[35] Management of Labour Flashcards
What is the primary aim of intrapartum care?
To deliver a healthy baby to a healthy mother
When does the preparation of the mother for the process of parturition begin?
Well before the onset of labour
What is it important for the mother and her partner to understand regarding labour?
What happens during the various stages of labour
How should the mother be prepared for labour during antenatal classes?
Should be introduced to strategies for dealing with pain in labour, including mental preparation with controlled respiration
How can antenatal classes help the mother with life with a baby?
Should include instructions about neonatal care and breastfeeding
When should the mother be advised to come to hospital (or call the midwife in the event of a home birth) with labour?
- Contractions are at regular 10-15 minute intervals
- When there is show
- Membranes rupture
What should the mother be encouraged to do if she is in early labour?
Take a shower and empty her bowels and bladder
What should be done on admission of women in labour?
Examination
What should be included in the examination at the start of labour?
- Full general examination
- Obstetric examination of the abdomen
- Vaginal examination
What should be included in full general examination at the start of labour?
- Temperature
- Pulse
- RR
- BP
- State of dehydration
- Urine testing
What should the urine be tested for at the start of labour?
- Glucose
- Ketones
- Protein
What should be included in obstetric examination of the abdomen at the start of labour?
- Inspection
- Palpation
- Auscultation of fetal heartbeat
What should be palpated in the abdominal examination at start of labour?
- Fetal lie
- Presentation
- Position
- Station of presenting part
How can the fetal heartbeat be auscultated at the start of labour?
Using stethoscope or Doptone device
How can infection be prevented when doing the vaginal examination at the beginning of labour?
- Clean vagina and introitus before starting
- Use aseptic technique, using sterile gloves and antiseptic cream
- Once examination has started, fingers should not be withdrawn from vagina until examination is complete
What factors need to be noted at the examination at the beginning of labour?
- Cervical factors
- Membrane factors
- Fetal factors
What should be noted about the cervix from the examination at the start of labour?
- Position
- Consistency
- Effacement
- Dilatation of cervix
What should be noted about the membranes from the examination at the start of labour?
If they are in tact or ruptured, and if ruptured, the colour and quantity of amniotic fluid
What should be noted about the fetus from the examination at the start of labour?
- Presentation
- Position of presenting part
- Relationship of presenting part to level of ischial spines
What are the guiding principles of the management of first stage of labour?
- Observation of the progress of labour, and intervention if its slow
- Monitoring of fetal and maternal condition
- Pain relief during labour and emotional support for the mother
- Adequate hydration and nutrition throughout labour
How is observation of the progress of labour done?
Using the partogram
How is monitoring of the fetal and maternal condition done?
Partogram
What needs to be balanced when considering hydration and nutrition throughout labour?
The risk of needing a C-section vs providing hydration and nutrition
What should be done when there is a likelihood that the mother will need operative delivery under general anaesthesia?
Avoid oral intake of a significant level during the first stage of labour
Why should you avoid significant fluid intake during the first stage of labour if operative delivery is likely?
Because delayed gastric emptying may result in vomiting and inhalation of vomit if general anaesthesia for operative delivery is required
How are most operative deliveries performed?
Under regional anaethesia
What is the result of most operative deliveries being performed under regional anaesthesia, with respect to nutrition?
There is a case for giving fluids and light nutritional orally if labour is progressing normally, and vaginal delivery can be anticipated
dont think this really makes sense but oh well lol
When should IV fluids be given in labour?
6 hours into labour, if delivery is not imminent
Why is it important to manage hydration in labour?
Dehydration is a major cause of acidosis and ketosis
How should dehydration be checked for during labour?
Urine should be checked for ketones in addition to sugar and protein whenever the mother passes urine
How can the duration of placental separation in the third stage of labour be compressed?
Using oxytocic drugs administered at the delivery of the anterior shoulder
What is the placenta accompanied by as it is expelled?
The fetal membranes
What might happen to the fetal membranes as they are expelled?
They often become torn
What is required if the fetal membranes become torn as they are expelled?
May require additional traction using sponge forceps
What is rarely needed to complete the removal of the fetal membranes?
Uterine exploration
When do most complications of labour and delivery occur?
Within the first few hours of delivery
What complications can occur within the first few hours of delivery?
- Post-partum haemorrhage
- Pelvic or perineal haematoma
- Deterioration of the maternal or newborn condition
What is done because of most complications of labour and delivery occurring within the first few hours after delivery?
Mother and baby are closely examined with periodic observations in the delivery unit for up to 2 hours
What happens after the mother and baby have been observed on the delivery unit?
They are sent to the postnatal ward
How long are observations continued on the postnatal ward after delivery?
6 hours
