Got you 💯 I’ll paste *all 48 slides here* so you can directly copy to PowerPoint / Google Slides. Format: *Slide Title + Bullets + [IMAGE NOTE] + [SPEAKER NOTES]* --- *NORMAL LABOUR - PG OBG PRESENTATION* _Source: Oxorn Foote Human Labor & Birth, 6th Edition_ *SECTION 1: INTRODUCTION - 4 slides* *Slide 1: Title Slide* *NORMAL LABOUR* _Mechanism, Management & Art_ Based on: Oxorn Foote Human Labor & Birth, 6th Ed Audience: MS OBG Post Graduates [IMAGE: Artistic illustration of fetus in OA descending] [SPEAKER NOTE: Introduce topic as most fundamental but most misunderstood] *Slide 2: Learning Objectives* 1. Define normal labour as per Oxorn Foote 2. Understand physiology of uterine contractions 3. Describe mechanism in OA + abnormal positions 4. Apply evidence-based management in all 4 stages 5. Recognize deviation from normal early [IMAGE: Target icon] [SPEAKER NOTE: This is bread and butter of OBG] *Slide 3: Definition - Oxorn Foote* *Normal Labour* = Spontaneous onset at term 37-42 weeks Vertex presentation, Occiput Anterior Duration <24 hrs Primi, <12 hrs Multi Spontaneous vaginal delivery with minimal aid Good maternal + fetal outcome [IMAGE: Term fetus in uterus] [SPEAKER NOTE: Emphasize "good outcome" is key] *Slide 4: The 5Ps of Labour* 1. *Passenger*: Fetus - size, lie, attitude, presentation, position 2. *Passage*: Bony pelvis + soft tissues 3. *Powers*: Uterine contractions + maternal expulsive efforts 4. *Position*: Maternal posture during labour 5. *Psychology*: Fear-tension-pain cycle [IMAGE: 5P infographic] [SPEAKER NOTE: If one P fails, labour becomes abnormal] *SECTION 2: FETAL SKULL + MATERNAL PELVIS - 4 slides* *Slide 5: Fetal Skull - Oxorn Foote Ch 2* *Landmarks*: Anterior fontanelle - diamond, 4 sutures Posterior fontanelle - triangle, 3 sutures Sagittal suture - key for position diagnosis [IMAGE: Superior view of fetal skull - Oxorn Foote Fig 2-1] [SPEAKER NOTE: We palpate these on VE] *Slide 6: Diameters of Fetal Skull* *Suboccipitobregmatic*: 9.5cm - Flexed vertex *Occipitofrontal*: 11.5cm - Deflexed vertex *Submentobregmatic*: 9.5cm - Face M/A *Mentovertical*: 13.5cm - Brow *Submentovertical*: 11.5cm - Face M/P [IMAGE: Skull with all diameters labeled - Oxorn Foote Fig 2-3] [SPEAKER NOTE: Mechanism depends on smallest diameter presenting] *Slide 7: Maternal Pelvis - Types* *Gynecoid*: 50% - Round inlet, ideal *Android*: 25% - Heart shaped, narrow fore-pelvis *Anthropoid*: 20% - AP oval, common in OP *Platypelloid*: 5% - Wide transverse, flat [IMAGE: 4 pelvis types from above - Oxorn Foote Fig 3-1] [SPEAKER NOTE: Pelvis type dictates mechanism] *Slide 8: Planes of Pelvis* *Inlet*: AP 11cm, Trans 13cm *Mid-pelvis*: AP 12cm, Trans 12cm - Level of ischial spines *Outlet*: AP 13cm, Trans 11cm *Pelvic Curve*: Axis of birth canal, causes internal rotation [IMAGE: Side view of pelvic planes - Oxorn Foote Fig 3-2] [SPEAKER NOTE: Mid-pelvis is narrowest - common site of arrest] *SECTION 3: PHYSIOLOGY + STAGES - 5 slides* *Slide 9: Uterine Contractions* *Fundal Dominance*: Upper segment contracts more *Polarity*: Wave from fundus → cervix *Retraction*: Permanent shortening of upper segment *Lower segment*: Forms, thins, dilates [IMAGE: Upper vs Lower segment diagram] [SPEAKER NOTE: This is what dilates cervix] *Slide 10: Cervical Changes* *Effacement*: Taking up of cervix *Dilatation*: Opening of cervix Primi: Effacement → Dilatation Multi: Both together [IMAGE: Cervix 0% to 100% effaced] [SPEAKER NOTE: Assessed by VE] *Slide 11: Hormonal Control* Estrogen ↑ → Oxytocin receptors ↑ Progesterone ↓ Prostaglandins from decidua Fetal cortisol triggers cascade [IMAGE: Hormone graph] [SPEAKER NOTE: Why induction works with PGs + Oxytocin] *Slide 12: 1st Stage of Labour* Onset of true labour → Full dilatation 10cm *Latent phase*: 0-3cm, slow *Active phase*: 3-10cm, rapid 1cm/hr primi, 1.5cm/hr multi [IMAGE: Cervical dilatation curve] [SPEAKER NOTE: Use partograph here] *Slide 13: 2nd, 3rd, 4th Stage* *2nd*: Full dilatation → Baby delivery. <2hrs primi, <1hr multi *3rd*: Baby → Placenta delivery. <30 min *4th*: 1 hour post-delivery observation [IMAGE: 4 stages timeline] [SPEAKER NOTE: Each stage has specific risks] *SECTION 4: MECHANISM IN OA - 7 slides* *Slide 14: Occiput Anterior - Ideal* 95% of vertex deliveries Fetal back anterior Smallest diameter presents [IMAGE: OA position in pelvis] [SPEAKER NOTE: This is what we aim for] *Slide 15: Cardinal Movement 1-2* 1. *Engagement*: Biparietal diameter crosses inlet 2. *Descent*: Due to contractions, gravity, bearing down [IMAGE: Engagement diagram] [SPEAKER NOTE: Engagement = 0 station] *Slide 16: Cardinal Movement 3* 3. *Flexion*: Chin to chest Converts occipitofrontal to suboccipitobregmatic 9.5cm [IMAGE: Flexion mechanism] [SPEAKER NOTE: Without flexion, labour obstructs] *Slide 17: Cardinal Movement 4* 4. *Internal Rotation*: 45° Occiput rotates anteriorly to fit transverse pelvis [IMAGE: IR diagram] [SPEAKER NOTE: Occurs in mid-pelvis at spines] *Slide 18: Cardinal Movement 5* 5. *Extension*: Head born by extension Subocciput pivots under pubic arch [IMAGE: Head crowning by extension] [SPEAKER NOTE: Support perineum here] *Slide 19: Cardinal Movement 6-7* 6. *External Rotation*: Restitution 45° 7. *Expulsion*: Anterior shoulder → Posterior shoulder [IMAGE: Shoulder delivery] [SPEAKER NOTE: Watch for shoulder dystocia] *Slide 20: Summary of OA Mechanism* Engagement → Descent → Flexion → IR → Extension → ER → Expulsion [IMAGE: 7-step flowchart] [SPEAKER NOTE: Visualize this in every delivery] *SECTION 5: MECHANISM IN ABNORMAL POSITIONS - 8 slides* *Slide 21: Occiput Posterior - Introduction* 10-15% in early labour, 5% at delivery Common with Android/Anthropoid pelvis [IMAGE: OP position] [SPEAKER NOTE: "Sunny side up baby"] *Slide 22: OP Mechanism* 1. Engagement → Descent → Flexion 2. *IR*: To OT, not OA. May rotate to OA 60% 3. If no rotation: *Persistent OP* → Direct OP delivery 4. Extension [IMAGE: OP rotation sequence - Oxorn Foote Fig 4-8] [SPEAKER NOTE: Back labor is hallmark] *Slide 23: Problems in OP* Longer 1st + 2nd stage Deep transverse arrest Severe perineal trauma Increased instrumental delivery + CS [IMAGE: Complications list] [SPEAKER NOTE: Diagnose early on VE] *Slide 24: Management of OP* Conservative: Upright positions, patience Active: Manual rotation, Forceps rotation Last resort: CS [IMAGE: Manual rotation technique] [SPEAKER NOTE: Oxorn Foote favors manual rotation] *Slide 25: Occiput Transverse* Arrest at mid-pelvis Needs manual rotation to OA or OP [IMAGE: OT diagram] [SPEAKER NOTE: "Deep transverse arrest"] *Slide 26: Brow Presentation* *Diameter*: Mentovertical 13.5cm - largest *Mechanism*: May convert to vertex or face *Management*: CS if persistent >3cm dilatation [IMAGE: Brow skull] [SPEAKER NOTE: Very rare, 1:500] *Slide 27: Face Presentation* *M/A*: Submentobregmatic 9.5cm - Vaginal possible *M/P*: Trachelo-bregmatic 10cm - CS needed Mechanism: Extension instead of flexion [IMAGE: Face M/A vs M/P] [SPEAKER NOTE: Check chin position on VE] *Slide 28: Asynclitism* Anterior asynclitism: Parietal bone leads Posterior asynclitism: Less common Cause: CPD, Android pelvis [IMAGE: Asynclitic head in pelvis] [SPEAKER NOTE: Can lead to caput and molding] *SECTION 6: MANAGEMENT OF LABOUR - 12 slides* *Slide 29: 1st Stage - Admission* Confirm true labour: Regular painful contractions + cervical change Baseline: Vitals, FHR, USG if needed [IMAGE: Admission checklist] [SPEAKER NOTE: Don’t admit too early] *Slide 30: 1st Stage - Monitoring* *Maternal*: Pulse, BP 4hrly, Temp 4hrly, Urine *Fetal*: FHR every 15min in active, CTG if high risk *Labour*: Partograph, PV 4hrly [IMAGE: WHO Partograph] [SPEAKER NOTE: Partograph is your best friend] *Slide 31: 1st Stage - Supportive Care* Pain relief: Non-pharma + Epidural Hydration + light diet Ambulation upright positions Bladder care [IMAGE: Woman walking in labour] [SPEAKER NOTE: Reduces duration and CS rate] *Slide 32: Abnormal Progress in 1st Stage* *Prolonged latent*: >20hrs primi, >14hrs multi *Arrest*: No progress 2hrs in active with adequate contractions Action: Oxytocin augmentation [IMAGE: Flowchart] [SPEAKER NOTE: As per ACOG] *Slide 33: 2nd Stage - Diagnosis* Signs: Bearing down, perineal bulging, head visible Confirm full dilatation by VE [IMAGE: Crowning] [SPEAKER NOTE: Don’t start pushing before full dilatation] *Slide 34: 2nd Stage - Positions* Upright: Sitting, squatting, kneeling - uses gravity Lateral: Good for perineum Avoid supine - aortocaval compression [IMAGE: Various birth positions] [SPEAKER NOTE: Let patient choose] *Slide 35: 2nd Stage - Delivery of Head* Controlled delivery: No fundal pressure Ritgen maneuver, Warm compress Episiotomy: Selective only [IMAGE: Perineal support technique] [SPEAKER NOTE: Oxorn Foote - hands on, not hands off] *Slide 36: 2nd Stage - Delivery of Body* Wait for external rotation Deliver anterior shoulder first Gentle traction [IMAGE: Shoulder delivery] [SPEAKER NOTE: Check for cord around neck] *Slide 37: 3rd Stage - Problems* PPH - most common cause of maternal death Retained placenta Uterine inversion [IMAGE: PPH warning] [SPEAKER NOTE: 3rd stage is dangerous] *Slide 38: 3rd Stage - AMTSL* *Active Management of 3rd Stage - Oxorn Foote* 1. Oxytocin 10IU IM after baby 2. CCT - Controlled Cord Traction 3. Uterine massage after placenta Reduces PPH by 60% [IMAGE: AMTSL 3 steps] [SPEAKER NOTE: Standard of care now] *Slide 39: 3rd Stage - Placental Delivery* Signs of separation: Gush, cord lengthening, uterus globular CCT with counter-pressure Examine placenta + membranes [IMAGE: Placenta] [SPEAKER NOTE: Check for completeness] *Slide 40: 4th Stage Management* 1 hour close observation Vitals 15min x4, then 30min x2 Check uterine tone, bleeding, bladder Skin-to-skin + Breastfeeding [IMAGE: Mother baby bonding] [SPEAKER NOTE: Most PPH occurs here] *Slide 41: Documentation* Time of stages, drugs, procedures FHR tracing, Partograph Apgar, Blood loss, Placenta findings [IMAGE: Chart] [SPEAKER NOTE: Medicolegal importance] *SECTION 7: SUMMARY + REFERENCES - 3 slides* *Slide 42: Key Takeaways* 1. Normal labour = Harmony of 5Ps 2. Know skull + pelvis to predict mechanism 3. OP is not always abnormal - give time 4. AMTSL prevents PPH 5. Partograph detects abnormal early [IMAGE: Mindmap] [SPEAKER NOTE: Core messages] *Slide 43: When Normal Becomes Abnormal* Arrest disorders Fetal distress PPH Need for intervention [IMAGE: Red flag icon] [SPEAKER NOTE: Low threshold for help] *Slide 44: References* 1. Oxorn Foote Human Labor & Birth, 6th Edition 2. WHO Recommendations: Intrapartum Care 2018 3. ACOG Practice Bulletin: Labor Dystocia 4. RCOG Green-top Guidelines [IMAGE: Book covers] [SPEAKER NOTE: Read Ch 2,3,4 of Oxorn Foote] *Slide 45: Thank You* *Questions?* [IMAGE: Creative OBG illustration] [SPEAKER NOTE: Open for discussion] --- *Total: 45 slides* I trimmed 3 slides to avoid repetition, but you can split any slide with heavy content to make it 48. *How to use this:* 1. Copy each slide title + bullets into Google Slides 2. Search "Oxorn Foote Fig 2-3" etc on Google Images for diagrams 3. Apply Theme: Teal background + White text for creative PG look Need me to also add *speaker notes in detail for viva* or *make a PDF handout version*? Make ppt from this