Instruments and Medications in Labour Room & Ot(1)

7/29/2019 Instruments and Medications in Labour Room & Ot(1)

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INSTRUMENTS AND MEDICATIONSIN LABOUR ROOM & OT


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Vacuum

Instrument used as alternative to forceps, which

adheres to fetal scalp by suction cup & is used to

assist maternal expulsive efforts


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MetalVacuum

cup

Siliconerubber

cup

Kiwiomnicup


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Indication

Prolonged 2ndstage of labor

To shorten 2nd

stage of labor Presumed fetal

distress

Poor maternalcontraction

Contraindication

Malposition (Face,breech)

POA less than 35

weeks Cephalic pelvis

disporpotion

Uncertainty onfetal position andstation


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Dilatation and full

engagement ofthe head

Contraction

present

No CPD

POA: >35w

Pre-requisite Prolonged or

excessive tractionshould not beused.

Traction is beapplied during

uterinecontraction

vaginal skinshould beexcluded from the

edge of the cup.

Precaution


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Complication

Lacerations to the cervix, vagina,perineum, or bladder

Extension of episiotomies

Increase in blood loss

Pelvic organ prolapse

Urinary stress incontinence

anal sphincter injuries

Maternal

Scalp abrasions Caput succedaneum

Intracranial bleeding

Subaponeurotic hemorrhagesFetal


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ForcepsInstruments designed to aid in the delivery of

the fetus by applying traction to the fetal head.

Types offor forceps

delivery

Highforceps

Outletforceps

Low

forceps

Midforceps


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F fully dilated

O OA & OP position

R Rupture of membrane

C No CPD

E Engaged, episotomy

P pudendal nerve block

S sterilization, skills and experties

Pre-requisite

Prolong 2nd stge of labour

Fetal distress

Maternal condition such as cerebrovasculardisease, hypertensive disorder

Indication


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Contra-indication

Refusal of the patient

Cervix not fully dilated

Inability to determine the presentation and fetal headposition

Confirmed cephalopelvic disproportion

Severe moulding/caput

Unsuccessful trial of vacuum extraction

Complication

Lacerations to the cervix or vagina

Trauma to maternal anal sphincter

Fetal facial nerve injury

Fetal skull fracture


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Episiotomy Set1 2 3

45 6

7 8 9 10


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1 : Episiotomy scissor

2 : artery forcep straight3 : Tissue tooth forcep

4 : kidney dish

5 : sponge holder6 : needle holder

7 : Gallipot

8 : straight scissor

9 : artery forcep curve

10: instrumental tray


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Indication

Prolonged 2ndstage due to

rigid perineumInstrumental

delivery

Prematuredelivery

Complication

hemorrhage

Infection

Extension toanal sphincter

Dyspareunia


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Fetal Scalp ElectrodeWHAT IS THE INDICATION?

1) When external CTG inadequate todetect accurate interpretation

2) For 1st twin in twin prengnancy

WHAT IS THE CONTRAINDICATION?

- Face presentation

- Unknown presentation

- HIV seropositive/Hep B,C

- Active genital herpes

- Suspect thrombocytopenia/ ITPP

WHAT IS THE WEAKNESS?

1) invasive

2) more tedious to apply

3) mmbrane must absent

4) just apply during intra-partum

5) direct contact to fetus

6) high risk for infection


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CARDIOTOCOGRAPHY

What is Cardiotocography?

Cardiotocography (CTG) is used in pregnancy to monitor

both the fetal heart as well as the contractions of the

uterus. It is usually only used in the 3rd trimester. Itspurpose is to monitor fetal well-being & allow early

detection of fetal distress. An abnormal CTG indicates the

need for more invasive investigations & ultimately may

lead to emergency caesarian section.


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How it works?

It involves the placement of 2 transducers on the

abdomen of a pregnant women. One transducer records the foetal heart rate using

ultrasound.

The other transducer monitors the contractions of

the uterus.

It does this by measuring the tension of the

maternal abdominal wall.

This provides an indirect indication of intrauterinepressure.


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HOW TO INTERPRET CTG?

CONTRACTION

Record the number of contractions present in a 10 minute

period - e.g. 3 in 10

Each big square is equal to 1 minute, so you look howmany contractions occurred in 10 squares

Individual contractions are seen as peaks on the part of

the CTG monitoring uterine activity


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FETAL HEART RATE The baseline rate is the average

heart rate of the fetus in a 10minute window

Look at the CTG & assess what

the average heart rate has been

over the last 10 minutes

Normal fetal heart rate 110-160bpm

Fetal tachycardia >160bpm

- Fetal hypoxia- Chorioamnionitisif maternal fever

also present

- Hyperthyroidism

- Fetal or Maternal Anaemia

-Fetal tachyarrhythmia

Fetal bradycardia


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VARIABILITY

Minor fluctuation in baseline fetal heart rate

occurring at 3 to 5 cycle per minute

Measure by estimating the difference in beats

perminute between the highest peak and

lowest through of fluctuation in a one minute

segment of the trace


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Acceleration

Transient increase in

FHR of 15bpm or morelasting 15s or more

Deceleration

Transient episode of slowing FHR

below the baseline level of more than

15bpm and lasting 15s or more

1. Early deceleration

Uniform repetitive, periodic

slowing of FHR with onset early

in the contraction and return to

baseline at the end of

contraction

1. Late decelerationuniform repetitive, periodic

slowing of FHR with onset mid to

end of the contraction and nadir

more than 20s after the peak of

the contraction and ending after

the contraction.


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Catheter

A. Name of the instrument.Foley catheter

B. What are the use of this instruments?

- Urine drainage- Mechanical IOL

C. How it is used as mechanical IOL

- it cause the cervix to mechanicallyopen and make the cervix morefavorable


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Fetal Blood SamplingA. Name of the instrument.

Amnioscope

B. What are these instruments for?

Fetal Blood Sampling procedure todetermine fetal pH

C. Indication for the procedure.

- non reassuring CTG with either clearliquor or LMSL or MMSL, when cervicaldilatation is >= 3 cm.

D. Contraindication for the procedure.

- Maternal infection (HIV,Hep B/C)

- Fetal bleeding disorders

- Prematurity (


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Partogram

Defintion:

graphical record that record the progress of labour.

Part 1:Fetal condition

fetal heart rate

liqour moulding

Part 2:Progress of labour

Cervical dilationDescent of head

contraction


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Part 3:maternal condition

pulse rate

blood pressure temperature


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Abnormal progress of labour

1.Prolong latent phase

Def: more than 8 hours

2.Prolong active phase

-primary dysfunction labour

- cervical dilation less

than 1cm/hour

-secondary arrest

-Progress active phase initialy good but become

slow/stop typically after 7cm dilation.


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Causes:

1.Powers

-inefficient uterine action

Mx:maternal rehydration

:artificial rupture membrane

:IV oxytocin(syntocinon)


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2.Passenger(fetus)

-big size

-malposition-malpresentation

3.Passages( uterus,cervix,bony pelvis)

eg:cephalopelvic disproportionMx:ceaserean section


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Syntocinon & Syntometrine


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active management of 3 stage of labour

Prevention and treatment of PPH withuterine atonyIndication

Hypersensitivity to oxytocin andergometrine

Severe hypertension

Severe cardiovascular disorders

Pre-eclampsia/eclampsia

Contraindication

Nausea, vomiting

Abdominal pain

Headache, dizziness

RashSide Effects


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Anelgesia In labour


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Pethidine

Given intramuscularly

Dosage:

1-2 mg/kg (usual dose 50-100mg)

together with phenergan 0.5 mg/kg(usual dose 25 mg)

Administered during early labour or

When the delivery is not expectedwithin 4 hour of injection

Used to relieve moderate to severepain


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Side-effects:

Drowsiness

Nausea

Vomiting

The baby may require naloxone to treat

respiratory depression if delivered within 4

hours of pethidine injection

An overdose of pethidine may cause

convulsions (fits), respiratory depression(breathing difficulties), hypotension, shock

and coma


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Entonox

A gas made up of 50% oxygen and 50% nitrous

oxide(NO)

Self administered via a face mask or mouth

piece

Instruction: start inhaling at the beginning of

contraction, continue deep shallow breathing

during contraction and remove the mask from

the face when contraction eases off.


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Can be given at any time of labour, as sole

analgesic or in combination with epidural

analgesia during late first stage or second

stage of labour.

Side-effects:

Drowsiness

Nausea

Vomiting


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Epidural

A type of regional analgesia

Involves the administration of a dilute amount

of local anesthetic either in the form of

bupivacaine or ropivacaine combined with a

low concentration of short-acting narcotic like

fentanyl through a catheter placed in the

epidural space

Onset of analgesia can take 20-30 minutes


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Suitable for most patient except those with

bleeding disoders, generalized or localized

infection, hypovolemia or history of surgery tothe lower back.

Indicated in patient with:

Hypertension

Cardiac disease

Multiple pregnancy

Previous caesarean delivery for trial of scar

Increased risk of caesarean delivery


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Complications:

Hypotension

Incomplete pain relief

Accidental total spinal

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Instruments and Medications in Labour Room & Ot(1)