Management of first stage of labor
Principle;
1. Non-interference with watchful expectancy
2. Prepare patient for natural birth
Actual Management
1. Maternal condition
Monitor progress of;
Labor
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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