December 14, 2009

Case: G1P0, Post date, currently in labour (VE 5cm)


a) Patient is a primid, never experience before, how are you going to ask her in Hx whether it is a true labour.

b) How to manage this patient

False labour or Braxton Hicks contractions

Normal Irregular uterine contraction starts occurring from fourth months of pregnancy

1) Timing of contractions

False Labor: Often are irregular and do not get closer together

True Labor: Come at regular intervals and as time goes on, get closer together. Contractions last about 30-70 seconds.

2) Change with movement

False Labor: contractions stop in association with walking or change in position.

True Labor: Contractions continue, despite movement or changing positions

3) Strength of contractions

False Labor: Contractions are usually weak and do not get much stronger (may be strong first, then get weaker)

True Labor: Contractions steadily increase in strength

4) Pain of contractions

False Labor: contractions are usually only felt in the front of the abdomen or pelvic region

True Labor: Contractions usually start in the lower back and move to the front of the abdomen

Management of this patient

Impression: Patient is already in active phase of first stage of labour. (Contraction at least once in five minutes)

Post date will not change the management and preparation for spontaneous vaginal delivery should be expected except there is indication for caesarian section or instrumental deliveries.

General management

1) Transfer patient to Labour room

2) FBC and GSH

First stage of labour

1) Review history and problems

2) Abdominal and VE+ARM

3) Starts partogram

4) Review patient after 4H since cervix is <6cm>6cm VE when full dilatation is expected)

5) Monitor

a) Maternal BP, PR, Uterine contraction

b) 4H temperature

c) FHR auscultation

Second stage of labour

1) Leave patient for 30 minutes if no pushing contraction. Notify MO if not deliver after 1H of active pushing

2) Episiotomy

Third stage of labour (30 Minutes)

1) Syntometrine (Oxytoxin 5U+ ergometrine 0.5 mg) IM

2) Delivery of placenta by controlled cord traction

3) Repairing of episiotomy wounds

Signs of placenta separation

- Uterus contract and fundus become globular and firm

- Small gush of blood flow out

- Lenghtening of umbilical cord.

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