Management of first stage labour in Pragnancy

Management of first stage labour in Pragnancy: Discuss here how to manage first stage of labour

Active management of labour

The concept of active management of labour includes:

• “one to one care,”
• frequent monitoring of maternal and foetal well-being,
• maintenance of a partogram,
• early amniotomy at a cervical dilatation of 4—5 cm, to accelerate labour and to see the colour of liquor,
• commencing an oxytocin infusion 2 hoursafter amniotomy, if the contractions are less than 3 per 10 minutes,
• adequate pain relief,
• adequate hydration,
• early detection of complications,

Active management of labour is preferred in Specialised and Teaching Hospitals because the patient will receive “one to one care” and will be monitored carefully. Also the duration of the first stage will be reduced.

Monitoring the mother and fetus in the first stage of labour in pregnancy

Certain maternal and foetal parameters are recorded in the partogram at regular intervals.

Observation recorded at 15 minutes intervals

Foetal heart sounds and maternal pulse: Foetal heart sounds are recorded for
1 minute, soon after a contraction using a hand Doppler machine. The maternal pulse
should be recorded at the same time, to differentiate between the maternal pulse
rate and the foetal heart rate.

Observation recorded at 30 minutes intervals

• Frequency of uterine contractions. The interval between 2 contractions is recorded and the number of contractions per 10 minutes is calculated.
• Inspection of pads for meconium.
• Adjustment of the oxytocin drip rate.
• Blood pressure in patients with hypertension.

Observation recorded at 4 hours intervals

• The progress of labour, is assessed 4 hourly by performing vaginal examination to assess the cervical dilatation and abdominal examination to assess the descent of the head.
• Temperature.
• Blood pressure.

Foetal heart-rate monitoring if their is

• significant meconium staining of amniotic fluid,
• abnormal foetal heart rate detected by intermittent auscultation,
• fresh vaginal bleeding,
• maternal pyrexia,
• pregnancy induced hypertension,
• foetal growth restriction,
• prematurity or postmaturity,
• induction or augmentation of labour

Artificial rapture of membrane

• It is done early at a cervical dilatation of 4—5 cm, to accelerate labour and to exclude the presence of meconium.
• It is delayed in the presence of a high head or breech presentation, due to the risk of cord prolapse.
• It is done in the labour ward under strict aseptic techniques.
• It should be preceded by exclusion of cord presentation and the liquor should be drained slowly to prevent cord prolapse.
• It is followed by an oxytocin infusion after 2 hours, if the contractions are inadequate.

Pain relief in first stage of labour

• Epidural analgesia is the best form of pain relief during the first and second stages of labour.
• Contraindications for epidural analgesia are antepartum haemorrhage, coagulopathy, hypervolemia, sepsis, heart disease with
  gross reduction of the ejection fraction, breech presentation (relative contraindication due to impairment of maternal bearing down efforts during the second stage) and spinal deformities.
• Intramuscular pethidine may be given, but should not be used if delivery is anticipated within 4 hours. Naloxone should be available
  to reverse the effects of pethidine on the newborn. Pethidine is given with intramuscular promethazine or metoclopramide to prevent nausea and vomiting.
• Entonox can be given in the first and second stages to patients who are not on epidural analgesia.

Adequate hydration in first stage labour

Clear fluids are given during labour. Parenteral fluids are not required as the duration
of normal labour is short. Intravenous fluids are commenced only in complicated cases.

Progress of Labour

• Abdominal and vaginal examinations are carried out 4 hourly to assess the progress.
• Parameters of progress are cervical dilatation and descent of the head.
• Cervical dilatation is the best parameter of progress as it is graphically recorded.
• Descent and dilatation should progress together. If labour is progressing normally, at full dilatation, the head should be fully
  engaged.

READ HERE : Active Management of second and third stage of labour