Professional Documents
Culture Documents
and delivery
Sardjana Atmadja
Professor of
OB & GYN Department
Faculty of Medicine
Syarif Hidayatullah State University
Objectives
25
?
?
days -
months
2.Fundal height
3. Quickening
4. Lightening
5. Ultrasonography
6. Fetal weight
5
36
32,40
28
24
History
A history of regular painful uterine
contraction in every 5- 8 min,
accompanied by the history of a bloody
show or spontaneous rupture of membrane
Physical examination
Reduction of interval between uterine
contractions
Abdominal pain of increasing intensity
Cervical effacement ( 50%)
Cervical dilation ( 2 cm)
10
irregular
Interval
decrease
irregular
Duration
increase
irregular
Intensity
increase
irregular
Cervical change
progress
no change
11
Vaginal birth
3 P
Power
Good contraction?
Passage
Contracted pelvis ?
Passenger
Large baby ?
12
Stage of labor
Latent phase
Active phase
2.
Leopold maneuver,
First Leopold
Third Leopold
Second Leopold
Fourth Leopold
15
Interval
Intensit
Duration
D
Interval
Intensity
Good contraction ( I= 2-3 min,
D 45-60 sec)? If not :
correct by using oxytocic drug
16
Pelvic examination
1. Birth canal
2. Cervical condition and
related part
17
Inlet
diagonal
Mid pelvis
interspinous
diameter > 10 cm
Outlet
subpubic
angle
intertuberosity
> 90
diameter > 10 cm
18
19
20
Cervical condition
* dilatation 0-10 cm
* effacement 0-100%
21
Nulliparous
Multiparous
22
Cervical dilatation
23
Vertex
Sinciput
Brow
Face
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25
26
3. Position
27
28
29
30
Presentation
Vertex
Face
Breech
Shoulder
Denominating point
Occiput
Mentum
Sacrum
Acromium
31
4. Station
32
5 Membrane :
Status : intact or rupture
Color : clear or meconium stain
Amount : normal or abnormal
33
Ultrasound
34
2.
3.
4.
5.
6.
7.
8.
Progress of labor
36
37
Partograph
Progress of labor
38
39
40
41
3.
4.
5.
6.
Second stage
Mechanism of labor : 7
cardinal movements in occiput
anterior presentation
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
Episiotomy
Routine episiotomy
Restrictive
episiotomy
44
45
Video viewing
46
47
Third stage
Delivery of placenta
sign
Crede,
Andrew
Controlled
cord traction
48
49
50
51
Prevent postpartum
hemorrhage
oxytocic
drugs
Syntocinon
: IV push, IV drip, IM
Methergin
: IM, IV
52
First-degree tear
Second-degree tear
Third-degree tear
Fourth-degree tear
53
54
55
56
Postpartum care : 10 Bs
Blood pressure
Bladder
Bloody discharge
Basket
Bowel
Breast engorgement
Breast feeding
Baby
Blue
Brain
57
59
60
Shaving perineum
Enema
NPO
IV fluid
Keep in bed
Continuous fetal monitoring
Episiotomy
Dorsolithotomy position
Rush the mother to push
61
Evidence-based practice
Best available
evidence
EBP
Clinical expertise,
experience, skills
and judgment
What is Evidence-Based
Practice?
EBP is the integration
of best research evidence
with clinical expertise
63
Levels of Evidence
Level 2
Level 3
1a)
systematic review of
randomised trials
1b)
2a)
2b)
2c)
outcomes research
3a)
3b)
Level 4
case series (and poor quality cohort and case control studies)
Level 5
expert opinion
64
Bias +
To reduce infection
Best Evidence:
Painful, embarrassing
Re-growth
To facilitate
suturing/makes it
easier to stitch
uncomfortable
Microabrasions cause
infection
Risk of HIV
transmission
No benefits shown for
shaving
Small cost benefit
Enemas in Labour
Traditional belief:
Best Evidence:
Shortens labour
Helps the babys head
descend
contractions
Does not shorten labour
No difference with
neonatal infections
Does not decrease
soiling at birth,
more messier bowel
movements
Marginally increases
cost of health care
Risk of inhalation if
general anaesthetic
needed
Best evidence
No difference in
anaesthetic risk
Dehydration leads to
acidosis, leads to fetal
distress
Dehydration can lead to
incordinate contraction
Nil per mouth only for
specific reason
Routine Episiotomy
Traditional Belief:
Clean incision
Heals better
Fewer 3 and 4 degree
tears
Less pain
Use routinely
Adapted from the WHO Better Birth Initiative http: /www.liv.ac.uk/lstm/bbimainpage.html
RR
CI 95%
0.88
0.84 to 0.92
Suturing
0.74
0.71 to 0.77
Healing Complications
0.69
0.56 to 0.85
1.79
1.55 to 2.07
71
72
THAILAND MALAYSIA
PHILIPPINES INDONESIA
73
lithotomies
Slow pushing efforts
Hot packs on the perineum during second stage
Undisturbed hormones
Traditional belief
Bedrest is best for
Best evidence
Improved progress
labour ward if
labouring women are
confined to bed
of labour if mobile
(contractions are
stronger)
Augmentation less likely
Labour may be less painful
Assists with fetal descent
No harms have been
associated
75
76
77
All illustrations from: Flint, C. (1987) Sensitive Midwifery. London: Heinemann Medical Books
Traditional belief:
Best Evidence:
More self-esteem
Better relationship with the
baby
More breastfeeding
Less depression
Birth Positions
Traditional belief
Supine position and
Best evidence
Supine -progressive
Outcome
Comfort
Experimental
Control
group
group
80%
Pain relief
70%
70%
54%
17%
23%
Episiotomy
3%
6%
Perineal Preservation and Heat Application During Second Stage of Labour - Randomised Controlled Trial,
Musgrove, Heather small RCT, we need a systematic review on this
81
Questions
&
Answers
82
83