Transcript ppt - HZ Undergraduate Obstetrics & Gynaecology

NORMAL & ABNORMAL LABOUR
Part 2: Abnormal Labour
HANGZHOU WOMENS HOSPITAL
International Undergraduate Course, 2011
1. Induction of labor (RCOG GTG)
2. Fetal monitoring
3. Failure to progress in labour
4. Malpresentation/Malposition OP, breech, etc
5. Cephalopelvic disproportion
6. Operative vaginal delivery (RCOG GTG)
7. Shoulder dystocia (RCOG GTG)
8. VBAC (RCOG GTG)
IMPORTANT TOPICS NOT COVERED IN DETAIL
1. External cephalic version (ECV)
2. Anal sphincter laceration (RCOG GTG)
3. Shoulder dystocia (RCOG GTG)
4. Hypoxic-ischaemic encephalopathy (HIE)
5. Other causes of cerebral palsy
6. CTG patterns (with examples) Beckmann 113
7. Meconium aspiration syndrome
8. VBAC (RCOG GTG)
9. Episiotomy – indications, techniques, repair
10. Epidural anaesthesia – indications, techniques
1. Induction of labour
INDUCTION OF LABOUR 1. AMNIOTOMY
INDUCTION OF LABOUR 2. OXYTOCIN
Poor uterine function, abnormal FHR patterns,
hyperstimulation, uterine rupture, water intoxication.
2. Fetal monitoring
2. Fetal monitoring
2.1 Cardiotocography or Non-stress testing
2. Fetal monitoring
2.2 Baseline rate, HR variability, accelerations, decelerations
2. Fetal monitoring
2.3 Early, variable and late decelerations
“DR C BRAVaDO”
Used in labor ward for interpreting a cardiotocograph:
Define Risk, Contractions, Baseline Rate, Accelerations,
Variability, Decelerations, Other features
2. Fetal monitoring 2.4 Fetal blood sampling
3. Failure to progress in labour
4a. MALPOSITION e.g. OP position
4b. MALPRESENTATION - breech
RCOG GT Guideline
RCOG GTG No.20
Term Breech trial
Unfavourable features
Trial of Labour
Epidural anaesthesia
Mauriceau-Smellie-Veit manoeuvre
Burns-Marshall manoeuvre
Lovset’s manoeuvre
After-coming head
5. Cephalopelvic disproportion (CPD)
Absolute
Or
Relative
6. Operative vaginal delivery
This is a disposable, vacuum delivery system.
It consists of a cup and a handle, connected by plastic tubing.
The cup contains a yellow, foam pad.
This prevents blockage of the tubing during a vacuum delivery.
The handle contains a vacuum indicator.
It is marked in yellow, green and red.
The handle also contains a traction force indicator.
It is marked in kilograms and pounds. It also has a vacuum release button
Application of the “Kiwi” cup
1. All the usual conditions for operative vaginal delivery are present
i.e. full dilatation of the cervix, ruptured membranes, empty
bladder, the presenting part is cephalic, etc.
2. Use plenty of obstetric cream on the cup.
3. Place two fingers at the fourchette and insert the cup.
4. Apply the cup to the “flexion point” of the fetal head. Place the
groove on the cup along the sagittal suture so that you can
check for rotation of the head during the delivery.
5. Use the pump to increase the vacuum to the “yellow mark”
6. Check that there is no vaginal wall trapped by the cup.
7. Wait for a contraction. Increase the vacuum to the “green mark”
8. Apply traction along the axis of the birth canal.
9. After delivery release the vacuum using the vacuum release
button. Check the scalp of the baby after delivery.
7. Shoulder dystocia
“HELPERR” mnemonic
http://www.rcog.org.uk/files/rcog-corp/uploadedfiles/GT42ShoulderDystocia2005.pdf
8.Vaginal birth after Caesarean section
IMPORTANT TOPICS NOT COVERED IN DETAIL
1. External cephalic version (ECV)
2. Anal sphincter laceration (RCOG GTG)
3. Shoulder dystocia (RCOG GTG)
4. Hypoxic-ishamic encephalopathy (HIE)
5. Other causes of cerebral palsy
6. CTG patterns (with examples) Beckmann 113
7. Meconium aspiration syndrome
8. VBAC (RCOG GTG)
9. Episiotomy – indications, techniques, repair
10. Epidural anaesthesia – indications, techniques