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STATEMENT OF PURPOSE : ( I.E OBJECTIVES): 1.1 diagnosis of labour 2.1 optimal management of stages of labour REVISION HISTORY : Revision History: New. Revision After : one year
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RELATED REFERENCES :
6.2 Steps
Are you sure that the patient is in labour? Certainly because:
1- contractions at regular intervals 2- gradually decreasing intervals 3- gradually increasing intensity 4- dilating cervix 5- discomfort in the back not stopping by sedation
Uncertain
Keep her in hospital& if she lives not far from hospital, let her go home and come back if she has more pains
Admit the patient and evaluate for the following Laboratory Maternal assessment History General examination Vaginal examination Fetal assessment -FHR -Presentation -size
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-Hematocrit, Hb% -ABO/Rh typing -Voided urine for glucose and protein
Active management of the first stage Clinical ly partogra m Maternal: her data vital signs every 4 hours ( if feverish or prolonged ROM every one hour). antibiotic : if ROM > 18 hours to prevent streptococcal inf.( amoxicillin 1.2gmIV to be repeated 4 hourly till delivery) periodic vag. Examination: according to stage of labour, in PG every 2-3 hours, in MG every2 hours in the 1st stage, avoid betadine and cidex as lubricant oral intake only ice chips, no food IV fluids 60- 120 ml/ h ( one bottle of saline /4-6 h.) to avoid dehydration and acidosis. enema, encourage bladder evacuation contractions: frequency, intensity and duration. cervicogram: dilatation, effacement, position, pelvic capacity electronic External cardiotocography
2- Fetal 1-heart rate monitoring by Pinard or sonicaide 2-presenting part( position, station, caput and moulding), 3-membranes, amniotic fluid( colour, amount, odour and mechonium)
If the progress is unsatisfactory after 2 hours of admission Do amniotomy and reevaluate after 2 hours Cervical dilatation < 1 cm / hour Start oxytocin: as protocol If mechonium Monitor the baby before syntocinon
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Give methergine one ampule IV( if not contraindicated) Dosage is 0.5 mg IM/IV or syntocinon 5 units IV. Active delivery of placenta by controlled cord traction, check the placenta for completeness of membranes, cotyledon and presentation. Delivery of placenta should take no more than 30 minutes. Watch time closely and notify the assistant lecturer when needed. Quick clinical assessment of patient's condition, blood loss, vital signs and feel the uterus if relaxed. Do gentle uterine massage. IV methergine one ampule and 10-20 units syntocinon in 500 ml of IV fluid. Check for any lacerations and tears. Do catheterization, position patient in supine position (flat position).
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RESPONSIBILITY:
The responsible for the application of this protocol is the resident on duty (ROD) under the supervision of the assisstent lecturer on duty
RECOMMENDED BY REVIEWED BY APPROVED BY
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