Management of Uncomplicated labour

• Painful contractions Not in labour Observe in antenatal ward

• Show
• Effacement & progressive Uncertain Review after 2 hours
dilatation of cervix
Established labour

Transfer to the labour suite Admission CTG to be

Identify risk factors by,
Episiotomy
o Review antenatal records.
- Medio-lateral Episiotomy
o Detailed clinical history
2.Cord clamp At the time of crowning
o Examination
Urine for protein
done in all three groups
o Avoiding faecal soiling and interpreted before
o Shaving of perineal hair decision is made (Y)
o Oral fluids
o IV access
o Left Lateral recombinant
position

Monitoring by Partogram
Maintain Partogram*(X)
Progress of labour
o Cervical dilatation
o Decent of the presenting part
o Uterine contractions
Routine

All steps in the management of labour should be carried out under aseptic conditions
care in

All steps in the management of labour should be documented in the bed head ticket
Maternal condition
labour suit Pain relief
o Pulse, BP, Temperature & hydration.
o Evaluation of drugs(oxytocin, antibiotics, Opioid -Pethidine
Anti hypertensives, Analgesics Regional analgesia-Epidural
o Undistended bladder-catheterize if Other-spinal analgesia
indicated Combined spinal-epidural analgesia
Fetal condition Inhalational analgesia-Entonox
o Intermittent auscultation of fetal heart Pudendal block for
o Liquor volume episiotomy/forceps/vacuum
o Meconeum in liquor

Positioning
Most comfortable Second stage
position Diagnosis
Second stage of labour

Supine position-avoided 9 Vaginal examination

Descent phase- for full dilatation
-Not to bear down 9 Perineal distention
-Fetal heart assessed 9 Anal dilatation
every 15 mints

Expulsive phase-
-Encourage to bear down
-Fetal heart assessed after
each contraction Episiotomy
- Medio-lateral
Episiotomy
At the time of
Delivery Delivery crowning
Third stage of labour

1.Oxytocics Third stage 3.Controlled

cord traction
Active
management
2.Cord clamp 4.Examine the
placenta

5. Observation for signs of

o Haemorrhage
o Utrine fundal level
o Evidence of collapse
o Respiratory difficulty
o Unusual behaviouror
o Abdominal pain
Monitoring
Mother should be
Post-partum

closely monitored in
the labour room for
at least two hours

Sri Lanka College of Obstetrics and Gynaecology

Health sector development Project
Guidelines- Management of Uncomplicated labour