OGCO-C3.3 Management of labor Flashcards
When is the vaginal exam done to assess progress in labor?
It must be performed immediately after the membranes have ruptured to exclude prolapse of the cord, to verify the presentation and position, and to ascertain the condition of the cervix.
Dilatation of the cervix is roughly expressed in centimetres as follow:
1 finger 2cm
2 fingers 4cm
3 fingers 6cm
4 fingers 8cm
Full dilatation 10cm
How to avoid laceration
Immediate management after delivery of shoulder?
a) By backward pressure with the left hand, the thumb and fore-finger over the occipital region of the baby’s head, maintain flexion of the head as it distends the vulva.
b) The palm of the right hand, protected by a sterile towel, should control the delivery of the head. The head must not be allowed to slip out too quickly at the height of a pain. Warm compress and ‘hands on’ perineal protection can help reduce OASIS.
c) When the head is nearly “crowned” the patient should be told to open her mouth widely, breathe in and out deeply, and at the same time cease all voluntary bearing-down efforts. Inhalation anaesthetic that is being used may be increased slightly.
d) The correct time to deliver the head is between two contractions and not at the height of a contraction. When the vulva is fully distended the head should be held back until the cessation of contraction, and then gently eased out by extension during the interval. Give 1 ml of Syntometrine (5 units of Syntocinon and 0.5 mg of Ergometrine) I.M.I. at the time of delivery of the shoulder, as it facilitates separation of the placenta and reduces the amount of haemorrhage in the 3rd stage.
When is posterior lateral episiotomy done?
Should be performed only when the head is almost delivered (at crowning) and a tear seems likely. Otherwise episiotomy is to be avoided unless specifically indicated.
What is Mx for delivery of the placenta?
What are the signs of expulsion?
The average time for the expulsion of the placenta is between 5 to 10 minutes with I.M. syntometrine when the shoulder is delivered. During this time the hand is to be rested upon the fundus in such a position that any enlargement of the uterus due to haemorrhage can at once be felt. The signs of expulsion are:
a) A small gush of blood from the vagina.
b) Lengthening of the cord.
c) The uterus becomes smaller, harder, more globular and more movable. The level of the fundus also rises slightly as the presence of the placenta below prevents the uterus from sinking into the pelvic cavity
When these signs are observed the patient is asked to bear down with the next contraction and she may be able to expel the placenta spontaneously. If this fails, the correct procedure is to wait until the uterus contracts (or hardens) again and then press downwards on the abdomen, thus forcing the placenta out of the vagina. This is expulsion by fundal pressure from the vagina, not expulsion from the uterus.
Immediately after delivery of the placenta 5u syntocinon is given IV in selected cases.
What is examined in the umbilical cord vessels?
What must be followed up?
Normal umbilical cord contains 2 umbilical arteries and 1 umbilical vein.
Single umbilical artery –> increased risk of malformations, but it can also be a normal variant.
Congenital defects may be of the genitourinary tract, GIT, the skeleton, the CVS and the CNS. Inform paediatrician if single umbilical artery is detected.
