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Obstetrics Phase 3A: Labour, Abnormal Presentations, Preterm & Postterm Birth, Puerperium

Learn about the various aspects of labour including stages, clinical features, monitoring parameters, hormones involved, and more. Understand abnormal fetal presentations, preterm and postterm birth, and the puerperium phase.

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Obstetrics Phase 3A: Labour, Abnormal Presentations, Preterm & Postterm Birth, Puerperium

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  1. Obstetrics Phase 3A Stephen Lau & George Lam The Peer Teaching Society is not liable for false or misleading information…

  2. Outline • Labour • Abnormal Fetal Presentations • Preterm Birth • Postterm Birth • Puerperium • NOT Multiple Pregnancy The Peer Teaching Society is not liable for false or misleading information…

  3. Labour • G1P0 34+2/40 26 year old woman is experiencing contractions. They are decreasing in frequency and intensity. • List 3 Clinical Features of Labour • If this is not labour, what is it? The Peer Teaching Society is not liable for false or misleading information…

  4. Labour • G1P0 34+2/40 26 year old woman is experiencing contractions. They are decreasing in frequency and intensity. • List 3 Clinical Features of Labour • If this is not labour, what is it? • Braxton-Hicks Contractions The Peer Teaching Society is not liable for false or misleading information…

  5. Labour • Same woman is now 39+1/40 and experiencing regular strong contractions. • What Are The 3 Stages of Labour? • Describe Start/End Points of Each • Name 2 Maternal and 2 Fetal Parameters to be Monitored Initially and How Frequently The Peer Teaching Society is not liable for false or misleading information…

  6. Labour • Same woman is now 39+1/40 and experiencing regular strong contractions. • What Are The 3 Stages of Labour? • Stage 1  Regular Contractions to Full Cervical Dilatation/Effacement • Stage 2  Full Cervical Dilatation/Effacement to Delivery of Baby • Stage 3  Delivery of Baby to Delivery of Placenta • Name 2 Maternal and 2 Fetal Parameters to be Monitored Initially and How Frequently • Maternal Obs q2h • Maternal Contractions q30 min • Maternal Cervix q4h • Fetal HR q15 min/After Contraction • Fetal Station q4h • Fetal Liquor on ROM The Peer Teaching Society is not liable for false or misleading information…

  7. Labour The Peer Teaching Society is not liable for false or misleading information…

  8. Labour • You assess the woman’s cervix to be fully effaced. • What Are The 2 Phases of Stage 1 Called? • What Is The Cervical Dilatation Cut-Off Between Them? The Peer Teaching Society is not liable for false or misleading information…

  9. Labour • You assess the woman’s cervix to be fully effaced. • What Are The 2 Phases of Stage 1 Called? • Latent • Active • What Is The Cervical Dilatation Cut-Off Between Them? • 4 cm (…6 cm) The Peer Teaching Society is not liable for false or misleading information…

  10. Labour • The woman’s cervix is now dilated 6 cm. • What is the minimum rate of cervical dilatation for nulliparous and multiparous women in the active phase? • Name 1 hormone involved in cervical ripening and where it’s synthesized • Name 1 hormone involved in promoting contractions and where it’s synthesized The Peer Teaching Society is not liable for false or misleading information…

  11. Labour • The woman’s cervix is now dilated 6 cm. • What is the minimum rate of cervical dilatation for nulliparous and multiparous women? • Nullip  1 cm/h • Multip  2 cm/h • Name 1 hormone involved in cervical ripening and where it’s synthesized • Prostaglandins  Uterus • Relaxin  Ovaries (CL) • Name 1 hormone involved in promoting contractions and where it’s synthesized • Prostaglandins • Oxytocin  Hypothalamus (to Post. Pituitary) • Estrogen  Placenta The Peer Teaching Society is not liable for false or misleading information…

  12. Labour • The woman’s cervix is now dilated 10 cm and is feeling the urge to push. • How frequently do you monitor the baby’s HR now? • Fill in the blanks • Engagement in ___ Position • Descent • ? • ? • Extension • ? • Expulsion The Peer Teaching Society is not liable for false or misleading information…

  13. Labour • The woman’s cervix is now dilated 10 cm and is feeling the urge to push. • How frequently do you monitor the baby’s HR now? • q5 min • Fill in the blanks • Engagement in OT Position • Descent • Flexion • IR  OA Position • Extension • ER (Restitution)  OT Position • Expulsion The Peer Teaching Society is not liable for false or misleading information…

  14. Labour • The baby is delivered and the umbilical cord is clamped. • What is the cut-off time before worrying about retained placenta? The Peer Teaching Society is not liable for false or misleading information…

  15. Labour • The baby is delivered and the umbilical cord is clamped. • What is the cut-off time before worrying about retained placenta? • 30 min The Peer Teaching Society is not liable for false or misleading information…

  16. Labour • Summary • Labour Dx vs. Braxton-Hicks • Stage 1  Contractions to 10 cm Dilatation • Monitoring • Latent Phase  4 cm • Active Phase • 1 cm/h (Nullip), 2 cm/h (Multip) • Hormones Involved • Stage 2  10 cm Dilatation to Baby Delivery • Monitoring (FHR) • 7-Step Process • Stage 3  Baby Delivery to Placental Delivery • Prolonged After 30 min The Peer Teaching Society is not liable for false or misleading information…

  17. Abnormal Fetal Presentation • Define & Give Example • Lie • Presentation • Position • Engagement • Station The Peer Teaching Society is not liable for false or misleading information…

  18. Abnormal Fetal Presentation • Define • Lie  Fetal Long Axis WRT Maternal Long Axis • E.g.) Longitudinal, Transverse, Oblique • Presentation  Fetal Part @ Lower Uterine Pole • E.g.) Cephalic, Breech, Shoulder, Cord • Position  Leading Fetal Part WRT Transverse Plane • E.g.) Occiput (OA, OT, OP, etc.), Chin (MA, MP), Sacrum • Engagement  Leading Fetal Part WRT Pelvic Inlet • 0-1/5 (5/5 completely above pelvic brim) • Station  Leading Fetal Part WRT Ischial Spine • +5 to -5 (+5 Outwards, -5 Inwards) The Peer Teaching Society is not liable for false or misleading information…

  19. Abnormal Fetal Presentation • Define & Give Example • Lie • Presentation • Position • Engagement • “Engaged” = Station 0 = At Ischial Spine • Station The Peer Teaching Society is not liable for false or misleading information…

  20. Abnormal Fetal Presentation • What is the ideal lie, presentation and position? The Peer Teaching Society is not liable for false or misleading information…

  21. Abnormal Fetal Presentation • What is the ideal lie, presentation and position? • Longitudinal • Cephalic • OA The Peer Teaching Society is not liable for false or misleading information…

  22. Abnormal Fetal Presentation • Woman is pregnant. On examination, wide uterus and fetal head at mother’s left flank are appreciated. • Diagnosis? • Investigation? • 2 Things on Ix? • 2 Management Options The Peer Teaching Society is not liable for false or misleading information…

  23. Abnormal Fetal Presentation • Woman is pregnant. On examination, wide uterus and fetal head at mother’s left flank are appreciated. • Diagnosis? • Transverse Lie • Investigation? • USS  Confirm Lie + ?Placenta Previa • 2 Management Options • ECV + Normal Delivery • C/S The Peer Teaching Society is not liable for false or misleading information…

  24. Abnormal Fetal Presentation • Woman is pregnant. On examination, subcostal tenderness and presenting part is softer than expected. • Diagnosis? • Investigation? The Peer Teaching Society is not liable for false or misleading information…

  25. Abnormal Fetal Presentation • Woman is pregnant. On examination, subcostal tenderness and presenting part is softer than expected. • Diagnosis? • Breech • Investigation? • USS The Peer Teaching Society is not liable for false or misleading information…

  26. Abnormal Fetal Presentation • Woman is pregnant. On examination, subcostal tenderness and presenting part is softer than expected. • Name 2 other types of breech presentation other than a frank breech presentation • Apart from traumatic injury, what is another important complication that can occur delivering The Peer Teaching Society is not liable for false or misleading information…

  27. Abnormal Fetal Presentation • Woman is pregnant. On examination, subcostal tenderness and presenting part is softer than expected. • Name 2 other types of breech presentation other than a frank breech presentation • Frank  Flexed Thighs, Extended Legs • Complete  Flexed Thighs, Flexed Legs • Incomplete/Footling  Extended Thighs • Apart from traumatic injury, what is another important complication that can occur delivering • Cord Prolapse The Peer Teaching Society is not liable for false or misleading information…

  28. Abnormal Fetal Presentation • A 30 year old G3P0+2 with PMH of DM and BMI of 35. After the head is delivered, the baby retracts backwards. • Name of the sign? • Diagnosis? • What Is It? • Management? The Peer Teaching Society is not liable for false or misleading information…

  29. Abnormal Fetal Presentation • A 30 year old G3P0+2 with PMH of DM and BMI of 35. After the head is delivered, the baby retracts backwards. • Name of the sign? • Turtle Sign • Diagnosis? • Shoulder Dystocia • What Is It? • Anterior Shoulder Trapped Under Symphysis The Peer Teaching Society is not liable for false or misleading information…

  30. Abnormal Fetal Presentation • A 30 year old G3P0+2 with PMH of DM and BMI of 35. After the head is delivered, the baby retracts backwards. • Management • Help • Episiotomy • Legs in MacRoberts (Knee to Chest) • Pressure on Suprapubic Area • Enter Pelvis • Rotational Manoeuvres • Remove Posterior Arm • Roll Pt on All Fours The Peer Teaching Society is not liable for false or misleading information…

  31. Abnormal Fetal Presentation • Summary • Definitions • Transverse Lie • Breech Presentation • Shoulder Dystocia • Didn’t Cover Brow/Face Presentation • Didn’t Cover Malpositions (OP, OT) The Peer Teaching Society is not liable for false or misleading information…

  32. Preterm Birth • A 24 year old, G2P1 32+3/40 woman presents at A&E complaining of contractions. • How can we classify prematurity? • What are the clinical manifestations for preterm labour? The Peer Teaching Society is not liable for false or misleading information…

  33. Preterm Birth • A 24 year old, G2P1 32+3/40 woman presents at A&E complaining of contractions. • How can we classify prematurity? • Week of Pregnancy • Birth Weight of the Baby • What are the clinical manifestation of preterm labour? • Regular, painful contractions • Cervical Effacement/Dilation • Backache • Cervical Discharge The Peer Teaching Society is not liable for false or misleading information…

  34. Preterm Birth • Her previous pregnancy was delivered at 34 weeks. • What are the risk factors for preterm birth? • What is a biomarker for predicting preterm birth? The Peer Teaching Society is not liable for false or misleading information…

  35. Preterm Birth • Her previous pregnancy was delivered at 34 weeks. • What are the risk factors for preterm birth? • Infection • Reproductive History • Multifetal Gestation • Lifestyle Factors • Autoimmune Disease • Cervical Surgery • Uterine Malformations • What is a biomarker for predicting preterm birth? • Fetal fibronectin The Peer Teaching Society is not liable for false or misleading information…

  36. Preterm Birth • Your history and examination confirms that she is undergoing preterm labour. • What medicines should now be given to the patient? The Peer Teaching Society is not liable for false or misleading information…

  37. Preterm Birth • Your history and examination confirms that she is undergoing preterm labour. • What medicines should now be given to the patient? • Tocolytics • Calcium Channel Blockers (nifedipine) • NSAIDs (indomethicin) • Beta adregenic receptor antagonists (salbutamol/ritodrine) • Steroids • Antibiotics • Magnesium Suphate The Peer Teaching Society is not liable for false or misleading information…

  38. Postterm Birth • 5% of pregnancies are delivered after term • What is the upper limit of time for a pregnancy? • What are the strongest risk factors for a postterm birth? The Peer Teaching Society is not liable for false or misleading information…

  39. Postterm Birth • 5% of pregnancies are delivered after term • What is the upper limit of time for a pregnancy? • 42+6 weeks • What are the strongest risk factors for a postterm birth? • Previous postterm birth • Nulliparity • Obesity • Male Foetus • Older maternal age • Maternal or Paternal history of postterm birth The Peer Teaching Society is not liable for false or misleading information…

  40. Postterm Birth A 26 year old woman, G1P0 with a 41+1 week pregnancy of a single male foetus wants have a home birth. The foetus is in a cephalic, left occiput anterior position. • Will you let this woman give birth at home? Explain your answer The Peer Teaching Society is not liable for false or misleading information…

  41. Postterm Birth Liz, 26 year old woman, G1P0 with a 41+1 week pregnancy of a single male foetus wants have a home birth. The foetus is in a cephalic, left occiput anterior position. • Will you let this woman give birth at home? Explain your answer • No, pregnancies past the 41st week should be induced. The Peer Teaching Society is not liable for false or misleading information…

  42. Postterm Birth • What are the dangers of a postterm pregnancy? The Peer Teaching Society is not liable for false or misleading information…

  43. Postterm Birth • What are the dangers of a postterm pregnancy? The Peer Teaching Society is not liable for false or misleading information…

  44. Postterm Birth Liz arrives at the maternity unit in hospital. • How is labor iatrogenically induced? • Cervical status is important for predicting success of induction. What scoring system is used for assessing cervical status? The Peer Teaching Society is not liable for false or misleading information…

  45. Postterm Birth Liz arrives at the maternity unit in hospital. • How is labor iatrogenically induced? • Oxytocin IV • Amniotomy • PGE1/PGE2 The Peer Teaching Society is not liable for false or misleading information…

  46. Postterm Birth 2. Cervical status is important for predicting success of induction. What scoring system is used for assessing cervical status? The Peer Teaching Society is not liable for false or misleading information…

  47. The Puerperium What changes can you expect in the postpartum period in the following areas? • Uterus • Cervix • Vagina/Vulva • Reproductive Hormones • Breasts The Peer Teaching Society is not liable for false or misleading information…

  48. The Puerperium What changes can you expect in the postpartum period in the following areas? • Uterus • Uterine involution and Lochia • Cervix • Contraction of the cervix. External os never fully recpovers. • Vagina/Vulva • Contracts but not to its nulligravid size • Reproductive Hormones • Beta HCG returns to normal levels in 12 days. 70% menstruate by week 12 postartum • Breasts • Swelling of the breasts and milk production The Peer Teaching Society is not liable for false or misleading information…

  49. The Puerperium • The observations show Liz has a temperature of 38 C. Are you worried? • What other routine procedures should be done for Liz after birth? The Peer Teaching Society is not liable for false or misleading information…

  50. The Puerperium • The observations show Liz has a temperature of 38 C. Are you worried? • No, only after the first 24 hours. Most common is cause is infection. • What other routine procedures should be done for Liz after birth? • Counselling/Practical help with breastfeeding • HR/BP/RR/Temp monitoring. • Examine for signs of bleeding • Distended bladder examination • Examine for perineal damage The Peer Teaching Society is not liable for false or misleading information…

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