Lecture 22: Child Birth

Question 1

Definition and time of ‘Childbirth’

Answer 1

• Process where baby and placenta expelled from the uterus.
• ~37-42 weeks gestation (and in a hospital)

Question 2

Step: Use your hands… what should you be able to find?

Answer 2

Feel soft and bony parts

Fetal Lie: the relation of the long axis of the baby to the uterus.

Fetal size/Gestational age

Presentation: part of fetus the occupies the lower segment of uterus (cephalic 95%, breech 4%, shoulder 1%)

Engagment: how deep the presenting part is engaged in the bony pelvis (movable= not engaged, not movable= engaged)

Question 3

Gestional age found by

Answer 3

Top of pubic symphysus to the top most portion of the uterus. Measured in cm

Question 4

When using your hands, what are the differences in findings with vaginal vs cesarean delivery?

Answer 4

.

Question 5

Step: use your mouth

Answer 5

Ask the mother if you can hear babies movement

Question 6

Step: Use your Ears

Answer 6

Using a doppler, CTG (cadiotocography) to find the fetal Heart rate

Question 7

What makes up an obstetric Examination

Answer 7

External Signs

Distension

Fetal Lie

Presentation

Engagment

Fetal HR

Ask for babies movements

Question 8

How do you know child-birth has started.

Answer 8

painful uterine contractions accompany dilation and effacement of the cervix

Question 9

Stages of Labour

Answer 9

Stage One: Effacement (cervix shortens) has occured. Cervix opens to full dilatation

Stage 2: from full dilatation to the delivery

Stage 3: delivery of baby → delivery of placenta

Question 10

Progress of the delivery/birth is determined by _____

Answer 10

Three Mechanical Factors

1. PASSENGER (diameter of the babies head)
2. PASSAGE (dimension of the pelvis)
3. POWER (degree of force expelling baby.)

Question 11

Passenger as a mechanical factor?

Answer 11

Diameter of the babies head (biggest part to pass through vaginal canal.) The head isn’t round, and bones are not yet fused

1. Sutures (elastic CT between bones) and Fontanelles (where sutures come together) shows us the Occiput (lead point of the head)
2. Position: degree of rotation w. reference to the ocipit
3. Attitude: degree of flexion of the head

Question 12

Occiput is?

Answer 12

A reference point that tells us where the babies head is.

Allows us to feel via vagina where the babies head is positioned and how far into pelvis.

Determines PROGRESS

Question 13

Why is the position most important?

Answer 13

inlet (wide transverse) and outlet (wide A-P) are different shapes, (mid is round) so within the bony pelvis you need to change the head position in order to get through!

Question 14

Attitude

Answer 14

The degree of flexion of the head

Ideal: maximal flexion; smallest diamter (9.5cm)

This is because Extension results in larger diameter
Extension 90 degrees = brow (13cm)
Extension 120 degrees= face

Question 15

Passage as a machanical factor

Answer 15

Due to the differences in inlet/mid/outlet pelvic regions, you have to negotiate a bend.

In the lateral wall of the mid cavity, bony prominences called ischial spines are palpable, which can be used as a reference point!

Question 16

Ischial Spine as a refernece point for birth.

Answer 16

Stays above spine= cesaurean
Negotiates below spines= natural birth

Level of Descent: Station (-2, -1, 0, +1, +2)

Question 17

Power as a mechanical factor.

Answer 17

Once labour is established the uterus (under the influence of oxytocin), contracts for 45-60 seconds, every 2-3minutes

Regular, painful contractions!

Question 18

Normal initiation of Labour

Answer 18

1. Contractions
   Braxton - hicks contractions (irregular)
   PG Production (relax cervix)
   oxytocin release from post. pituitary gland.
2. Effacement of the Cervix

Question 19

Normal Labour: first stage (onset to full cervical dilatation)

Answer 19

1. Contractions regular painful contractions
2. Effacement shortening of cervix
3. Dilatation latent phase (first 3cm). Then at a rate of 1cm/hr (nulliparous) and 2cm/hr (multiparous)
4. Descent, Flexion and internal rotation to a varying degree
5. Rupture of membranes (release of liquid)

Question 20

Normal Labour: second stage (full dilatation to delivery)

Answer 20

Contractions
Descent, flexion and int.rotation completed

Passive stage: till head reaches pelvic floor and mother experiances desire to push.

Active stage: irresistable desair to bear down (40-60mins nulliparous, 20-30mins multiparous)

Question 21

Normal Labour: delivery

Answer 21

As babies head reaches perineum, it extends to come out of the pelvis (tear, episiotomy may be required) crowns and is born

The head then rotates 90 degrees to adopt the transverse position in which it enetered the pelvis again.

Ant. shoulder comes under the symphisis first

Rest follows

Question 22

Normal Baby: Third stage (delivery of baby to delivery of the placenta)

Answer 22

uterine contractions compress blood vessels formerly supplying placenta, shearing them from the uterine wall.

Vital stage as everyone is very excited, but there’s a big bleeding risk!!

Ecbolic injection often given!

Question 23

Ebolic Injection?

Answer 23

Given during third stage of labour, massive dose of oxytocin, so the uerine wall contracts!

Question 24

How do we manage/measure progress? Definition of slow progress?

Answer 24

Nice way to document progress of labour.
Slow progress: <1cm/hr dilatation and a prolonged labour >12hours duration

Question 25

“PPP” slow progress Aetiology

Answer 25

• *Power**: Insufficient uterine action
• Augmentation: oxytocine*

Passanger: Fetal size
Disorder of rotation OP/OT

Passage: Cephalo-pelvic disproportion

Question 26

Instramental Delivery is done with?

Answer 26

Forceps: quicker, but more birth canal injuries and facial nerve palsies

Ventouse (vacuum): Rotation possible, more neonatal cephalhaematomas

*can only be done in low/mid cavities

Question 27

Issues with Caesarean Delivery

Answer 27

Are now being used not because of danger, but to avoid discomfort! This is bad and harming the women, leaving her with long-term issues.