L4: Labor (Management) Flashcards
Managment of Labor
- 1st stage
- 2nd Stage
- 3rd Stage
- 4th Stage
- Care of Newborn
Managment of Labor
- 1st Stage
Management of 1st stage of Labor
- Position
Management of 1st stage of Labor
- Bearing Down?
No, To avoid exhaustion.
Management of 1st stage of Labor
- Nutrition
Management of 1st stage of Labor
- Bladder & Rectum
Management of 1st stage of Labor
- Asepsis
Before any vaginal examination.
Management of 1st stage of Labor
- Analgesia
Pethidine (50 mg) or morphine if labor isn’t expected in 3 hours.
Management of 1st stage of Labor
- Vaginal Examination
Management of 1st stage of Labor
- Time of Vaginal Examination
1) On admission: To ensure onset of labor.
2) After ROM: To exclude cord prolapse.
3) Every 2 hours: To assess progress of labor.
Management of 1st stage of Labor
- Aim of Vaginal Examination
Management of 1st stage of Labor
- Monitoring of Labor
Management of 2nd stage of Labor
- Before Head Delivery
- Head Delivery
- After Head Delivery
Management of 2nd stage of Labor
- Before Head Delivery
Management of 2nd stage of Labor
- position
Lithotomy position on delivery table.
Management of 2nd stage of Labor
- Sterialization & Towelling
…
Management of 2nd stage of Labor
- Evacuation
Evacuation of bladder & rectum.
Management of 2nd stage of Labor
- Bearing Down?
Ask patient to bear down during uterine contractions only & relaxes () contractions.
Management of 2nd stage of Labor
- Observation
Observations for maternal & fetal conditions.
Management of 2nd stage of Labor
- Head Delivery
Aim in Head delivery
Decrease Perineal Lacerations
Head delivery
- When to support Perineum?
As soon as head distends vulva, attendant supports perineum by closed fist of hand & pad of cotton
Head delivery
- Why Support The Perineum?
to maintain flexion of head till crowning occurs (to ensure distension of vulva by the smallest diameter of fetal head).
Head delivery
- Managment of Head Extension
- 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.
Head delivery
- After Crowning
- 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.
Head delivery
- Episiotomy
Episiotomy is done è crowning when it is indicated.
Management of 2nd stage of Labor
- After Delivery of Head
Management of 2nd stage of Labor
- Swabbing
Baby’s eyelids, mouth & nose are swabbed.
Management of 2nd stage of Labor
- Suction
Suction is done to clear airway starting by mouth then nose.
Management of 2nd stage of Labor
- Examination of Cord
- 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.
Management of 2nd stage of Labor
- Delivery of Shoulders
Management of 2nd stage of Labor
- Delivery of Trunk & rest
Easily
Management of 2nd stage of Labor
- Holding Newborn
- Newborn is held from his feet è head down for few seconds to drain respiratory passage
Management of 2nd stage of Labor
- When to avoid Holding Newborns in upside down way?
Except in cases of
- Prematurity
- Asphyxia
- Possibility for ICH
Management of 2nd stage of Labor
- Ligation & Cutting of Cord
Management of 2nd stage of Labor
- When to avoid milking Cord?
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.
Management of 2nd stage of Labor
- Inspection of Lower Genital Tract & Perineum
For lacerations & tears.
Managment of 3rd stage of Labor
Managment of 3rd stage of Labor
- Aims
1) Ensuring complete expulsion of placenta & membranes.
2) Prevention of PPH.
Managment of 3rd stage of Labor
- Methods
- Conservative
- Active
Expectant Managment of 3rd stage of Labor
- Method
Expectant Managment of 3rd stage of Labor
- Advantages
Safe
Expectant Managment of 3rd stage of Labor
- Disadvantages
Time consuming & more blood loss.
Active Managment of 3rd stage of Labor
- Method
Active Managment of 3rd stage of Labor
- Advantages
Decrease duration of 3rd stage —-> Decrease blood loss —–> decrease incidence of PPH.
Active Managment of 3rd stage of Labor
- Disadvantages
Managment of 4th stage of Labor
Observation for 1 hour for PPH.
Neonatal Care After Labor
Neonatal Care After Labor
- Apgar Score
Done routinely at 1 & 5 minutes after delivery.
Neonatal Care After Labor
- Bathing
To clean neonate from blood & vernix caseosa.
Neonatal Care After Labor
- Clear Respiratory Tract
Head low down 15° & resuction to remove mucus.
Neonatal Care After Labor
- Umbilical Stump
- 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.
Neonatal Care After Labor
- Position
- Put neonate on rigid flat table under radian heat from above (to avoid chills. & hypothermia).
Neonatal Care After Labor
- Weighing
of the baby
Neonatal Care After Labor
- Marking
to avoid loss
Neonatal Care After Labor
- Examination
Examination for sex & congenital anomalies.
Neonatal Care After Labor
- Eyes
Give antibiotic or antiseptic eye drops to avoid ophthalmia neonatorum.