NORMAL & ABNORMAL LABOUR

Part 2: Abnormal Labour

HANGZHOU WOMENS HOSPITALInternational 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)

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

IMPORTANT TOPICS NOT COVERED IN DETAIL

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

2.1 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

2. Fetal monitoring

“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/uploaded-files/GT42ShoulderDystocia2005.pdf

8.Vaginal birth after Caesarean section

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

IMPORTANT TOPICS NOT COVERED IN DETAIL