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Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
Labour Management
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Labour Management

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SALSO Series - Labour Management

SALSO Series - Labour Management

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  • 1. LABOUR MANAGEMENT SALSO SGH
  • 2. Correct diagnosis of labour
    • Contraction occur at regular interval
      • Interval gradually shortens
    • Intensity of pain gradually increase
    • Duration of contraction increase
    • There is progressive cervical effacement and dilatation
    • Progress of labour not stopped by sedation
  • 3. Why important??
    • Proper monitoring
    • Prevent unnecessary intervention
    • * ARM
    • * Wrong diagnosis of prolonged latent phase
  • 4. Normal labour
    • Latent phase : Considered prolonged if it is greater than 8h in nullipara and 6h in multipara.
    • Normal active phase: On or at the left of an alert line
    • Second stage (active): Need assessment if more than 30 minutes
    • Third stage : Retained placenta if not delivered by 30 minutes
  • 5. Labour: Principles of management
    • Initial assessment
    • Diagnosis and intervention of abnormal labour
    • Close monitoring of fetal and maternal condition
    • Adequate pain relief
    • Adequate hydration
    • Emotional support/ supportive companion
  • 6. Initial assessment
    • Define risk
    • Degree of monitoring needed
    • Level of staff to manage the patient
  • 7. PARTOGRAPH
    • PARTOGRAM X 2 PAGES
    • = PERINATAL MORTALITY
    • PARTOGRAM X 3 PAGES
    • = MATERNAL MORTALITY
  • 8. PARTOGRAPH
  • 9. PARTOGRAPH
  • 10. PARTOGRAPH
  • 11. PARTOGRAPH
  • 12. PARTOGRAPH
  • 13.  
  • 14. Non progressive labour:The three P’s
    • Power
    • Passage
    • Passenger
    • * Position
    • * Size
    • * Attitude
  • 15. POWER
    • Adequate contractions are needed for adequate progress of labour
    • Usually 3-4 in 10 min
    • Usually 40-60s duration
  • 16. AUGMENTATION
    • Oxytocin (Pitocin)
    • Correct dose and titration
    • To achieve “efficient “/”adequate” contraction.
    • Prevent hyperstimulation
    • Careful consideration in multipara and previous scar
  • 17. Hyperstimulation
    • Prolonged contractions (> 2 mins)
    • Frequent contractions (<1:2)
    • Tetanic contractions (continuous)
  • 18. Passage
    • Clinical @ x-ray pelvimetry – not used in modern obstetrics
    • Adequacy of pelvis can only be ascertain through labour and delivery
    • Passage may be adequate but might not be for a big baby!!
  • 19. Passenger
    • Size of baby
    • Congenital abnormalities e.g. hydrocephalus
    • Malposition (e.g. OP), malpresentation (e.g. breech, brow)
  • 20. PARTOGRAPH
  • 21. PARTOGRAPH
  • 22. PARTOGRAPH
  • 23. FHR monitoring
    • In latent phase:
    • * Low risk : Hourly
    • * High risk : Every 15-30 min
    • : CTG
  • 24. FHR monitoring
    • In active phase
    • * Low risk: Every 30 min
    • *High risk: Every 15 min
    • CTG
  • 25. FHR monitoring
    • During second stage:
    • * Low risk : Every 15 min
    • *High risk: Every 5 min or
    • after each contraction/pushing
    • CTG
  • 26. FHR monitoring
    • Management of suspicious tracing is not to wait or repeat the CTG until it become normal/reactive
  • 27. FHR monitoring
    • The stressor to the fetus is the contraction not the degree of cervical dilatation
  • 28. FHR monitoring
    • If patient in labour (contracting)
    • FETAL HEART HEARD
    • !!! NOT ENOUGH
  • 29. Adequate analgesia
    • Every patient have a right for good analgesia in labour
    • “ TARIK NAFAS” is not an analgesia at all
  • 30. Hydration
    • Good hydration is important for satisfactory labour progress
    • Review hydration status regularly (Don’t just concentrated on VE finding)
  • 31. PARTNER
    • PARTNER ARE IMPORTANT, ESPECIALLY SUPPORTIVE AND HELPFUL ONES
  • 32. Instrumental delivery
    • *** Learn how to assess the patient first rather than how to do
  • 33. Instrumental delivery
    • A DIGITAL EXAMINATION WILL DETERMINE STATION; AND THE DEGREE OF DIFFICULTY OF THE DELIVERY
  • 34. Instrumental delivery
    • Safe-guard:
    • * Head not palpable per-abdomen
    • * Station : 0 or below for vacuum
    • At least +2 for forcep
  • 35. THANK YOU

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