

11. Passenger Fetal size Fetal presentation Fetal position Moulding

13. 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

15. Student exercise

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

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

18. 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

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

20. Partogram - Fetal Gestational age Fetal heart rate Liquor

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

22. Pain relief Support Water Opiates Entonox Epidural Complementary

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

24. Abnormal Labour & Delivery

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

26. Abnormal powers Artificial rupture of membranes Oxytocin infusion Change position Encouragement

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

28. Primary arrest

29. Secondary arrest

30. Arrest in Second Stage

31. Types of assisted birth Forceps Vacuum / Ventouse Caesarean section

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

36. Forceps / Vacuum - Criteria Expertise Consent Analgesia Fully dilated / membranes ruptured Bladder empty Position known Fully engaged Station @/below spines

37. Complications Failed attempt Trauma to baby Trauma to mother

40. Video – vacuum delivery

41. Induction of labour

42. Definition Artificial onset of labour

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

44. Methods Artificial rupture of membranes Prostaglandin

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

46. Summary

47. Covered Normal Labour Abnormal Labour Induced Labour

48. Practice Assessment