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Abnormal Delivery - Zhahrullail Shahid
Abnormal Delivery - Zhahrullail Shahid
You are said to have a normal delivery if you deliver your child vaginally at full term, with the
baby’s head coming first, without any instrumentation. Episiotomy is considered to be
normal.Even twins are considered to be abnormal-medically speaking .Though in layman's
term a normal delivery is
Prolonged Labour
The word ‘difficult labour’ or ‘dystocia’ suggests that labour has failed to progress normally
and is causing difficulties for you and your baby.
Delayed progress of labour can be due to various causes. If the labour doesn’t complete
within-18 hours in case of the first time pregnant woman and 12 hours in case of those
who have had a prior delivery,it is considered prolongued.
If you have not completely evacuated your urinary bladder / bowels, they may rarely
cause failure of progress of labour. In most hospital enema is given during the 1st
stage of labour.
Assess your condition by checking your pulse, blood pressure, uterine activity and
cervical dilatation.
Assess your baby’s condition.
To hasten the process of labour your doctor might adopt various measures.
Mode of delivery:
Your doctor may consider operative vaginal delivery by the forceps or vacuum .
OR
May consider caesarean section, if no satisfactory progress in cervical dilatation /
descent of the head of the baby/ any irregularities in your baby’s heart rate
suggestive of foetal condition being compromised.
Malpresentations:
Your baby is said to be in a normal position if it is facing toward the mother’s back with the
face angled toward the right or left, and upside down with the head coming first (vertex
presentation), with the neck bent forward, chin tucked in and arms folded across the chest.
Any variation from this position makes your baby’s journey through the birth canal difficult,
sometimes hazardous and occasionally impossible. Hence known as ‘malpresentations’.
Causes of Malpresentations:
Pre-Trem Labour
Multiple pregnancy.i.e twins,triplets etc.
Breech presentation.
Face presentation.
Brow presentation.
Transverse lie.
Shoulder presentation.
Breech Presentation:
When the buttocks of your baby is the presenting part (i.e. the 1 st part of
your baby to be delivered) your baby is in a breech presentation.
In most cases, the breech detected earlier in the pregnancy spontaneously turns to the head
down position as the pregnancy progresses.
Your doctor can confirm the position of the baby by an abdominal examination / USG.
This spontaneous change of position of breech does not occur in and may persist as breech
in:
During vaginal delivery, the buttock comes out early as they are easily compressible. But the
after coming head being hard and less compressible may (occasionally) get stuck at the
outlet of the birth canal such head can be removed by using forceps .
Correction of breech position:
IF near full term, the position of the baby is breech, your doctor can change the position of
the baby to head down by the maneuver called ‘external cephalic version'
The procedure is not done if:
Your doctor will examine you and will monitor your uterine contractions, your progress of
labour and your baby’s condition and decide about the mode of delivery.
Mode of delivery:
In primigravidas (1st time pregnant woman) the vaginal delivery of breech is difficult because
the mother’s birth canal has not been stretched by a previous delivery. In such cases,
caesarean section gives the option of well-planned delivery, under controlled conditions.
Although, the delivery maneuver is the same, it is done under anaesthesia as an ‘open’
procedure. Hence, it is easier to handle any difficulties in the delivery of your baby.
In multigravidas ( women who have delivered a child before ) vaginal delivery can be
considered as a good option before going for a caesarean section.
Face Presentation
This is a rare variety of presentations of your baby in which there is complete
extension of your baby’s head almost touching to the back. In this case, the
baby's face is delivered first rather than the top of the head.
Diagnosis of the face presentation is usually made at the time of labour. It can only be
suspected on abdominal examination.
Your doctor will do your internal examination to:
Feel the mouth, nose, cheekbone and chin of your baby thus confirming if your baby
is in a face presentation.
Check for the adequacy of the pelvis.
He will also rule out associated complicating factors like increased blood pressure, post
caesarean pregnancy, post caesarean pregnancy, post maturity etc.
To confirm the diagnosis USG can be done if available. In case of emergency an X-ray of
your abdomen may be required.
Mode of delivery:
Your doctor is the best person to decide the mode of delivery. i.e. either by vaginal delivery
or by a caesarean section
Brow Presentation:
When your baby’s neck is moderately arched so that the brow presents first
i.e. the head lies in between the normal position and the face presentation.
This is a very rare type of presentation, commonly unstable and converts to
either the normal position or the face presentation.
For a while your doctor may observe the progress of labour. If your baby spontaneously
converts to the face presentation or the normal position, vaginal delivery is possible.
Caesarean section is the best option for the persistent brow presentation associated with
complicating factors.
Transverse Lie:
When baby’s spine lies perpendicular to your spine, it is called as
transverse lie.
When the baby’s spine is placed oblique to the maternal spine. This is
known as ‘oblique lie’.
In oblique lie, if the head of the baby is above the navel of the baby then
during labour this position is mostly changed to the breech position.
uterus with oblique lie
In both the transverse and oblique lie, commonly during the delivery the shoulder comes
first and is known as shoulder presentation
Diagnosis:
Big baby.
Mode of Delivery:
Occipito posterior per say does not require a caesarean section.Vaginal delivery may be
opted but a careful watch has to be kept.A liberal episiotomy may be required. There may be
a slight delay. In most cases delivery is spontaneous. In other few cases forceps / vacuum
may be required.
Multiple Pregnancies
When more than one foetus simultaneously develops in the uterus, it is called multiple
pregnancy. The most commonly seen type of multiple pregnancy is the twin pregnancy. I.e.
two babies in the uterus. Rarely, development of three foetuses (triplets) four foetuses
(quadruplets) may also occur.
Twins:
Identical Twins:
Identical (maternal) twins are the result of a single ovum fertilised by a single sperm, which
later divides in 2 separate cells. These form 2 different foetus. Both foetuses have same
placenta, same sex and look similar.
Drugs used for induction of ovulation in infertility cases e.g. Gonadotriophin therapy
clomiphene citrate.
Diagnosis:
Your doctor can also locate two separate spots with two
distinct heart sounds.
Mode of Delivery:
If both the babies are lifting vertically in the uterus a vaginal delivery may be
possible.
If both are in a transverse / oblique lie , a caesarean section is a must.
If one is vertical and other is transverse than your doctor will be a better person to
judge and decide the mode of delivery.
Forceps and vacuum extractors are used to assist the mother to deliver her baby in certain
cases when spontaneous birth is not possible.
Common indications include:
Forceps:
Forceps are twin steel blades that are placed in the vagina and
secured on either side of the baby's head. The blades are locked
and the doctor pulls until the head is delivered.
The forceps that is in use in modern day obstetrics is the low or
outlet forceps. There are certain pre-requisites required before the
use of forceps, the main being that the head of the baby is almost
fully rotated, the scalp is easily visible, the cervix is fully dilated, and
the mother’s urinary bladder is empty.
Vacuum:
With both of these instruments, mothers may very well need an episiotomy to facilitate
insertion of the instrument.
Risks:
In the past ‘forceps’ was thought to be a fairly dangerous or risky procedure.In today’s
obstetric practice, the forceps is used to facilitate easy delivery of the head of the baby.
Risks of the vacuum extractor to the baby are less than forceps. Complications occur much
less often with the vacuum extractor than with forceps.