ASSIGNMENT ON OBSTETRICS,

GYNAECOLOGY, LABOR ROOM

Subject - Hospital Operation

Management
Prepared by - Bhavnil Chheda , Kritika
Goswami
18SCRH2020014
,18SCRH2020017
Submitted To - Mrs. Adyaasa
(Asst. Proffessor,Galgotias University)

OBSTETRICS GYNECOLOGY AND LABOUR ROOM

Overview

Gynaecology and obstetrical services are generally combined in the general hospitals.

Obstetrics deals with the procedure of childbirth and pregnancy related problems. Whereas,
Gynaecology deals with the problems related to the Female Reproductive System.

The Department of Obstetrics and Gynaecology offers comprehensive services for the
reproductive health and gynaecological needs of women.

Routine Gynaecology needs no specific/special accommodation and can be treated in the

gynaecology section of the surgical ward. However, surgeries like LAPROSCOPIC
SURGERY (minimum incision, maximum invasion / keyhole surgery) requires special
equipment and is performed in the operating rooms.

Obstetrical services require special amenities.

Two specific areas that a obstetric department consists are :-

a. Patient Accommodation
1. Private Ward
2. Semi Private Ward
3. General Ward
b. Clinical Facilities
1. Preparation Room
2. Pre- delivery Room / Labour Room
3. Delivery Room
4. Nursery

In addition to these the obstetrical department requires the following services :-

 a. Clinical Laboratories
b. X-ray
c. Ultra sound

Location of Labour room And Delivery Suite

Clinical section of the department should be in a convenient but in an area which experiences less
crowd so that the movement of patients is done in an effective way and without any commotion.

The Labour and the delivery room should be located in a space as remote as practicable.

The facility should be close to the nursery, obstetrical nursing unit and to the vertical transport (lifts,
escelators, etc.) so that patients can access them easily.

Should be close to the operating room.(If there is no particulate OT available specific to the
department )

The facilities of the department should be located such that it facilitates

movement of patients and observations by the unit personnel

Design of the Labour and Delivery Suite

The delivery suite is very similar to operating rooms and the same general considerations of location
and control are applicable here.

While designing the labour and delivery suite, special emphasis should be given to specific areas.
They are as follows

1. Preparation Room :-
When in labour the patient is taken to the preparation room to prepare them for labour
and delivery. The patient receives a cleansing bath, is shaved and is given an enema
before being transferred to the labour room.
This room should be located in the labour and delivery suite but should be away from
labour and delivery rooms.
The room must have the facilities to conduct/perform procedures in relation to the
preparation procedures .They are :-
a. An examining table
b. Bath
c. Wash Basin
d. Kit for giving enema
e. Preparation tray
f. Locker to keep patients belonging

2. Labour Room
This is the room in which the patient remains in the first stage of labour i.e. from the
commencement of the labour pains
These rooms must be designed in such a way that they can serve as Emergency
Delivery Rooms. Most preferred surface area for a labour room is 18feet x 18 feet
 Single Rooms are mostly recommended.
The Labour Room must provide the patient maximum comfort and relaxation to the
patient.
It should have facilities for examination, preparation and observation.
Should be equipped with Electronic Foetal Monitors.
Should be close to delivery room.
Should be Sound proofed so that the noise in other vicinities of the hospital don’t
disturb the patients
Lighting should be conductive to patients relaxation.
The furniture in the labour room is similar to any other patient room but there is a
requirement for a good extension light so that the obstetrician or the nurse can observe
the patient effectively/properly.
Should have the facility of :-
a. Toilet
b. Bedpan flushing
c. Washbasin with a gooseneck type spout
d. Foot or wrist operated controls for hand washing by patients, doctor and nurse

Doors should be 4ft. wide to permit the passage of the stretchers or the bed with the
attendants. BEDS should be furnished with :-

a. Oxygen ,suction and compressed air outlets

b. Nurse call system
c. Lighting controls

3. Delivery Rooms
Delivery rooms should be similar to operating rooms in their designs with
emphasis to create maximum aseptic conditions. Facilities in the delivery
room are similar to that of the surgical suite. They are as follows : -
a. Scrub up area with view to the delivery rooms.
b. General Lighting and Operating Lights
c. Oxygen ,Suction and air
d. Clock with seconds timer
e. Built in Protection against explosion hazards
f. Equipments and supplies

Only one patient should be accommodated at a time. It is difficult to

keep/maintain aseptic conditions in a room where more than one patient is
delivered. There is also a chance of babies getting mixed up if multiple
deliveries take place in the same room

It should also contain a special designated area to receive the new born
baby immediately after birth. This area should have :-

a. A baby receiving tray.

 b. Warmer
c. Suction
d. Oxygen
e. Ambu Bag

The area should be adequately lighted.

Each delivery room should have a foot or elbow operated emergency call
system with a dome light and buzzer on the corridor over each delivery
room. Similar light signals should be installed in the lounge and the nurses
station.

Minimum size of a delivery room should be 18ft. x 18 ft.

4. Caesarian Section :-
It is recommended that there should be an operating room in the
department where major obstetrical surgeries are performed
If this is not possible one of the delivery rooms should be completely
equipped. It should however ,be remembered that maintaining aseptic
conditions comparable to those of the operating room may not be possible
in a delivery room set-up. Operating Room should have facilities for the
new born similar as to that of the delivery room.

5. Scrub Facilities :-
Two scrub positions should be provided near the entrances to each
delivery room

6. Recovery Room :-
Recovery room is to be designed with major emphasis on the utmost clo se
observation and special care. Every patient who has general anaes thesia
should be given constant nursing care until fully conscious.
It is similar to a post surgical recovery room where all post partum
patients are watched by the nurse or the doctor for any signs of delayed
haemorrhage post partum at least for the firs t six hours after the delivery.
Although recovery can be in the delivery room, the labour room or in the
obstetrical nursing unit, room exclusively for this purpose is
recommended so that the patient can be under close observation.
Each recovery room can have two or more beds. Should have a nursing
station with charting facilities and visual control of all beds.Provision
must be made for dispensing medicine, washing hands, clinical sink with
bedpan flushing device and storage for sup plies.

7. Fathers’ Room :-
This should be conveniently located near the labour rooms, but outside the labour-
delivery suite.
8. LDRP suites and Birthing rooms :-
Some facilities also offer what is called a Labor, Delivery, Recovery, and Postpartum
(LDRP) room. In the LDRP, you will give birth here and your baby will stay with you
until you are ready to go home. Many of these facilities use the nursery only for
babies or mothers who are very ill, rather than for well newborn care.
As with the LDR, the LDRP is equipped to handle only vaginal births. Though you
can have an epidural or other pain medication in this room if they are available at your
place of birth.If you are in a hospital and require it, you may also have a forceps
or vacuum delivery in the vast majority of LDR rooms. If you require a c-section at
the hospital, you will generally not recover in the LDR, even if you labored in one.
This may depend on space and the number of people on shift.
The best advantage is that the patient is discharge fro m the hospital within
36hrs and at most cases 24 hours

.
LABOUR AND DELIVERY SUITE AND SURGICAL SUITE COMBINED

ORGANISATION STRUCTURE OF LABOUR AND DELIVERY SUITE

EQUIPMENTS ANDMACHINES USED IN LABOUR AND DELIVERY SUITE

Warm and clean room

 Delivery bed: a bed that supports the woman in a semi-sitting or lying in a lateral position, with
removable stirrups (only for repairing the perineum or instrumental delivery)
 Clean bed linen
 Curtains if more than one bed
 Clean surface (for alternative delivery position)
 Work surface for resuscitation of newborn near delivery beds
 Light source
 Heat source
 Room thermometer

Hand washing
 Clean water supply
 Soap
 Nail brush or stick
 Clean towels

Waste
 Container for sharps disposal
 Receptacle for soiled linens
 Bucket for soiled pads and swabs
 Bowl and plastic bag for placenta

Sterilization
 Instrument sterilizer
 Jar for forceps

Miscellaneous
 Wall clock
 Torch with extra batteries and bulb
 Log book
 Records
 Refrigerator
Equipment
 Blood pressure machine and stethoscope
 Body thermometer
 Fetal stethoscope
 Baby scale
 Self inflating bag and mask - neonatal size
 Suction apparatus with suction tube
 Infant stethoscope

Delivery instruments (sterile)

 Scissors
 Needle holder
 Artery forceps or clamp
 Dissecting forceps
 Sponge forceps
 Vaginal speculum

Supplies
 Gloves:
a) Utility
b) sterile or highly disinfected
c) long sterile for manual removal of placenta
 Long plastic apron
 Urinary catheter
 Syringes and needles
 IV tubing
 Suture material for tear or episiotomy repair
 Antiseptic solution (iodophors orchlorhexidine)
 Spirit (70% alcohol)
 Swabs
 Bleach (chlorine-base compound)
 Clean (plastic) sheet to place under mother
 Sanitary pads
 Clean towels for drying and wrapping the baby
 Cord ties (sterile)
 Blanket for the baby
  Baby feeding cup
 Impregnated bednet
 Alcohol-based handrub
 2 ml and 1 ml syringes (for giving ARV to babies)

Vaccines
 BCG
 OPV
 Hepatitis

Test
 Syphilis testing (e.g. RPR)
 Proteinuria dip sticks
 Container for catching urine
 HIV testing kits (2 types)
 Haemoglobin testing kit

Medical Procedures Performed in Labour and delivery suite

There are a wide range of surgical procedures that have been developed to treat the various conditions that
affect the female reproductive organs.
THE VAGINA.
The vagina is the muscular canal that extends from the opening of the vulva (the external female genitals)
to the cervix, the lower part of the uterus
Some common surgical procedures that are performed on the vagina include:

 Episiotomy. A surgical incision made in the perineum (the area between the vagina and anus) to
expand the opening of the vagina to prevent tearing during delivery.
 Colporrhaphy. Surgical repair of the vagina may be necessary after childbirth, sexual assault, or
other injuries.
 Colpotomy. This incision into the wall of the vagina may be used to excise ovarian cysts,
perform tubal ligation , or remove uterine fibroids.
 Colposcopy. A colposcope is a specialized instrument used to visualize the vagina and cervix, to
diagnose abnormalities, or to test for the presence of precancerous or cancerous cells.

THE UTERUS.
The uterus is the hollow, muscular organ at the top of the vagina. The cervix is the neck-shaped opening at
the lower part of the uterus, while the fundus is the rounded upper portion. The endometrium is the inner
lining of the uterus; it is where a fertilized egg will implant during the early days of pregnancy. The
endometrium normally sheds during each menstrual cycle if the egg released during ovulation has not been
fertilized. The myometrium is the middle muscular layer of the uterus; it is the myometrium that
rhythmically contracts during labor contractions.
Some common surgical procedures that are performed on the uterus include:
  Myomectomy. A procedure in which myomas (uterine fibroids) are surgically removed from the
uterus.
 Cesarean section . A surgical procedure in which incisions are made through the woman's
abdomen and uterus to deliver her baby.
 Cervical cerclage . The cervix is stitched closed to prevent a miscarriage or premature birth.
 Cervical cryosurgery. Cryosurgery freezes and destroys an area of the cervix in which
precancerous cells have been found.
 Induced abortion. The intentional termination of a pregnancy before the fetus can live
independently.
 Hysterectomy. The removal of part or all of the uterus may be done to treat uterine cancer, fibroid
tumors, endometriosis, uterine prolapse, or other conditions of the uterus.
 Hysterotomy. This incision into the uterus is done during a cesarean section, open fetal surgery ,
and some second-trimester abortions.
 Dilatation and curettage. D&C is a gynecological procedure in which the cervix is dilated
(expanded) and the lining of the uterus (endometrium) is scraped away.

THE OVARIES.
The ovaries are egg-shaped structures located to each side of the uterus. It is within the ovaries that the
female egg develops. A mature egg is released from one of the ovaries approximately every 28 days during
a process called ovulation.
The surgical procedures that are performed on the ovaries include:

 Oophorectomy. One or both ovaries may be removed during this procedure to prevent or treat
ovarian or other cancers, to remove large ovarian cysts, or to treat endometriosis.
 Cystectomy . An ovarian cystectomy may be used to remove part of an ovary to treat ovarian
tumors or cysts.

THE FALLOPIAN TUBES.

The fallopian tubes are the structures that carry a mature egg from the ovaries to the uterus. These tubes,
which are about 4 in (10 cm) long and 0.2 in (0.5 cm) in diameter, are found on the upper outer sides of the
uterus, and open into the uterus through small channels. It is within a fallopian tube that fertilization, the
joining of the egg and the sperm, takes place.
Some common surgical procedures that are performed on the fallopian tubes include:

 Salpingostomy. An incision is made in the fallopian tube, often to excise an ectopic pregnancy.
 Salpingectomy. One or both fallopian tubes are removed in this procedure. It may be used to treat
ruptured or bleeding fallopian tubes (as a result of ectopic pregnancy), infection, or cancer.
 Tubal ligation. A permanent form of birth control in which a woman's fallopian tubes are
surgically cut or blocked off to prevent pregnancy.

THE VULVA.

The external female genital organs (or vulva) include the labia majora, two lips or folds that enclose the
labia minora. The labia minora, in turn, are two lips or folds that enclose the clitoris, a small sensitive
organ with a high number of nerve endings.
Some examples of surgeries that affect the vulva are:

 Vulvectomy. The vulva may be partially or completely removed, as in the case of vulvar cancer.
 Laceration or hematoma repair. Vulvar hematoma (a localized collection of blood) or laceration
may result from a "straddle" injury, sexual assault, or childbirth. Severe hematomas may need
surgical drainage.
Recent Trends in Labour and Delivery Suite

1. Delayed umbilical cord clamping after birth

Delayed cord clamping means waiting anywhere from 30 seconds to a few minutes to clamp
and cut the umbilical cord instead of immediately following delivery. By delaying cord
clamping, baby will get additional blood from mom, which contains oxygen-carrying iron
stores. Although this is something that many midwives and doctors have been doing for a
long time, it isn't universally practiced. ACOG has recently recommended that in healthy
infants, cord clamping should be delayed at least 30-60 seconds.

2. Laboring in water

You may have heard that soaking in a tub during labor can help you cope with contraction
pain. It's true! Immersion in water can help decrease the need for an epidural or other pain
medications in women with healthy, uncomplicated pregnancies. However, once it's time to
begin pushing it's best to get out of the tub because delivering baby in the water hasn't been
well studied and there have been reports of serious complications. If you do choose to make a
tub part of your labor experience, make sure that it has been properly cleaned and there is a
plan in place to monitor the baby at appropriate intervals.

3. Cell-free DNA genetic screening

Cell-free DNA screening is the newest way to screen for genetic problems in the baby. This
is a simple blood test that can detect pieces of the baby's DNA in mom's blood to determine if
there may be a problem with the pregnancy.

4. Immediate postpartum IUD insertion

An IUD is one of the most reliable methods of birth control available. In the past, you would
need to return to the office a few weeks postpartum to get an IUD. However now,
immediately following birth, an IUD can be inserted, eliminating the need for an extra visit
and an extra procedure. Talk to your provider to see if the IUD is the right choice for you.

5. Limiting interventions during low-risk labor

Physicians have gotten a bad reputation for unnecessary interventions during labor and
delivery. While there are definitely times that interventions are needed for a safe delivery,
limiting unnecessary interventions can also be beneficial. As a doctor who considers herself a
midwife at heart, I was excited to see that ACOG recently came out in support of limited
interventions in low-risk labors. They are encouraging the use of doulas, changing positions
during labor, intermittent monitoring and non-pharmacologic methods of pain control in
conjunction with women's birth plans.