[ppt]powerpoint presentation - trinity college, dublin · web viewspecial tutorial programme...
TRANSCRIPT
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Special Tutorial programme
Professor Deirdre MurphyTrinity College
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Labour & Delivery
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Objectives
Normal Labour
Abnormal Labour
Induced Labour
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Normal Labour & Delivery
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Components of normal labour
Powers
Passages
Passenger
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Powers
Uterine contractions
Maternal effort
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Passages
Maternal pelvis
Inlet
Outlet
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Pelvic inlet
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Pelvic outlet
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Passenger
Fetal size
Fetal presentation
Fetal position
Moulding
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Mechanism of birth
Engage in transverse positionRotate in mid-pelvisFlexed descent onto perineumCrowning Extension of neckRestitutionDelivery anterior shoulderDelivery posterior shoulder
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Student exercise
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Student exercise
Diagnosis of labourStages of labourPartogram
Maternal FetalProgressPain relief
Delivery
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Diagnosis of labour
Regular painful contractions resultingin progressive change of the cervix
+/- show+/- rupture of membranes
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Stages of labour
First stageOnset of labour until full dilatation of cervix
Second stageFull dilation of cervix until delivery of baby
Third stageDelivery of baby until complete delivery of placenta and membranes
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Partogram - Maternal
Name / DOB /Gestation
Medical / Obstetrical issues
HR / BP/ Temp
Urinalysis
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Partogram - Fetal
Gestational age
Fetal heart rate
Liquor
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Partogram - Progress
Uterine contractionsCervical dilatationDescent of presenting partCaput / MouldingFetal position
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Pain relief
SupportWaterOpiatesEntonoxEpiduralComplementary
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Partogram - delivery
Time of birthGender of infantBirthweightApgar scores at 1/5 minsCord gasResuscitationComplications
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Abnormal Labour & Delivery
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What can go wrong?
Powers Poor contractions/Maternal effort
Passages Small pelvis/Pelvic shape
PassengerBig baby/Presentation/Malposition
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Abnormal powers
Artificial rupture of membranesOxytocin infusion
Change positionEncouragement
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Passages / Passenger
Cannot influence pelvic size / fetal wtCan correct malposition / descent
Oxytocin infusionChange positionAssisted birth
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Primary arrest
012345678910
2 4 6 8 10 12
Dilatation
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Secondary arrest
012345678910
6 8 10 12 14
Dilatation
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Arrest in Second Stage
012345678910
6 8 10 12 14 16
Dilatation
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Types of assisted birth
Forceps
Vacuum / Ventouse
Caesarean section
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Forceps / Vacuum - Indications
Prolonged second stage
Suspected fetal compromise
Maternal medical conditions
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Forceps / Vacuum - Criteria
ExpertiseConsent AnalgesiaFully dilated / membranes rupturedBladder emptyPosition knownFully engagedStation @/below spines
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Complications
Failed attempt
Trauma to baby
Trauma to mother
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Video – vacuum delivery
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Induction of labour
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Definition
Artificial onset of labour
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Indications
Maternal conditionFetal condition
Prolonged pregnancyProlonged rupture of membranesHypertensive disordersFetal growth / well-beingMedical disordersMaternal request
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Methods
Artificial rupture of membranes
Prostaglandin
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Risks
Dates / prematurity
Failed induction
Long/difficult labour
Interventions
Neonatal complications
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Summary
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Covered
Normal Labour
Abnormal Labour
Induced Labour
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Practice Assessment