| ID | 338 |
|---|---|
| Name | NORMAL LABOUR |
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| Management | Management of the 1st stage of labour: On admission the general condition of the patient is assessed, her pulse rate and B.P. are recorded, and her urine is tested for protein. By abdominal examination the presentation and position of the foetus, and the relation of the presenting part to the brim of the pelvis, and also the frequency and strength of the uterine contractions are determined. The foetal heart rate is counted for a full minute and any abnormality of rate or rhythm is noted. A vaginal examination will show the degree of dilatation of the cervix, whether the membranes are intact or ruptured, and the level and position of the presenting part. An enema simplex may be given. The mother is told what to expect in each stage and she should never be left alone. If the head is engaged the mother is allowed to walk during early labour. If the presenting part is not engaged the mother is kept in bed. Towards the end of the first stage the pain become much more severe then intramuscular injection of 100 mg of Pethidine. When there is full bladder and the mother cannot empty it- a soft catheter should be passed. During labour a mother must only be given fluid or sieved foods. If there is any evidence of dehydration or of ketosis appropriate fulid is given i.v. Management of the 2nd stage of labour: During the second stage the mother should be in bed. The mother is placed in left lateral or supine position. In a first labour the mother needs to be encouraged to relax the muscles of the pelvic floor at the time of contraction. When the head stretches the perineum, the anus will begin to open. When the head no longer recedes between contractions this indicates that it has passed through the pelvic floor and that delivery is imminent.By the time that the head begins to appear at the vulva some form of analgesia is usually desirable. At this stage the obstetrician must control the head to prevent its being bom suddenly and it must be kept flexed untill the largest diameter has passed the vulval outlet. Once the head is ‘crowned’ the mother should be discouraged from bearing down by telling her to take rapid shallow breath. The head may now be delivered carefully by pressing through the perineum onto the fore part of the head, by means of a finger and thumb placed on either side of the anus. If the perineum threatens to tear- an incision of the perineal body i.e. Episiotomy may be done. Directly the head is born a finger is inserted to feel whether a loop of cord is round the neck, such a loop should be slipped over the head. Then the shoulder is delivered, the anterior soulder being delivered before the posterior. If the shoulder do not descend and the baby’s head is becoming cyanosed, birth must be assisted, the shoulder must be rotated into antero-posterior diameter of the pelvis by digital pressure. Once the anterior shoulder has passed the symphysis pubis the posterior shoulder can usually be delivered after pulling the head forwards. As soon as the child is delivered it is held with its head downwards. The mouth and pharynx are sucked clear with a mucous extractor. The cord should be clamped when the child has cried vigorously and pulsation of the cord has ceased by two artery forceps placed at 15 & 16cm. from the umbilicus. Then the cord is crushed & divided l-2cm from the umbilicus & ligated. Management of the 3rd stage: The third stage of a normal labour should be managed very actively & skillfully. In a normal delivery, the uterus usually remains quiscent for a few minutes after the delivery of the baby. The regular contraction begins again & separate the placenta from the uterine wall and push it down into the vagina. The following signs indicate that the placenta has separated and is descending: i. Cord moves down ii. The empty upper segment feels hard, round and movable from side to side. iii. There is often a small gush of blood when the placenta leaves the uterus. Then with slight cord traction placenta would be delivered as soon as possible. To prevent post-partum hemorrhage some times intramuscular injection of ergometrine O.5mg is given after the placenta has been delivered. The placenta, membranes, and cord should be checked immediately. If a piece of placenta is retained, it should be examined and removed as soon as possible. Examination of the perineum: After the placenta is delivered the vulval outlet must be examined carefully for any laceration. Any tear other than a minute one must be sutured immediately. |
| Introduction | Symptoms & signs of onset of Labour: These are- 1. Regular and painful uterine contractions. 2. Mucous discharge from the cervix mixed with a little blood (called ‘the show’) 3. Shortening and dilatation of the cervix. 4. Formation of bag of water. The obstetrician’s duty in the management of normal labour includes: 1. To maintain constant observation of the general condition of the mother and fetus & progress of labour. 2. To supervise nursing care. 3. To alleviate pain and. 4. To prevent infection. Labour consists of 3 stages: 1st stage or stage of dilatation of the cervix. 2nd stage or stage of expulsion of the foetus. 3rd stage or stage of delivery of the placenta. |
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