management of first stage of labor

Management of first stage of labor


1. Non-interference with watchful expectancy

2. Prepare patient for natural birth

Actual Management

1. Maternal condition

Monitor progress of;


Maternal condition

Fetal behaviour

2. General and obstetrical examination, vaginal examination

3. Records of;

Antenatal visits

Investigation reports

If specific treatment given (reviewed)

4. Detect intrapartum complication

5. Bowel and bladder care; if required give suppository/enema

6. Rest and ambulation

If membrane intact allow to walk.

Ambulation can reduce duration of labour.

7. Relief of pain

Need of analgesics and improve maternal comfort.

Pain in active labour;

Pethidine 50-100; IM; opioid; analgesics

Metoclopramide 10mg ; IM; vomiting

Drug not given if delivery is anticipated within 24 hours.

8. Diet

Food not taken during active labour because of delayed emptying of stomach in labor.

Take fluid; plain water, ice chips, fruit juice/ intravenous RL

10. Access of progress of labour and partograph recording

Start partograph in active phase first stage of labor, cervix dilatation; 4cm or above

Pulse; every 30 minutes (.)

Blood pressure; every 4 hours 

Temperature; every 2 hours

Urine output; recorded for; volume, protein,  acetone or glucose

Any drug (oxytocin or other); recorded in partograph

11. Abdominal palpation

(For decent of fetal head)

1. Assess frequency, intensity, duration of pain

Number of contraction in 10 minutes and duration of each contraction in second recorded.

Contraction duration;

<20 seconds

20-40 seconds

>40 seconds

2. Pelvic grip

12. Observe tongue for dehydration

2. Fetal well-being

1. Fetal heart rate (FHR)

Normal FHR; 110-160 b/minutes

In every 30 minutes in first stage, every 5 minutes in second stage.

2. Evidence of fetal distress

Fetal heart by Doppler ultrasonic cardiotocography

Uterine contraction by tomography 

3. Vaginal examination

Dilatation of cervix in cm.

Position of head and degree of flexion

Station of head in relation to ischial spine

Color of liquor (clear meconium stained), if membrane is rupture.

Degree of moulding of head; moulding first at junction of occipito-parietal bone and then between parietal bone.

Caput formation

3. Evidence of  Maternal distress

1. Anxious look with sunken eyes

2. Dehydration , dry tongue

3. Rising pulse rate >100 b/m

4. Hot and dry vagina

5. Scanty (small amoun) dark colour urine with presence of acetone 

6. Acetone smell breath 

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