L4: Labor (Management)

Question 1

Managment of Labor

Answer 1

• 1st stage
• 2nd Stage
• 3rd Stage
• 4th Stage
• Care of Newborn

Question 2

Managment of Labor

• 1st Stage

Answer 2

Question 3

Management of 1st stage of Labor

• Position

Answer 3

Question 4

Management of 1st stage of Labor

• Bearing Down?

Answer 4

No, To avoid exhaustion.

Question 5

Management of 1st stage of Labor

• Nutrition

Answer 5

Question 6

Management of 1st stage of Labor

• Bladder & Rectum

Answer 6

Question 7

Management of 1st stage of Labor

• Asepsis

Answer 7

Before any vaginal examination.

Question 8

Management of 1st stage of Labor

• Analgesia

Answer 8

Pethidine (50 mg) or morphine if labor isn’t expected in 3 hours.

Question 9

Management of 1st stage of Labor

• Vaginal Examination

Answer 9

Question 10

Management of 1st stage of Labor

• Time of Vaginal Examination

Answer 10

1) On admission: To ensure onset of labor.
2) After ROM: To exclude cord prolapse.
3) Every 2 hours: To assess progress of labor.

Question 11

Management of 1st stage of Labor

• Aim of Vaginal Examination

Answer 11

Question 12

Management of 1st stage of Labor

• Monitoring of Labor

Answer 12

Question 13

Management of 2nd stage of Labor

Answer 13

• Before Head Delivery
• Head Delivery
• After Head Delivery

Question 14

Management of 2nd stage of Labor

• Before Head Delivery

Question 15

Management of 2nd stage of Labor

• position

Answer 15

Lithotomy position on delivery table.

Question 16

Management of 2nd stage of Labor

• Sterialization & Towelling

Answer 16

…

Question 17

Management of 2nd stage of Labor

• Evacuation

Answer 17

Evacuation of bladder & rectum.

Question 18

Management of 2nd stage of Labor

• Bearing Down?

Answer 18

Ask patient to bear down during uterine contractions only & relaxes () contractions.

Question 19

Management of 2nd stage of Labor

• Observation

Answer 19

Observations for maternal & fetal conditions.

Question 20

Management of 2nd stage of Labor

• Head Delivery

Answer 20

Question 21

Aim in Head delivery

Answer 21

Decrease Perineal Lacerations

Question 22

Head delivery

• When to support Perineum?

Answer 22

As soon as head distends vulva, attendant supports perineum by closed fist of hand & pad of cotton

Question 23

Head delivery

• Why Support The Perineum?

Answer 23

to maintain flexion of head till crowning occurs (to ensure distension of vulva by the smallest diameter of fetal head).

Question 24

Head delivery

• Managment of Head Extension

Answer 24

• If extension occurred before crowning (premature extension) → Increased diameter distending vulva → perineal tear.
• After crowning, head is allowed to extend in () uterine contractions (not during uterine contractions) by Ritgen ‘s maneuver which means upward & backward pressure on perineum & downward pressure on occiput to allow gradual extension of head.

Question 25

**Head delivery** - After Crowning

Answer 25

- After crowning, head is allowed to extend in () uterine contractions (not during uterine contractions) by Ritgen 's maneuver - Which means upward & backward pressure on perineum & downward pressure on occiput to allow gradual extension of head.

Question 26

**Head delivery** - Episiotomy

Answer 26

Episiotomy is done è crowning when it is indicated.

Question 27

Management of 2nd stage of Labor - After Delivery of Head

Question 28

Management of 2nd stage of Labor - Swabbing

Answer 28

Baby's eyelids, mouth & nose are swabbed.

Question 29

Management of 2nd stage of Labor - Suction

Answer 29

Suction is done to clear airway starting by mouth then nose.

Question 30

Management of 2nd stage of Labor - Examination of Cord

Answer 30

- Examination for any loop of cord coiled around neck: If coils of cord are present, do either slipping of coil or division of cord if tight) in () 2 clamps.

Question 31

Management of 2nd stage of Labor - Delivery of Shoulders

Answer 31

Question 32

Management of 2nd stage of Labor - Delivery of Trunk & rest

Answer 32

Easily

Question 33

Management of 2nd stage of Labor - Holding Newborn

Answer 33

- Newborn is held from his feet è head down for few seconds to drain respiratory passage

Question 34

Management of 2nd stage of Labor - When to avoid Holding Newborns in upside down way?

Answer 34

Except in cases of - Prematurity - Asphyxia - Possibility for ICH

Question 35

Management of 2nd stage of Labor - Ligation & Cutting of Cord

Answer 35

Question 36

Management of 2nd stage of Labor - When to avoid milking Cord?

Answer 36

Cord is clamped immediately eout milking in the following conditions: - Premature baby: To avoid hypervolemia, HF & hyperbilirubinemia. - Rh isoimmunization: To Decrease Abs reaching neonate. - Diabetic mother: To avoid hypervolemia. - Multifetal pregnancy. - After general anesthesia: To anesthetic agents & get early recovery.

Question 37

Management of 2nd stage of Labor - Inspection of Lower Genital Tract & Perineum

Answer 37

For lacerations & tears.

Question 38

Managment of 3rd stage of Labor

Question 39

Managment of 3rd stage of Labor - Aims

Answer 39

1) Ensuring complete expulsion of placenta & membranes. 2) Prevention of PPH.

Question 40

Managment of 3rd stage of Labor - Methods

Answer 40

- Conservative - Active

Question 41

**Expectant** Managment of 3rd stage of Labor - Method

Answer 41

Question 42

**Expectant** Managment of 3rd stage of Labor - Advantages

Answer 42

Safe

Question 43

**Expectant** Managment of 3rd stage of Labor - Disadvantages

Answer 43

Time consuming & more blood loss.

Question 44

**Active** Managment of 3rd stage of Labor - Method

Answer 44

Question 45

**Active** Managment of 3rd stage of Labor - Advantages

Answer 45

Decrease duration of 3rd stage ----> Decrease blood loss -----> decrease incidence of PPH.

Question 46

**Active** Managment of 3rd stage of Labor - Disadvantages

Answer 46

Question 47

Managment of 4th stage of Labor

Answer 47

Observation for 1 hour for PPH.

Question 48

Neonatal Care After Labor

Answer 48

Question 49

Neonatal Care After Labor - Apgar Score

Answer 49

Done routinely at 1 & 5 minutes after delivery.

Question 50

Neonatal Care After Labor - Bathing

Answer 50

To clean neonate from blood & vernix caseosa.

Question 51

Neonatal Care After Labor - Clear Respiratory Tract

Answer 51

Head low down 15° & resuction to remove mucus.

Question 52

Neonatal Care After Labor - Umbilical Stump

Answer 52

- Cord is ligated (by 2 silk ligatures) or clamped (by plastic sterile clamp) 5 cm from umbilicus (to avoid tying any hernia protruding in cord). - Paint cut end of cord è alcohol & cover it by sterile bandage.

Question 53

Neonatal Care After Labor - Position

Answer 53

- Put neonate on rigid flat table under radian heat from above (to avoid chills. & hypothermia).

Question 54

Neonatal Care After Labor - Weighing

Answer 54

of the baby

Question 55

Neonatal Care After Labor - Marking

Answer 55

to avoid loss

Question 56

Neonatal Care After Labor - Examination

Answer 56

Examination for sex & congenital anomalies.

Question 57

Neonatal Care After Labor - Eyes

Answer 57

Give antibiotic or antiseptic eye drops to avoid ophthalmia neonatorum.