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Labour Stage Mx

Protocols

1st stage:

  • True Labour Pain.
  • Show
  • Progressive effacement and dilation of cervix.
  • Formations of bag of membrane.
  • Monitoring BP, Pulse, Temp, P/V/E 4 hourly.
  • Monitoring Uterine contraction, FHR 30 min Interval.



 Latent Phase: If Cervical dilations <4cm or utetine contraction <2 in 10min.

  • Primi: 12 hour's.
  • Multi:8 hour's.


 Active Phase: If Cervical dilations >4cm or acyive utetine contraction >3 in 10min and Lasting >40 sec.

  • Primo: 6-8 hour's. (Dialation >1cm/hr)
  • Multi: 4-6 hour's. (Dialation >1.5cm/hr)

 After maximum dialation of cervix:

  • If no fetal Distress
  • No meconium stained
  • Favourable cervix
  • Cephalic Position
  • Inj. HS (1L)+ Inj. Linda DS (1 amp)
    • IV stat (@8 d/min. After 30 min @16 d/min.
    • Increase the rate of infusion Until 3-5 contraction each 10min & lasting >40 sec.
  • Stop infusion if FHR (<110/min or >160/min) or >5 contraction each 10 min.

 If Pain:

  • Inj. Viset(Tiemonium) 5mg
    • 2 amp IV stat & 1 amp TDS
  • Inj. Anadol (Tamadol)100mg
    • 1 amp IV stat....s0s (if severe Pain)
  • Inj. Pantonix(Pantoprazole) 40mg.
    • 1 Vial IV BD

 If Repeated P/V/E: (Injectable /Oral)


 If Bladdee full & Not Pass the urine:

  • Continuous Catheterization

2nd stage of Labour:

  • Bearing down by women
  • Contraction more frequent & lasting >1 min.
  • Rupture of membrane.
  • Delivery of baby


Time:

  • Primi:1 hour's.
  • Multi: 30 hour's.

Monitoring:

  • FHR: Every 5 min Interval.
  • BP, Pulse, Temp, Uterine contraction 30 min interval.
  • PVE: hourly.

 New Born Care: If not Crying within 1 min.

  • Clamp Umblical Cord
  • Inf. 25% Nutridex (3ml) + Inj. Roxadex (0.5ml)
  • Given via Umblical Vain.
  • NP-OP suction
  • CPR
  • 02 Inhalation
  • Clean whole Body gently.
  • Stimulate for crying

 New Born Care: If Crying within 1 min.

  • Clamp
  • Cut the Umblical cord (immediately)
  • Clean whole Body gently.
  • NP-OP suction
  • Stimulate for crying
  • Baby keep with mother contact.

3nd stage of Labour:
Expulsion of placenta

  • Control cord traction & Fundal message.


Time:

  • Primi:30 min.
  • Multi: 15min.

 If Cervical/ Perineal Tear/ Episiotomy

  • Repair with Catgut

 To prevent PPH: After deliver Placenta.

  • Inj. Linda DS, (1 amp IM or IV stat).
  • Tab. Cytomis 200nmcg. (3 Tab P/R Stat)
  • Inj. Metherspan 0.2mg (1 amp IM stat)
  • Inj.Duratocin (1 amp IM or IV stat)