Management of normal labour Flashcards
Examination at the commencement of labour
Full general examination
Obstetrical examination of the abdomen
Vaginal examination
Factors should be noted
Full general examination
includes temperature, pulse, respiration, bp and state of hydration; urine
should be tested for glucose, ketone bodies and proteins
Obstetrical examination of the abdomen
Inspection is followed by palpation to determine the fetal lie, presentation and position.
Auscultation of fetal heartbeat is by a stethoscope or by using Doptone
device
Vaginal examination
Labour should be performed after cleansing vulva using an aseptic technique.
Once examination is started, fingers should not be withdrawn from vagina until examination is
completed.
Factors should be noted
position, consistency, effacement and dilation of the cervix, fetal presentation,
membrane (intact/ruptured), color and quantity of amniotic fluid and bony pelvis and its outlet.
General principles of the management of the first labour stage
Observation of the progress of labour
Fetal condition
- Progress in labour
Fluid and nutrition during labour
Observation of the progress of labour
Partogram!!
§ A single sheet of paper on which there is a graphic representation of progress in labour.
§ Section for frequency and duration of contractions, fetal heart rate (FHR), cervical dilation, color liquor,
caput and moulding, station or descent of the head, maternal HR, BP, and temperature.
§ It should be started as soon as the mother is admitted to the delivery suit and this is recorded as zero
time regardless the start of contractions.
This reduces mortality due to avoidance of complications!
Fetal condition
includes fetal HR and their decelerations that occurs during contractions by CTG.
Progress in labour
Measured by assessing rate of cervical dilation (cervicograph) and descent of presenting part.
- Effaced and dilated 0-3 cm in latent phase (6 hours).
- Expected chart is 1 cm dilation per hour from 3-10 cm during active phase =alert line.
- Multipara dilates faster. Alert line helps to identify those progressing slowly.
- A line 2 hours parallel with alert line called action line to decide when to actively intervene with
artificial ROM, prolonged labour, or oxytocin infusion to augment labour in absence of
malpresentation.
§ Assisted by vaginal examination every 3-4 hours during 1st stage of labour.
§ Descent of station of the head is charted on partogram based on palpable portion of the head above the
pelvic brim in fifths!! (whether it needs 5, 4, 3, 2 or 1 finger to cover the head.
§ The station of the head is plotted on the 0-5 gradation of partogram.
§ Descent is also recorded by assessing level of presenting part in cm above (-1, -2, -3) or below (+1, +2,
+3) ischial spines!
§ Nature and frequency of uterine contractions are recorded on the chart by shading in number of
contractions per 10 mins.
§ Frequency of contractions can also be measured by clinical palpation or external tochography.
§ The intensity of contractions cannot be assessed by degree of pain felt by the mother or palpating the
uterus abdominally.
It can only be determined by intrauterine pressure catheters.
Fluid and nutrition during labour
§ Avoid oral intake at any significant level during the 1st stage of labour if the mother will need operative
delivery under anesthesia.
Delayed gastric emptying may result in vomiting.
§ In case of regional anesthesia, fluids and light nutrition orally may be given.
§ IV fluid replacement is considered after 6 hours in labour if delivery is not imminent.
§ Administration of normal saline or Hartmann’s solution is preferred and fluid input and output should be
monitored to prevent over/under hydration.
§ Acidosis and ketosis are major complications of dehydration; check urine!
§ Classical signs of dehydration: tachycardia, mild pyrexia and loss of tissue turgor.
