management of labour

Page 1: Introduction to Labour Management

Objective

  • By the end of this lecture, 4th year students will be able to:

    • Assess patients presented with labour.

    • Describe management of labour.

    • Outline techniques for monitoring mother and fetus during labor.

Principles in the Management of Labour

  1. Diagnosis of Labour and Assessment of Patient in Labour

  2. **Monitoring: **

    • Monitor progress of labour.

    • Ensure maternal and fetal well-being.

  3. Management of Stages of Labour

Page 2: Management of First Stage of Labour

History Taking

  • Obtain detailed history including:

    • Past obstetric history.

    • Current pregnancy history.

    • Medical history relevant to current condition.

  • Admission History

    • Previous births and sizes of babies.

    • Previous caesarean sections.

    • Onset, frequency, duration, and strength perception of contractions.

    • Status of membranes (intact/broken, colour, and amount).

    • Presence of abnormal discharge or bleeding.

    • Fetal movement activity.

    • Notable medical or obstetric issues (e.g., diabetes).

    • Special requirements (e.g., interpreter).

General Examination

  • Identify women with raised BMI for potential complications.

  • Record temperature, pulse, and blood pressure.

  • Urine sample tested for protein, blood, ketones, and glucose.

Abdominal Examination

  • Check for surgical scars.

  • Assess fetal lie (longitudinal, transverse, oblique) and presenting part (cephalic or breech).

  • Determine degree of engagement and assess contractions.

Page 3: Vaginal Examination

Purpose and Technique

  • Explain purpose and seek consent from the woman.

  • Assess cervix for:

    • Position, length, effacement consistency, dilatation.

  • Assess fetal head position and size, presence of caput or moulding.

  • Perform pelvimetry to assess pelvis adequacy.

  • Note condition of membranes if ruptured, including fluid characteristics.

Prognosis Indicators

  • A generous amount of clear fluid is good.

  • Scanty, blood-stained, or meconium-stained fluid indicates potential compromise.

  • A high, unengaged head is poor for vaginal delivery—consider an ultrasound if unclear.

Contraction Assessment

  • palpate uterus directly for a minimum of 10 minutes.

Page 4: Analgesia and partogram

Analgesia

  • Provide appropriate analgesia to women not in established labour.

Labour Record (Partogram)

  • Introduce a graphic record of labour including: a) Fetus Partb) Mother Partc) Progress of Labour

Monitoring Progress

  • Identify vertex presentation, check occiput position, assess engagement, and monitor contractions.

Page 5: Partogram Details

Patient Information

  • Fill details: name, gravida, para, hospital number, admission date, time of ruptured membranes.

Fetal Heart Rate Monitoring

  • Record every half hour.

Amniotic Fluid Observation

  • Document colour of fluid: intact, clear, meconium-stained, blood-stained.

Monitoring Parameters

  • Moulding, cervical dilatation, station, contractions, oxytocin administration, additional drugs given, pulse, blood pressure, temperature, urine analysis.

  • Establish progress and actions needed on the partogram if cervical dilation is slow.

Page 6: Fetal Assessment During Labour

Amniotic Fluid Inspection

  • Noting signs indicative of potential fetal compromise.

Auscultation of Fetal Heart

  • Use stethoscope or Doppler ultrasound, listen immediately post-contraction, intervals vary by stage.

Indications for Continuous EFM

  1. Significant meconium staining.

  2. Abnormal fetal heart rate (FHR).

  3. Maternal fever.

  4. Fresh vaginal bleeding.

  5. Oxytocin infusion augmentation.

  6. Maternal request.

Electronic and Fetal Scalp Monitoring

  • Address issues with fetal position or maternal obesity.

  • Perform Fetal Scalp Blood Sampling (FBS) for accuracy in assessment.

Page 7: CTG Interpretation

CTG Analysis in Labour

  • Differences in interpretation compared to antenatal CTG.

  • Definition of normal, suspicious, and pathological classifications based on features monitored.

Normal FHR Pattern Features

  • Baseline heart rate (110-160 bpm), variability, accelerations, absence of decelerations.

Page 8: Management of Latent Phase

Expectations for Latent Phase

  • Encourage mobility and manage away from labour suite if possible.

  • Deliver simple analgesics preferred over stronger pain relief unless risk factors are present.

Support Measures

  • Offer encouragement and reassurance.

  • Conduct vaginal examinations to determine the active phase.

Page 9: Management of First Stage

Monitoring Progress

  • Use a partogram, monitor maternal and fetal well-being.

  • Vaginal examinations standard practices and adjusted frequency based on progress.

Comfort and Diet

  • Allow fluid intake and position flexibility, discourage supine position.

  • Measure and record urinary output; address bladder care.

Page 10: Management of Second Stage of Labour

Diagnosis of Second Stage

  • Confirm full dilatation and guide mother on bearing down techniques.

Maternal Positioning

  • Encourage comfortable positioning, avoiding supine.

Monitoring and Pain Relief

  • Increase monitoring frequency in high-risk situations.

  • Assess pain relief options considering their effects on the urge to push.

Page 11: Delivery Techniques

Delivery Process

  • Manage delivery to minimize perineal damage and ensure safe birth.

Ritgen Maneuver

  • Guidelines for controlled delivery to alleviate stretching of perineum.

Page 12: Episiotomy Management

Indications for Episiotomy

  • Situations warranting episiotomy include complicated deliveries and fetal compromise.

  • Guidelines on when and how to perform an episiotomy safely.

Page 13: Delivery of the Shoulders and Body

Delivery Techniques

  • Check for cord complications, help with shoulder delivery, and keep infant in desirable position.

Immediate Neonate Care

  • Perform post-delivery checks while managing cord clamping and ensuring airway clearance.

Page 14: Post-Delivery Procedures

Skin-to-Skin Contact

  • Importance affirming maternal-child bonding and initiating breastfeeding.

Newborn Care

  • Administer vitamin K, eye care, and newborn examinations.

Page 15: Management of Third Stage of Labour

Understanding Third Stage

  • Definition, clinical signs of separation, and timeline for normal expectations.

Management Techniques

  • Active versus passive management approaches, emphasizing oxytocin use and controlled cord traction to secure positive outcomes.

Page 16: Complications and Post-Management Care

Post-Delivery Considerations

  • Address undue bleeding and inspect for tears or lacerations post-third stage.

Characteristics of Normal Labour

  • Criteria detailing a normal delivery process, encompassing gestational timelines, presentations, and stages.