Summary: Labour
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1 Labour
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Management of Inefficient Uterine Action
Common in nulliparous and induced
Reduce anxiety (as this can decrease length)
Encourage mobility.
AROM then oxytocin -
Management of Hyperactive Uterine Action
Excessive strong frequent or prolonged contractions
Can result in Foetal distress as less placental blood flow
Can be side-effect of prostaglandin administration
If no abruption then salbutamol
Caesarean usually indicated -
Pelvic variants and deformities
Gynaecoid = 50 to 80% of caucasian women
Anthropoid (20%) = narrower inlet
Android (5%) = heart shaped inlet
Platypelloid (10%) = oval shape -
Screening of Foetal Distress
Level 1 = Intermittent ausculatation of foetal heart. If abnormal or neconium, or high risk labour then...
Level 2 = Continuous CTG. If sustained bradycardia, deliver. Then...
Level 3 = Foetal blood sampling. Then...
Level 4 = Deliver fastest way possible -
Management of Foetal Distress
Lay woman in left lateral position (avoid aortocaval compression)
O2 and IV fluid administered
Stop oxytocin infusion
ß2 agonists can stop contraction.
Exclude cord prolapse -
Non-medical Care of Mother
Back rubbing
TENS
Immersion in water
Don't recommend but can help:
- Hypnotherapy
- Acupuncture
- Localized pressure on back
- Application of superficial heat or cold
- Aromatherapy -
Pudendal nerve block
Ischial spine
Good for instrumental delivery -
Management of Prolonged Pregnancy
41 weeks - Examine vaginally. Induce unless unfavourable or patient prefers to wait
No induction - Sweep cervix and have daily CTG
CTG abnormal - Caesarian. -
Induction with Amniotomy ± oxytocin
Forewaters ruptures with amnihook (ARM)
Oxytocin infusion started within 2 hours if no labour
Can use oxytocin alone if SROM -
What to suspect if Meconium-stained liquor?
If preterm then worry about infection or chorioamnionitis
Sometimes hypoxia causes peristalsis of the bowel and relaxation of anal sphincter.
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