instruments and medications in labour room & ot(1)
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INSTRUMENTS AND MEDICATIONSIN LABOUR ROOM & OT
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Vacuum
Instrument used as alternative to forceps, which
adheres to fetal scalp by suction cup & is used to
assist maternal expulsive efforts
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MetalVacuum
cup
Siliconerubber
cup
Kiwiomnicup
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Indication
Prolonged 2ndstage of labor
To shorten 2nd
stage of labor Presumed fetal
distress
Poor maternalcontraction
Contraindication
Malposition (Face,breech)
POA less than 35
weeks Cephalic pelvis
disporpotion
Uncertainty onfetal position andstation
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Dilatation and full
engagement ofthe head
Contraction
present
No CPD
POA: >35w
Pre-requisite Prolonged or
excessive tractionshould not beused.
Traction is beapplied during
uterinecontraction
vaginal skinshould beexcluded from the
edge of the cup.
Precaution
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Complication
Lacerations to the cervix, vagina,perineum, or bladder
Extension of episiotomies
Increase in blood loss
Pelvic organ prolapse
Urinary stress incontinence
anal sphincter injuries
Maternal
Scalp abrasions Caput succedaneum
Intracranial bleeding
Subaponeurotic hemorrhagesFetal
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ForcepsInstruments designed to aid in the delivery of
the fetus by applying traction to the fetal head.
Types offor forceps
delivery
Highforceps
Outletforceps
Low
forceps
Midforceps
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F fully dilated
O OA & OP position
R Rupture of membrane
C No CPD
E Engaged, episotomy
P pudendal nerve block
S sterilization, skills and experties
Pre-requisite
Prolong 2nd stge of labour
Fetal distress
Maternal condition such as cerebrovasculardisease, hypertensive disorder
Indication
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Contra-indication
Refusal of the patient
Cervix not fully dilated
Inability to determine the presentation and fetal headposition
Confirmed cephalopelvic disproportion
Severe moulding/caput
Unsuccessful trial of vacuum extraction
Complication
Lacerations to the cervix or vagina
Trauma to maternal anal sphincter
Fetal facial nerve injury
Fetal skull fracture
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Episiotomy Set1 2 3
45 6
7 8 9 10
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1 : Episiotomy scissor
2 : artery forcep straight3 : Tissue tooth forcep
4 : kidney dish
5 : sponge holder6 : needle holder
7 : Gallipot
8 : straight scissor
9 : artery forcep curve
10: instrumental tray
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Indication
Prolonged 2ndstage due to
rigid perineumInstrumental
delivery
Prematuredelivery
Complication
hemorrhage
Infection
Extension toanal sphincter
Dyspareunia
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Fetal Scalp ElectrodeWHAT IS THE INDICATION?
1) When external CTG inadequate todetect accurate interpretation
2) For 1st twin in twin prengnancy
WHAT IS THE CONTRAINDICATION?
- Face presentation
- Unknown presentation
- HIV seropositive/Hep B,C
- Active genital herpes
- Suspect thrombocytopenia/ ITPP
WHAT IS THE WEAKNESS?
1) invasive
2) more tedious to apply
3) mmbrane must absent
4) just apply during intra-partum
5) direct contact to fetus
6) high risk for infection
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CARDIOTOCOGRAPHY
What is Cardiotocography?
Cardiotocography (CTG) is used in pregnancy to monitor
both the fetal heart as well as the contractions of the
uterus. It is usually only used in the 3rd trimester. Itspurpose is to monitor fetal well-being & allow early
detection of fetal distress. An abnormal CTG indicates the
need for more invasive investigations & ultimately may
lead to emergency caesarian section.
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How it works?
It involves the placement of 2 transducers on the
abdomen of a pregnant women. One transducer records the foetal heart rate using
ultrasound.
The other transducer monitors the contractions of
the uterus.
It does this by measuring the tension of the
maternal abdominal wall.
This provides an indirect indication of intrauterinepressure.
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HOW TO INTERPRET CTG?
CONTRACTION
Record the number of contractions present in a 10 minute
period - e.g. 3 in 10
Each big square is equal to 1 minute, so you look howmany contractions occurred in 10 squares
Individual contractions are seen as peaks on the part of
the CTG monitoring uterine activity
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FETAL HEART RATE The baseline rate is the average
heart rate of the fetus in a 10minute window
Look at the CTG & assess what
the average heart rate has been
over the last 10 minutes
Normal fetal heart rate 110-160bpm
Fetal tachycardia >160bpm
- Fetal hypoxia- Chorioamnionitisif maternal fever
also present
- Hyperthyroidism
- Fetal or Maternal Anaemia
-Fetal tachyarrhythmia
Fetal bradycardia
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VARIABILITY
Minor fluctuation in baseline fetal heart rate
occurring at 3 to 5 cycle per minute
Measure by estimating the difference in beats
perminute between the highest peak and
lowest through of fluctuation in a one minute
segment of the trace
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Acceleration
Transient increase in
FHR of 15bpm or morelasting 15s or more
Deceleration
Transient episode of slowing FHR
below the baseline level of more than
15bpm and lasting 15s or more
1. Early deceleration
Uniform repetitive, periodic
slowing of FHR with onset early
in the contraction and return to
baseline at the end of
contraction
1. Late decelerationuniform repetitive, periodic
slowing of FHR with onset mid to
end of the contraction and nadir
more than 20s after the peak of
the contraction and ending after
the contraction.
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Catheter
A. Name of the instrument.Foley catheter
B. What are the use of this instruments?
- Urine drainage- Mechanical IOL
C. How it is used as mechanical IOL
- it cause the cervix to mechanicallyopen and make the cervix morefavorable
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Fetal Blood SamplingA. Name of the instrument.
Amnioscope
B. What are these instruments for?
Fetal Blood Sampling procedure todetermine fetal pH
C. Indication for the procedure.
- non reassuring CTG with either clearliquor or LMSL or MMSL, when cervicaldilatation is >= 3 cm.
D. Contraindication for the procedure.
- Maternal infection (HIV,Hep B/C)
- Fetal bleeding disorders
- Prematurity (
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Partogram
Defintion:
graphical record that record the progress of labour.
Part 1:Fetal condition
fetal heart rate
liqour moulding
Part 2:Progress of labour
Cervical dilationDescent of head
contraction
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Part 3:maternal condition
pulse rate
blood pressure temperature
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Abnormal progress of labour
1.Prolong latent phase
Def: more than 8 hours
2.Prolong active phase
-primary dysfunction labour
- cervical dilation less
than 1cm/hour
-secondary arrest
-Progress active phase initialy good but become
slow/stop typically after 7cm dilation.
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Causes:
1.Powers
-inefficient uterine action
Mx:maternal rehydration
:artificial rupture membrane
:IV oxytocin(syntocinon)
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2.Passenger(fetus)
-big size
-malposition-malpresentation
3.Passages( uterus,cervix,bony pelvis)
eg:cephalopelvic disproportionMx:ceaserean section
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Syntocinon & Syntometrine
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active management of 3 stage of labour
Prevention and treatment of PPH withuterine atonyIndication
Hypersensitivity to oxytocin andergometrine
Severe hypertension
Severe cardiovascular disorders
Pre-eclampsia/eclampsia
Contraindication
Nausea, vomiting
Abdominal pain
Headache, dizziness
RashSide Effects
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Anelgesia In labour
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Pethidine
Given intramuscularly
Dosage:
1-2 mg/kg (usual dose 50-100mg)
together with phenergan 0.5 mg/kg(usual dose 25 mg)
Administered during early labour or
When the delivery is not expectedwithin 4 hour of injection
Used to relieve moderate to severepain
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Side-effects:
Drowsiness
Nausea
Vomiting
The baby may require naloxone to treat
respiratory depression if delivered within 4
hours of pethidine injection
An overdose of pethidine may cause
convulsions (fits), respiratory depression(breathing difficulties), hypotension, shock
and coma
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Entonox
A gas made up of 50% oxygen and 50% nitrous
oxide(NO)
Self administered via a face mask or mouth
piece
Instruction: start inhaling at the beginning of
contraction, continue deep shallow breathing
during contraction and remove the mask from
the face when contraction eases off.
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Can be given at any time of labour, as sole
analgesic or in combination with epidural
analgesia during late first stage or second
stage of labour.
Side-effects:
Drowsiness
Nausea
Vomiting
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Epidural
A type of regional analgesia
Involves the administration of a dilute amount
of local anesthetic either in the form of
bupivacaine or ropivacaine combined with a
low concentration of short-acting narcotic like
fentanyl through a catheter placed in the
epidural space
Onset of analgesia can take 20-30 minutes
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Suitable for most patient except those with
bleeding disoders, generalized or localized
infection, hypovolemia or history of surgery tothe lower back.
Indicated in patient with:
Hypertension
Cardiac disease
Multiple pregnancy
Previous caesarean delivery for trial of scar
Increased risk of caesarean delivery
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Complications:
Hypotension
Incomplete pain relief
Accidental total spinal