2. If was not supposed to be hard
work, it would not have been
called LABOR.
Anonymous
3. 33
““PovertyPoverty is lot likeis lot like childbirthchildbirth – you know it is– you know it is
going to hurt before it happens, but you’llgoing to hurt before it happens, but you’ll
never know how much until younever know how much until you experienceexperience it”it”
Joanne Kathleen RowlingJoanne Kathleen Rowling
4. Birthing is one of the most wonderful &Birthing is one of the most wonderful &
treasured moments in the life of a woman.treasured moments in the life of a woman.
But birthing is not without complicationsBut birthing is not without complications
44
5. A day in a labour Room……A day in a labour Room……
55
7. Prevention is betterPrevention is better
Experienced providerExperienced provider
Assessment of maternal pelvisAssessment of maternal pelvis
Selection of procedureSelection of procedure
Adequate anesthesiaAdequate anesthesia
Fulfillment of prerequisitesFulfillment of prerequisites
Willingness to abandon attemptWillingness to abandon attempt
Ability to perform C-sectionAbility to perform C-section
77
10. Center of the cupCenter of the cup
over the sagittalover the sagittal
suture, about 2suture, about 2
cm in front of thecm in front of the
posterior fontanel.posterior fontanel.
Some tips……
11. Soft cupSoft cupMetal cup 1111
Release suction between Pushes
2 pop-offs, abandon procedure
12. Vacuum ProcedureVacuum Procedure
Check for vaginal or vulvarCheck for vaginal or vulvar
tissues trap between the cuptissues trap between the cup
and fetal surface.and fetal surface.
Gradual Vs Rapid ApplicationGradual Vs Rapid Application
of Vacuum Pressureof Vacuum Pressure
1212
22. AA uterine ruptureuterine rupture is a frank opening between theis a frank opening between the
uterine cavity and the abdominal cavityuterine cavity and the abdominal cavity (Complete).(Complete).
RUPTUR UTERUS
23. AA uterine dehiscenceuterine dehiscence is a “window” covered by theis a “window” covered by the
visceral peritoneumvisceral peritoneum (incomplete)(incomplete)..
24. Rupture can occur: at the site of a previous cesareanRupture can occur: at the site of a previous cesarean
delivery or other surgical procedure involving thedelivery or other surgical procedure involving the
uterine wall,uterine wall,
30. For early detection and intervention:For early detection and intervention:
Vaginal spotting (minimal bleeding)Vaginal spotting (minimal bleeding)
acute abdominal painacute abdominal pain
cessation of uterine contractionscessation of uterine contractions
maternal hemodynamic changes,maternal hemodynamic changes,
non-reassuring fetal heart patterns,non-reassuring fetal heart patterns,
loss of fetal station.loss of fetal station.
31. Surgical repair depends onSurgical repair depends on
the extent and site of rupture,the extent and site of rupture,
the patient’s current clinical condition,the patient’s current clinical condition,
her desire for future childbearingher desire for future childbearing
32. Rupture of a previous cesarean delivery scarRupture of a previous cesarean delivery scar
often can be managed by revision of the edgesoften can be managed by revision of the edges
of the prior incision, followed by primary closureof the prior incision, followed by primary closure
3232
33. Regardless of the patient’s wishes for theRegardless of the patient’s wishes for the
avoidance of hysterectomy, this procedure may beavoidance of hysterectomy, this procedure may be
necessary in a life-threatening situation.necessary in a life-threatening situation.
34. Consideration must be given to the neighboringConsideration must be given to the neighboring
structures, such as the broad ligament,structures, such as the broad ligament,
parametrial vessels, ureter, and bladdeparametrial vessels, ureter, and bladder.r.
35. 3535
If a woman in the battle to reproduce
her race has ruptured her uterus ,she
should be invalidated from the service,
for it is not with cripples that an army
takes the field” whatever ‼‼‼‼‼‼‼‼
36. instrumented delivery,instrumented delivery,
manipulative delivery such as a breech extraction,manipulative delivery such as a breech extraction,
precipitous labor,precipitous labor,
MalpresentionMalpresention
,,
Macrosomia,Macrosomia,
Cervical scar.Cervical scar.
Lacerations of the Lower Genital Tract
Predisposing factorsPredisposing factors
37. Lacerations to theLacerations to the cervixcervix that are extensive andthat are extensive and
those that are actively bleeding usually requirethose that are actively bleeding usually require
repair.repair.
Types:Types:
1- Unilateral1- Unilateral
2- Bilateral.2- Bilateral.
3- Stellate3- Stellate
4- Annular detachment.4- Annular detachment.
38. May lead toMay lead to
Rupture uterus due to upward extension.Rupture uterus due to upward extension.
Cervical incompetence leading to futureCervical incompetence leading to future
recurrent abortion or preterm labor.recurrent abortion or preterm labor.
40. (first-degree through fourth-degree vaginal(first-degree through fourth-degree vaginal
and periurethral lacerations) may requireand periurethral lacerations) may require
repair when bleeding is significant.repair when bleeding is significant.
Lacerations of the vaginavagina and
perineumperineum
48. Periurethral lacerationsPeriurethral lacerations may be associated withmay be associated with
sufficientsufficient edemaedema to occlude the urethra,to occlude the urethra,
causing urinary retention;causing urinary retention;
a Foley catheter for 12 to 24 hours usuallya Foley catheter for 12 to 24 hours usually
alleviates this problem.alleviates this problem.
49. HEMATOMASHEMATOMAS
HematomasHematomas can occurcan occur anywhereanywhere from the vulvafrom the vulva
to the upper vagina as a result of deliveryto the upper vagina as a result of delivery
trauma.trauma.
Hematomas may also develop at the site ofHematomas may also develop at the site of
episiotomy or perineal laceration.episiotomy or perineal laceration.
51. Observation to limit haematomasObservation to limit haematomas
1. Ice packs1. Ice packs
2. Pressure dressings2. Pressure dressings
3. Appropriate analgesia3. Appropriate analgesia
ManagmentManagmentManagmentManagment
Need for surgical interventionsNeed for surgical interventions
1. Haematomas >5cm in diameter1. Haematomas >5cm in diameter
2. Rapidly expanding2. Rapidly expanding
52. If the hematoma is at the site of episiotomy, the suturesIf the hematoma is at the site of episiotomy, the sutures
should be removed and a search made for the actualshould be removed and a search made for the actual
bleeding site, which is then ligated.bleeding site, which is then ligated.
53. DrainsDrains andand vaginal packsvaginal packs are often used to preventare often used to prevent
reaccumulation of blood.reaccumulation of blood.
Large amounts of blood can dissect andLarge amounts of blood can dissect and
accumulate along tissue planes, especiallyaccumulate along tissue planes, especially into theinto the
ischiorectal fossa.ischiorectal fossa.
CarefulCareful monitoringmonitoring of hemodynamic status isof hemodynamic status is
important in identifying those with occult bleeding.important in identifying those with occult bleeding.
55. casecase
32-years-old comes to DR in labor (G4P2+1).32-years-old comes to DR in labor (G4P2+1).
She gives history of a first vaginal delivery atShe gives history of a first vaginal delivery at
home, then spontaneous abortion but thehome, then spontaneous abortion but the
last labor was CS at a public hospital 2 yearslast labor was CS at a public hospital 2 years
ago due to fetal distress. On examination: BPago due to fetal distress. On examination: BP
115/70, pulse 84, 36.9 temperature, fundus at115/70, pulse 84, 36.9 temperature, fundus at
xiphisternum, FHR: 148, tender lowerxiphisternum, FHR: 148, tender lower
abdomen in between pains, the cervix is 5abdomen in between pains, the cervix is 5
cm and 70% effaced, she suffers persistentcm and 70% effaced, she suffers persistent
pain in the lower abdomenpain in the lower abdomen
56. Choose the best route of delivery, and why?Choose the best route of delivery, and why?
1.1.Allow vaginal delivery.Allow vaginal delivery.
2.2.CS (repeat).CS (repeat).
3.3.Ventouse (assist).Ventouse (assist).
4.4.Pitocin drip (augment).Pitocin drip (augment).
………………………………………………………………………………………………………………………………
…………………………………………………………………………
………………………………………………………………………………………………………………………………
…………………………………………………………………………
What is the main risk if you allow trial of vaginalWhat is the main risk if you allow trial of vaginal
delivery?delivery?
………………………………………………………………………………………………………………………………
…………………………………………………………………………
Mention four clinical features of the risk that mayMention four clinical features of the risk that may
occur?occur?
………………………………………………………………………………………………………………………………
…………………………………………………………………………
………………………………………………………………………………………………………………………………
…………………………………………………………………………
57. Signs of uterine ruptureSigns of uterine rupture
severe, localized painsevere, localized pain
abnormalities of the fetal heart rateabnormalities of the fetal heart rate
vaginal bleedingvaginal bleeding
the vaginal examination may show thatthe vaginal examination may show that
the baby is not as low in the birth canal asthe baby is not as low in the birth canal as
he had been earlier.he had been earlier.
