Makindo Medical Notes

Related Subjects: |Introduction to Obstetrics and Gynaecology |Female Reproductive Anatomy and Physiology |Basic Concepts of Pregnancy |Health Issues In Pregnancy |Risk assessment In Pregnancy |Anaemia In Pregnancy |Hypertension In Pregnancy |Diabetes In Pregnancy |Epilepsy In Pregnancy |Hyperemesis In Pregnancy |Obesity In Pregnancy |Prescribing in Pregnancy |Multiple Pregnancy |Preterm Labout |Management of Labour and Complications |Assessment of the newborn

Management of Labour and Complications

• Labour is a physiological process characterized by regular uterine contractions leading to cervical dilation and delivery of the fetus. Proper management involves monitoring maternal and fetal well-being and addressing potential complications promptly.
• Labour management is divided into three stages, each requiring different interventions.

First Stage of Labour

• The first stage begins with the onset of regular uterine contractions and ends when the cervix is fully dilated (10 cm).
• It is subdivided into:
  • Latent phase: Slow cervical dilation up to 4-6 cm. Contractions may be mild and irregular.
  • Active phase: From 6 cm to full dilation (10 cm), with stronger, regular contractions. Cervical dilation occurs faster (1-1.5 cm per hour in primigravidas, 1.5-2 cm per hour in multiparous women).
• Management during the first stage:
  • Monitor maternal vital signs (BP, heart rate, and temperature) for complications like infection or preeclampsia.
  • Use continuous fetal heart rate monitoring (Doppler or CTG) to assess fetal well-being. Indicators of distress include bradycardia, tachycardia, or late decelerations.
  • Pain management options include non-pharmacological methods (e.g., hydrotherapy, breathing techniques) and pharmacological options (opioids, nitrous oxide, epidural or spinal anesthesia).
  • Assess the progress of labour by performing periodic cervical examinations.

Second Stage of Labour

• The second stage begins with full cervical dilation and ends with the delivery of the baby.
• This stage may last from minutes to a few hours, often shorter in multiparous women.
• Management during the second stage:
  • Encourage the mother to push with contractions using a physiological or active pushing technique.
  • Continue fetal heart rate monitoring to ensure fetal well-being.
  • Support the mother in optimal delivery positions (e.g., lithotomy, upright, or lateral positions).
  • Consider an episiotomy if necessary to prevent severe perineal tears.
  • If labour is prolonged or fetal distress is detected, use assisted delivery methods such as vacuum extraction or forceps with proper anesthesia and informed consent.

Third Stage of Labour

• The third stage begins after the baby’s delivery and ends with the expulsion of the placenta.
• Management during the third stage:
  • Active management includes administering uterotonic agents (e.g., oxytocin 10 IU IM) immediately after the anterior shoulder is delivered to promote uterine contractions and reduce the risk of postpartum hemorrhage.
  • Controlled cord traction (CCT) can be used to assist in placental delivery while applying counterpressure to the uterus.
  • Observe for signs of placental separation, such as a gush of blood or lengthening of the umbilical cord.
  • Examine the placenta to ensure it is intact and that no retained products remain, as these could lead to haemorrhage or infection.

Complications of Labour