Labour Management

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SALSO Series - Labour Management

Labour Management

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

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