Conduct of vaginal delivery

H e n r y O s a z u w aC o n s u l t a n t O b s t e t r i c i a n

Not to teach new things

Its is a Doctor’s world

We run things here

Things should be done our way

You guys are under us

We k

now more

than

you

Not to teach new things

Things should be done our way

Its is a Doctor’s world Its is a Doctor’s world

U n i fi e d T e m p l a t e

IntroductionV a g i n a l d e l i v e r y i s s a f e s t w a y o f e n d i n g a p r e g n a n c y

C o m p a r i s o nC o m p l i c a ti o n r a t e s f o r m o t h e r a n d b a b y

Performed in the second stage of labour

W h a t i s s e c o n d o f l a b o u r ?

F r o m f u l l c e r v i c a l ( 1 0 c m ) d i l a t a ti o n t o d e l i v e r y o f

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 )

Performed in the second stage of labor

S t a m i n a │ C o u r a g e │ C o n fi d e n c e

T h r e e k e y s

W a r n i n g ! Confidence should be based on competence in providing care

Be professional – ALL the time!

S t a m i n a │ C o u r a g e │ C o n fi d e n c e

T h r e e k e y s

Pati ence is C R U C I A L

Be professional – ALL the time!

Watch the “ARROWS”

Pati ence is C R U C I A L

Signs of second stageO n l y p o s i ti v e s i g n – F U L L c e r v i c a l d i l a ta ti o n

1 . U n c o n t r o l l a b l e u r g e t o p u s h ( n e e d s t o p a s s s t o o l ) .

2 . M a y h o l d b r e a t h o r g r u n t d u r i n g c o n t r a c ti o n .

3 . S t a r t t o s w e a t .

4 . M o o d c h a n g e s – s l e e p y o r m o r e f o c u s e d .

5 . E x t e r n a l 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 d u r i n g

c o n t r a c ti o n s .

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 .

What is crowning !

C r o w n i n g m e a n s t h e w i d e s t p a r t o f t h e b a b y ' s h e a d ( t h e c r o w n ! ) h a s p a s s e d t h r o u g h

t h e b o n y p e l v i c o u t l e t .

I n - b e t w e e n c o n t ra c ti o n s , t h e p r o t r u d i n g fo e t a l h e a d t h ro u g h

t h e va g i n a l i n t ro i t u s d o e s n o t r e c e d e .

Equipments, Instruments & personnel

D e l i v e r y / E p i s i o t o m y p a c k P e r s o n n e l

R e s u s c i t a i r e / R a d i a n t w a r m e r – S h o u l d b e o n

D r a p e sB a b y b l a n k e tS w a b sC o r d c l a m p ; S c i s s o r sS p o n g e h o l d i n g f o r c e p sA r t e r y f o r c e p sN e e d l e h o l d e rD i s s e c ti n g f o r c e p sP l a c e n t a b o w lE p i s i o t o m y s c i s s o r sS ti t c h e s

M i d w i v e sD o c t o r s – O b s t e t r i c & P a e d i a t r i cC a r e a s s i s t a n c eR e l a ti v e s

Monitoring

F o e t a l h e a r t r a t e m o n i t o r i n g

E v e r y 5 m i n u t e s

D u r i n g c o n t r a c ti o n s , t h e F o e t a l H e a r t R a t e c a n b e a s s l o w a s 1 0 0 / m i n u t e

R e c o v e r s a ft e r C O N T R A C T I O N !

What is the Normal foetal

heart rate?1 2 0 – 1 6 0

beats/minute

Mothers position

E n c o u r a g e h e r t o b e a r d o w n w i t h e a c h u t e r i n e c o n t r a c ti o n

M a n y ! !!

Squirting

Sitting

Under water

StandingD o r s a l p o s i ti o n w i t h h e a d p r o p p e d u p a n d

h a n d s a r o u n d t h e a n k l e s .

Guarding & Guiding THE PERINEUM

M a n y t e c h n i q u e s h a v e b e e n d e s c r i b e d .

D i ffi c u l t t o d e fi n e a s u p e r i o r t e c h n i q u e .

E n c o u r a g e fl 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.

C u p t h e f o e t a l s c a l p .

S w e e p t h e p e r i n e u m o v e r t h e f o e t a l h e a d .

Delivery the baby

B & C

Delivery the baby

D & E

Delivery of the baby

F

Delivery of the Placenta

3 R D S TA G E O F L A B O U R

A c ti v e a n d E x p e c t a n t M a n a g e m e n t

A c ti v e – D o n ’ t w a i t f o r s i g n s o f p l a c e n t a s e p a r a ti o n .

Delivery of the PlacentaC l a m p i n t w o p l a c e a n d

c u t b e t w e e n c l a m s ; c l o s e t o t h e p e r i n e u m

A p p l y C C T w i t h c o u n t e r p r e s s u r e o n t h e U T E R U S .

Oxytocic- Del ivery o f the anter ior shou lder or the foetus .

O x y t o c i n ( I V/ I M )

E r g o m e t r i n e o r M e t h y l E r g o m e t r i n e

( I V/ I M )

R i s k f o r P P H : 2 0 – 4 0 I U o f O x y t o c i n i n 5 0 0 m l D e x t r o s e i n W a t e r t o r u n 2 H O U R S

M i s o p r o s t o l ( R e c t a l / O r a l )

1 0 I U b o l u s

0 . 5 m g E r g o m e t r i n e

0 . 2 m g M e t h y l E r g o m e t r i n e

4 0 0 – 8 0 0 m i c r o g r a m ( 2 – 4 t a b l e t s )

Immediate post-partum careF o e t a l r e s u s c i t a ti o n

M a s s a g e t h e u t e r u s

E x a m i n e t h e p l a c e n t a

E x a m i n e t h e l o w e r g e n i t a l t r a c t

M a t e r n a l v i t a l s i g n m o n i t o r i n g

E p i s i o t o m y / p e r i n e a l t e a r s

E n c o u r a g e b r e a s t f e e d i n g ( F i r s t h o u r )

Thank you