Pregnancy is a physiologic process that is very competent in numerous regards. Vaginal delivery

1. Conduct of vaginal delivery
H e n r y Osazuwa
C o n s u l t a n t
O b s t e t r i c i a n

2. Its is a Doctor’s world
Things should be done our way
Not to teach new things
U n i f i e d Te m p l a te
You guys are under us
Its is a Doctor’s world
Its is a Doctor’s world

3. Introduction
Vaginal delivery is safest way of ending a pregnancy
Comparison
C o m p l i c a t i o n
r a t e s
f o r
m o t h e r
a n d
b a b y

4. Performed in the second stage
of labour
What is second of labour?
From full cervical (10 cm)
dilatation to delivery of
t h e b a b y.
2 phases – Phase 1 (P e l v i c ) & Phase 2 (P e r i n e a l )

5. Performed in the second stage
of labor
Three keys
Stamina │ Courage│ Confidence
Warning!
Confidence should be based on competence in providing care

6. Be professional – ALL the time!
Patience is
CRUCIAL
Three keys
Stamina │ Courage│ Confidence
Be professional – ALL the time!

7. Watch the “ARROWS”
Patience is
CRUCIAL

8. Signs of second stage
Only positive sign – FULL cervical dilatation
1. U n c o n t r o l l a b l e u r g e to push(needs to pass stool).
2. May h o l d b r e a t h o r g r u n t during contraction.
3. Start to s w e a t .
4. Mood changes – s l e e p y o r m o r e f o c u s e d .
5. External g e n i t a l i a o r a n u s b e g i n s t o b u l g e during
contractions.
6 . F e e l s t h e b a b y ’s h e a d b e g i n t o m o v e i n t h e v a g i n a .

9. What is crowning !

10. Crowning means the
widest part of the
baby's head
(the crown!) has passed through
the bony pelvic outlet.
In-between contractions, the
protruding foetal head through
the vaginal introitus does not
recede.

11. Equipments, Instruments &
personnel
Delivery/Episiotomy pack
Drapes
Baby blanket
Swabs
Cord clamp; Scissors
Sponge holding forceps
Artery forceps
Needle holder
Dissecting forceps
Placenta bowl
Episiotomy scissors
Stitches
Personnel
Midwives
Doctors – Obstetric & Paediatric
Care assistance
Relatives
Resuscitaire/Radiant warmer – Should be on

12. Monitoring
Foetal heart rate
monitoring
Every 5 minutes
During contractions, the Foetal Heart Rate can be
as slow as 1 0 0 / m i n u t e
R e c o v e r s after CONTRACTION!

13. What is th e
Norm al foetal
heart rate?
120 – 160
beats/minute

14. Mothers position
M a n y ! !!
Squirting
Sitting
Under water
Standing
Dorsal position with head propped up and
hands around the ankles.
Encourage her to bear down with each uterine contraction

15. Guarding & Guiding
THE PERINEUM
Many techniques have been described.
Difficult to define a superior
technique.
E n c o u r a g e f l e x i o n o f t h e f o e t a l h e a d – done too early
may increase the pressure on the perineum.
Cup the foetal scalp.
Sweep the perineum over the foetal head.

16. Delivery the baby
B & C

17. Delivery the baby
D & E

18. Delivery of the baby
F

19. Delivery of the Placenta
3 R D S TA G E O F L A B O U R
A c t i v e and Expectant
Management
Active – Don’t wait for signs of placenta
separation.

20. Delivery of the Placenta
Clamp in two place and
cut between clams;
close to the perineum
Apply CCT with counter pressure on the UTERUS.

21. Oxytocic-
Delivery of the anterior shoulder
o r t h e f o e t u s.
O x y t o c i n ( I V/ I M )
E r g o m e t r i n e or
Methyl Ergometrine
( I V/ I M )
Misoprostol
(Rectal/Oral)
10
0.5
0.2
IU bolus
mg Ergometrine
mg Methyl Ergometrine
400 – 800
microgram
(2 – 4 tablets)
Risk for PPH: 20 – 40 IU of Oxytocin in
500 ml Dextrose in Water to run 2 HOURS

22. Immediate post-partum care
Foetal resuscitation
Massage the uterus
Examine the placenta
Examine the lower genital tract
Maternal vital sign monitoring
Episiotomy/perineal tears
Encourage breast feeding (First hour)

23. Thank you