Normal Delivery

For LU7

Objectives

To outline the conduct of normal labor and delivery

To define personnel requirements

Ideal Situation

How big should OBAS be?

Accurate Diagnosis of Labor

Contractions occur at regular intervals Intervals shorten Intensity increases Discomfort in back and abdomen Cervix dilates Discomfort not stopped by sedation

Transfer of patients

“A woman in true labor is considered unstable for interhospital transfer purposes until the child and placenta are delivered … unless the risks of transfer are outweighed by benefits of treatment at another facility…violation (carries) civil penalties of up to $50,000…” (Williams, 2001)

Electronic Admissions Testing

Non stress test is performed before patient is discharged from admitting of labor unit..

Vaginal examination Not performed if bleeding in excess of

bloody show Amniotic fluid egress examined using

sterile speculum to check for pooling Cervix softness, effacement,

dilatation, position Presenting part Station Pelvimetry

Monitoring in 1st stage

Fetal heart rate every 15 to 30 min (110-170 beats per minute)

Uterine contractions by intervals, duration and intensity

Maternal vital signs at least every 4 hours (hourly for hypertensives)

Vaginal examinations every 2 to 3 hours (hourly if in active phase)

Monitoring during 2nd stage

Fetal heart rate every 15 min for low risk and every 5 min for high risk

Positioning in lithotomy and prepping

Episiotomy Not routine Increases the risk

of tears through the rectum

Done once fetal head bulges through the perineum

Delivery of head Crowning is when

the largest diameter of the fetal head is encircled by the peritoneum

Ritgen’s maneuver Forward pressure

on chin of fetus in direct occiput anterior position once perineum is distended 5 cm or more

Favors extension of head

Delivery of shoulders Head in transverse

position and bisacromial diameter in AP

Sides of head are grasped and gentle traction exerted downward to deliver anterior shoulder from under symphysis pubis

Handling the nuchal cord

Delivery of placenta 4 signs of

separation Globular uterus Gush of blood Uterus rises Lenghtening of cord

Active management of 3rd stage

Oxtyocin drip 5 to 10 units after cord clamping

Methyl ergometrine 0.5 mg IM after placenta is delivered (deferred for hypertensive patients)

Management of 4th stage of labor

Involution of uterus Postpartum hemorrhage >500 cc

assessed (laceration, atony, etc.) Uterine massage and uterotonics

given (including misoprostol)

Repair of episiotomy

Features median vs. mediolateral episiotomy

Assess extent of tears Cervical lacertaion Urethral, periurethral Vaginal side walls Sphincter tears Rectal mucosal tears

Episorraphy Goal is to control

hemorrhage and restore anatomy without excessive suturing

Sutures used are chromic 2-O and vicryl 2-O with big round needle

Thank you!