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Management of

labour

Learning objectives:

1 - to distinguish between normal and
abnormal labour
2 - to learn the clinical approach and
dealing with a woman with labour, from
the time of diagnosis to the end of the 3 rd
stage of labour

When a pregnant woman started

labour or when she has
spontaneous rupture of membranes
at term she should be admitted and
full assessment of her condition is
accomplished.

FULL HISTORY ON ADMISSION

 contractions
 vaginal discharge or bleeding
 LMP, GA , ANC
 past obstetrical history, mode of
deliveries, any history of delivering big
baby? C/S
 recent activity of the fetus

PROCEED FOR EXAMINATION

 General examination, vital signs
 abdominal examination:
previous scars
 Leopold's maneuvers
 Palpate the abdomen for assessment of the
uterine contractions for at least ten minutes
 FHR: pinard stethoscope
or sonicaid

Leopold's

maneuvers

1 - lateral grip

2 - fundal grip

3 - pawlick

4 - pelvic grip

Vaginal examination to assess

cervix and station of PP
Bishop’s score:
It include:
1 - dilatation
2 - effacement
3 - station
4 - position of the cervix
5 - consistency

ST 1 MANAGEMENT OF THE

STAGE
Woman in the latent phase:
 E ncouraged mobilization,
 Adequate analgesia , and support
 L ight foods and drinks
 U rine testing (for protein and glucose),
 CBC.
 B lood sampling to be available for cross -
match
 If she is low risk she can go home and come
back when contractions increased

 Maternal blood pressure (BP ) and temperature

recorded every 4 hours,
 pulse should be recorded every hour during the first
stage of labor and every 10 minutes during the
second stage of labor.
 Vaginal examination in early labour is infrequently
performed ( 4 hourly is the standard) and the
frequency may be increased accordingly to assess
dilatation and descent of the presenting part, and
every 1 hour in the 2 nd stage
 No need to do ARM if the labor is progressing well.
STAGE ST 1 MANAGEMENT OF THE
active phase:

 Adequate monitoring of both the maternal and

fetal conditions
 giving her antacid, adequate analgesia and may
be urinary catheter if labor is prolonged and
abnormal, or if she has epidural analgesia
 evacuate the rectum ( may be done by enema) in
the 1 st stage.
 All of the data obtained since the admission to
the labour world should be recorded on a
partogram
ST STAGE 1 MANAGEMENT OF THE

P
A
R
T
O
G
R
A
P
H

WHO PARTOGRAPH 2010

 Fetal condition
fetal heart
recording
AF
moulding

Amniotic fluid

moulding

 Fetal condition

fetal heart
recording
AF
moulding

contractions

Ut contractions

Uterine contractions

N
O
R
M
A
L

L
A
B
O
U
R


رفعت المحاضرة من قبل: Hatem Saleh
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