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
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

10
9
8
7
6
5 Dilatation
4
3
2
1
0
2 4 6 8 10 12
Secondary arrest

10
9
8
7
6
5 Dilatation
4
3
2
1
0
6 8 10 12 14
Arrest in Second Stage

10
9
8
7
6
5 Dilatation
4
3
2
1
0
6 8 10 12 14 16
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
Station @/below 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