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Normal and Abnormal Birth

By
Dr Nur Azurah Abdul Ghani
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How do I know that I am in labour?
Painful uterine
contractions
Show
Rupture of the
membrane
Shortening of the
cervix and dilatation
of os
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Other signs and symptoms
Reduced foetal
movement
Diarrhoea
Nausea/vomiting
Nesting behaviour
Lightening

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Braxton-Hicks contractions are:
~ irregular contractions that are painless
~ occur throughout the pregnancy
Labour contractions are:
~ regular, start from the back
~ increase in frequency
~ increase in intensity
How do I know that it is not false labour?
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What do I need to bring?
Patients clothing
Towel
Toiletries
Sanitary pads
Panties (disposable)

Babys clothing
Diapers
Blankets
Cotton balls
Baby wipes
Towel for baby
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Stages of labour
First stage ~ latent phase
~ active phase
Second stage ~ pelvic phase (passive)
~ perineal phase (active)
Third stage
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First stage of labour
(onset of labour till full dilatation of the os):
Longest phase of labour
i) Latent phase ~ from 0 till 3cm
~ primid 8 hours
~ multip 6 hours
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What will happen to me when I come to
deliver?
Patient will be assessed to determine the
stage of labour
If still latent phase, patient will be managed
in the ward
Nurse will check BP, PR, T, urine ketone
Encouraged to have food and drinks to
ensure hydration
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Patient is encouraged to walk around
CTG is performed to assess the baby
Mother is reassessed every 4 hours
Once her os is already more than 3cm, her
membrane will be ruptured, and she will
then be transferred to the labour ward
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First stage of labour
(onset of labour till full dilatation of the os):
ii) Active phase ~ from 3cm till full dilatation
~ primid 1cm/hr
~ multip 1.5cm/hr
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What will happen to me in the labour
ward?
Will be given enema
NO MORE FOOD
Put on CTG monitoring
BP, PR, T and urine check
Husband will be allowed to
stay with the patient
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Patient will be offered analgesia
Intraveneous fluid infusion
If poor contractions, pitocin
will be started
Patient will be reviewed regularly
by doctors and nurses
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Second stage of labour
(full dilatation till delivery of baby):
Primid ~ 1 hour; Multip ~ 30mins
May be longer with the use of epidural
How will I know how to push?
Advise patient to remain calm and listen to
instructions
Help patient with breathing techniques in
between contractions
Teach patient proper techniques of pushing
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Perineum is guarded properly
Episiotomy is performed if
required
Once the head is delivered, allow
restitution then external rotation
Check for any cord around the
neck
Apply gentle downward and
upward traction to deliver the
shoulder and whole body
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Third stage of labour
(from delivery of baby till expulsion of placenta):
Usually 5-10 mins
Signs of separation:
~ uterus contracted
~ gushing of blood
~ lengthening of cord
Active management:
~ early clamping, give syntometrine/syntocinon, CCT
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What happens after delivery?
Baby will be shown to the mother and will be
allowed to be breastfed
Episiotomy repaired
Check uterus for contractility
Observe for BP, PR and T (at least 1hr)
Check pad
Will be given food and drinks
Will be given analgesia
Baby will be weighed and measured
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Final result
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ABNORMAL BIRTH
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Abnormal Birth
Induction of labour
Vaginal breech delivery
Instrumental delivery
Caesarean section
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What is induction of labour?
Labour is induced for either obstetric
reasons or maternal medical conditions
Methods used to promote labour
Two ways of inducing:
i) surgical sweeping membrane
amniotomy
ii) medical Prostin
iii) combination
INDUCTION OF LABOUR
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Common indications for induction of
labour:
Post-date
Pre-eclampsia
Gestational diabetes
Prelabour rupture of membrane
Intrauterine death
Intrauterine growth restriction
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I s it more painful than natural labour?
Actually, no
I s it safe?
Generally, yes. But associated with complications:
~ failed induction
~ foetal distress
~uterine rupture
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BREECH DELIVERY
Why is my baby in breech
presentation?
Most of the time unknown.
Need to be assessed by doctor.
Could be due to prematurity,
abnormal baby, oligo/
polyhydramios, placenta
praevia, abnormal uterus, pelvic
mass, contracted pelvis,
abdominal laxity

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What are my options for the delivery?
After assessment by doctor, generally there are
three options: assisted vaginal breech delivery,
external cephalic version or elective Caesarean
section.
I s assisted vaginal breech delivery safe?
If criteria is fulfilled, yes.
However, associated with some complications
such as femur fracture, hip dislocation, head
entrapment, etc
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Breech Delivery
Criteria for assisted vaginal
breech delivery:
~ EBW 2.5-3.5kg
~ adequate pelvimetry
~ flexed neck
~ extended/flexed breech
~ no medical illness
~ positive attitude of couple
~ skilled staff
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I s it safe?
Yes. Prior to procedure, patient is kept NBM in
case there is a need to do LSCS if complications
arise. Complications: abruptio placenta,
PROM, cord accident, foetal distress, uterine
rupture, transplacental haemorrhage
What is ECV?
Baby is turned to cephalic
position. Usually done after 37
weeks.
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External cephalic version
Contraindication for ECV:~ placenta
praevia, pre-eclampsia,
oligo/polyhydramios, previous LSCS or
myomectomy, multiple gestation
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INSTRUMENTAL DELIVERY
What is instrumental delivery?
When a doctor needs to use an additional
instrument to help deliver the babys head
(forceps or vacuum). Reasons for this: delayed
second stage, foetal distress, to shortened second
stage, aftercoming head

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INSTRUMENTAL DELIVERY
I s it safe?
With correct application, yes. However,
associated with maternal and foetal injury.

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CAESAREAN SECTION
Can I request LSCS?
Need to discuss with doctor. If
no risk factor, best is to try
vaginal delivery. LSCS is not
without complications such as
anaesthetic cx, surgical cx
such as bleeding, injury to
bladder and haemorrhage,
infection and
thromboembolism.
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When is LSCS indicated?
Foetal distress, cord prolapse, obstructed
labour, malposition, malpresentation,
multiple pregnancy, placenta praevia,
maternal illness eg pre-eclampsia, previous
LSCS
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THANK YOU