Special Tutorial programme Professor Deirdre Murphy Trinity College.
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Transcript of Special Tutorial programme Professor Deirdre Murphy Trinity College.
Mechanism of birth
Engage in transverse positionRotate in mid-pelvisFlexed descent onto perineumCrowning Extension of neckRestitutionDelivery anterior shoulderDelivery posterior shoulder
Student exercise
Diagnosis of labourStages of labourPartogram
Maternal FetalProgressPain relief
Delivery
Diagnosis of labour
Regular painful contractions resultingin progressive change of the cervix
+/- show+/- rupture of membranes
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
Partogram - Progress
Uterine contractionsCervical dilatationDescent of presenting partCaput / MouldingFetal position
Partogram - delivery
Time of birthGender of infantBirthweightApgar scores at 1/5 minsCord gasResuscitationComplications
What can go wrong?
Powers Poor contractions/Maternal effort
Passages Small pelvis/Pelvic shape
PassengerBig baby/Presentation/Malposition
Passages / Passenger
Cannot influence pelvic size / fetal wtCan correct malposition / descent
Oxytocin infusionChange positionAssisted birth
Forceps / Vacuum - Indications
Prolonged second stage
Suspected fetal compromise
Maternal medical conditions
Forceps / Vacuum - Criteria
ExpertiseConsent AnalgesiaFully dilated / membranes rupturedBladder emptyPosition knownFully engagedStation @/below spines
Indications
Maternal conditionFetal condition
Prolonged pregnancyProlonged rupture of membranesHypertensive disordersFetal growth / well-beingMedical disordersMaternal request
Risks
Dates / prematurity
Failed induction
Long/difficult labour
Interventions
Neonatal complications