PREPARATION

AND
CONDUCTION
OF LABOUR
CAUSES-MATERNAL MORTALITY
Anaemia-20%
Haemorrhage-20%
Sepsis-13%
Abortion-11%
Obstructed labour-12%
Toxemia-9%
Others-15%
 COMPARATIVE FINDINGS
INDICATOR Base line Repeat
Assessment% Assessment %
Registration 55.25 86.74
3 Visit 5.61 13.81
All Visit 68 34.80
TT imm
1 Dose 65.91 87.29
2 Dose 55.11 83.97
IFA Tab 57.51 84.54
Indian Journal of Public Health 48th ALL India
Annual Conference – Jan 2005
ESSENTIAL MATERNAL CARE
Periodic health check ups
Early registration
At subcentre level- 5000 popn
Birth rate:29/1000 popn
No.of pregnant women:160
 ANTENATAL CHECK UPS
PURPOSE - 3 TRIMESTERS
- Progress of pregnancy
- Treat any maternal
complications early.
 AWARENESS
Nearest hospital- FRU
Advance arrangement for
transportation in emergency
Blood transfusion in obstetric
emergency
 MINIMUM- 3 VISITS

1st - at 20 wks or as soon as

pregnancy is known d registered.
2nd - at 32 wks
3rd – at 36 wks ( often in 3rd
trimester)
 CLINICAL ASSESSMENT

Careful history
Physical examination
 HISTORY

Date - LMP
AGE
ORDER of pregnancy
INTERVAL between preg
 ANY PROBLEMS
1. Abortions or premature births
2. Eclampsia
3. APH
4. Prolonged labour,retained placenta
5. PPH
6. Sepsis
7. Previous LSCS
8. Still births OR NEONATAL DEATHS
SYSTEMIC ILLNESS
Heart disease
Diabetes
Tuberculosis
Hypertension
PRESENTING COMPLAINTS
H/O PIH
Bleeding / draining pv
Pain abdomen
Fever
Breathlessness
Palpitation
PHYSICAL EXAMINATON

GENERAL O/E
- Pallor
- Puffiness of face
- Edema-feet
- HT,WT,BP
ABDOMEN O/E
PALPATION - FUNDAL HT
- FOETAL
LIE,PRESENTATION,
PRESEN. PART
AUSCULTATION - FHS
XRAY,DRUGS - avoided.
 ADVICE TO MOTHERS
Extra meal
Rest - 2Hrs n afternoon
- 8Hrs at night
ANAEMIA PROPHYLAXIS
-100 IRON d FA TAB
T T immunisation - 5th d 7th months
 PREPARING FOR LABOUR
TRAINED DAIS d VHN
should advise to buy
- New blade
- Thread: sterilised
- Keep ready cotton cloth : mother d
newborn
Transportation d blood transfusions
MANAGEMENT
OF
LABOUR
CONDUCTED….
Trained dais
village health nurse
 INTRODUCTION

DEFINITION
NORMAL LABOUR
STAGES – LABOUR

12019.mov
 FIRST STAGE

Encourage frequent emptying of

bladder
Soap d water enema
Mother - warm drinks d soft foods -
maintain STRENTH
Can walk till membranes rupture
 SECOND STAGE
encourage mother to BEAR DOWN during
pains
Provide support to perineum
When CROWNING, ask mother to take
DEEP BREATHS - deliver head slowly
Tie and cut cord 2.5inchs or less from
umblicus.
 THIRD STAGE

Cut the cord - wipe and dry

the baby --- WEIGH and
covered with towel.
SIGNS OF PLACENTAL SEPARATION
Uterus is hard and globular

Sudden gush of fresh blood

Extra vulval lenthening of cord

If fundus pushed up,cord will not recede into

vagina

If severe bleeding, REFERRAL- HIGHER CENTERS

DELIVER PLACENTA
CHECK - any tears irregularities..
 CONTROL OF INFECTIONS
FIVE CLEAN PRACTICES
CLEAN HANDS
CLEAN DELIVERY SURFACE
CLEAN RAZOR BLADE r CLAMPS
CLEAN CORD TIE
CLEAN CORD STUMP
REFERRAL- OBSTETRIC EMERMENCY
Position of the patient
Medication
Referral note
Advice to family members
 REFERENCES

National child survival and safe motherhood

newborn care.
Indian journal of public health- 48th all India
Annual Conference.
Dutta - textbook of obstetrics.
Park - textbook of social and preventive
medicine.