Professional Documents
Culture Documents
Term
Labour
PTL prolonged
24 W 28 W 37 W 40W 42W
1 LNMP
Stages of labor
Stage 1st 2nd 3rd 4th
Diagnosis
How to deal
Preparations
Monitoring
Procedures
Management of the
First Stage of Labour
Diagnosis {made within one hour of admission}
A. symptoms:
1. True labour pains colicky pain in the abdomen and
back are characterized by:
character True labour pain False labour pain
contractions regular Irregular
Interval between Progressive Short duration, not
contractions and (increase in progressive
intensity frequency and
intensity)
Changes in the Associated with Not associated with
cervix effacement and effacement and
dilation of the dilation of the cervix
cervix
Membranes Associated with Not associated with
bulging of bulging of
membranes membranes
Response to Not relieved by Relieved by sedation
analgesia sedation
Labour Followed by labour Not followed by labour
Patient preparations:
Full history and clinical
examination
Position: Encourage any non-
supine position and movement
throughout labor and childbirth.
Diet: nothing by mouth, IV fluid, or
light diet but fat ,proteins are not
allowed at all.
IV line : recommended.
Patient preparations:
Rectum: no evidence that routine
enema is beneficial .
Bladder:
Encouraged patient to empty her bladder
regularly.
Urinary catheter only when woman is
unable to void.
Pain Control: antenatal women education
about pain relief techniques- epidural anesthesia
satisfaction.
2. Show blood stained mucous.
3. SROM
B. Signs:
o palpable or recorded uterine
contraction
o effacement and dilation of the cervix
o formation of forewater
What is a partogram
(partograph) ?
PARTOGRAM
Def: diagrammatic record of the
events of labour.
Advantages:
Monitoring
the progress of labour,
maternal and fetal wellbeing
Early detection and management of
labour abnormalities.
Fetal
cervical
Descent
Uterine
Materna
l
Timing observations of different parameters
of partogram in the the1st stage of labor
Vaginal examination 4 8 4
Descent of head 4 8 4
Contractions 4 2
Fetal heart beats 4 1
Temperature, PR, BP, urine 4 4 4
Phases of cervical dilatation
The alert line:
Drawn from 3 cm dilatation ( at rate of dilatation
of 1 cm / hour).
Represents the rate of dilatation of the slowest 10 % of
labours in primigravidae.
Crossing the alert line suggests that the patient should be
transferred to a hospital for extra care.
The action line :
parallel and 2 (4) hours to the right of the alert line;
crossing the action line suggests the need for intervention
(eg, artificial rupture of the membranes, administration of
oxytocics.
Vaginal examination:
single individual to minimize
interobserver variations
Indications:
On admission
At one to four hour intervals in the first stage
At rupture of membranes to evaluate for cord prolapse
Feeling the urge to push to determine whether the
cervix is fully dilated
If the FHR falls, to evaluate for conditions such as cord
prolapse or uterine rupture.
Vaginal examination:
Disadvantages:
Increases womans anxiety.
Amniotomy
Oxytocin
administration
of <1 cm/hour
Management of second stage
of labour
Onset of second stage
Full cervical dilatation (sure)
Involuntary Bearing down
The urge to defecate and urinate.
Contractions becomes more prolonged.
Expiratory grunting with expulsive efforts.
Rupture of membranes (suggestive)
Preparation for delivery
Position: Patient is put in dorsal Lithotomy position and
the legs are half-flexed
Patient is properly draped
Asepsis:
Diet
Bladder and rectum
Pain relief
Patient is asked to take deep breath & breath held then
exerts downward pressure at the time of uterine
contraction and relax in between
Fetal heart rate monitoring
Episiotomy
labour
Management of third stage of labour
aimed at:
uterus.
3-prevention of postpartum
haemorrhage
Delivery of the placenta and membranes: uterus should
be examined for the presence of second baby
a-Conservative method:
The left hand is placed just above the fundus to detect any
change in the fundal level, shape and consistency of the
uterus which indicate atony.
Wait for signs of placental separation and decent,
Massage uterus to contract
The patient is asked to bear down to deliver the placenta
spontaneously.
Ergometrine 0.5mg or Syntometrine(5 units syntocinon +
0.5mg Ergometrine) to be given intravenouslly.
Signs of separation and decent of the
placenta:
1. -The body of the uterus becomes smaller, harder, and
globular.
2. -The fundal level rises in the abdomen because the
lower segment becomes distended by the placenta.
3. -Suprapubic bulge may appear due to presence of the
placenta in the lower segment.
4. -Elongation of the cord out side the vulva.
5. -Sudden gush of blood from the vagina.
b-Active methods (prophylaxis against postpartum haemorrhage)
1-Give Methargine 0.5 mg IM or Syntometrine (5units
oxytocin+0.5mg Methargine), at the time of the anterior
shoulder is free from symphysis pubis or as soon as possible
thereafter.
2-Deliver the placenta and membranes by control cord traction by
right hand, and the left hand is placed on the suprapubic
region, pushing the uterus upwards.
hour if necessary.
Descent
Flexion
Internal rotation
Extension
Restitution
External rotation
Expulsion
Induction