Normal vaginal delivery

Question 1

Normal vaginal delivery
Definition + features

Answer 1

marks the end of the second stage of labor

Features

• Duration is normally 2 hours in nulliparous woman and 1 hour in multipara (analgesics extend the duration by 1 hour)

• Monitor progression of the second phase descendent of the head using abdominal and vaginal examination.

• Fetal engagement – widest part (usually BPD measure of the head) has passed the pelvic inletand on abdominal palpation no more than 1/5 of the head confirms engagement

• Semi-reclining position is the preferred position as it suitable for assisted delivery, better for perineal repair and it reduces risk of supine hypotensive syndrome

o Supine hypotensive syndrome (“inferior vena cava compression syndrome”) caused when the gravid uterus compresses the inferior vena cava when a pregnant woman is in a supine position

Question 2

Second phase of labor

Answer 2

Question 3

Forehead delivery

Answer 3

a. Hands on technique – perineum support and flexion of the head

b. Hands poised technique – hands off but are in ready position

Question 4

Episiotomy

Answer 4

c. Not routinely required for spontaneous vaginal delivery

d. Indicated in perineal tear, perineal resistance or concern of fetal wellbeing.

e. Incisions techniques

i. Mediolateral (30-45 degree) – better because it avoids anal Incision techniquessphincter damage

ii. Medial incision – when mediolateral cannot be performed such as in the case of varicose veins.

Question 5

Apgar score evaluation

Answer 5

Question 6

Third phase of labor

Management

Answer 6

Active management

f. Administration of oxytocing.

G. Cord clamping (2 minutes after oxytocin infusion)

h. Cutting of the cord

i. Placental separation signs (trickling of fresh blood, cord lengthening and fundal elevation) using Brandt-Andrews technique.