PROGRAMMED LABOUR

Dr. BHARTI KALRA

Programmed Labour
Protocol includes :- Active management of labour. - Provide optimum pain relief. - Partogram with Alert Guidelines. Active Guidelines.

Active Management
Active Management to prevent Infection. Dehydration. Exhaustion. Disillusion in mother.

Ketosis.
Steps Amniotomy.

Fetal distress.

Judicious use of PGs/ oxytocin.

Obstetric Analgesia
Obstetric analgesia includes - Epidural analgesia. - Combination of analgesic drugs and antispasmodic

drugs.

 Protograph for documentation of labour events (Indian Potogram by Daftory 1977.) Active management of 3rd stage of labour.

10 8 6 4 2

Alert

Action

Nomogram

0
2 4 6 8 10 12 14 16 18 20

Time elapsed (hrs.)

Modern Management Of Labour

Selection Criteria 1) Primi/ Multi > 38 Weeks 2) Low risk patient.

3) Presence of anaesthetist and neonatologist.

4) Consent. 5) During active phase of labour.

Pain Score Score 0- No appreciable pain Score 1- pain bearable, relief not desired. Score 2 Severe Pain. Score 3 Unbearable pain.

Pain relief Score No relief. Pain relief present but not to desired extent. Substantial relief. Complete relief.

Protocol
1) 1/V line c RL/5./. Dext at 20 drops/min. 2) 3-4 sustained pains /10 min. (Primprost /hr. OR Oxytocin 24 min. in drip) 3) Dilute 30 mg Pentazoncine (1 ampoule) in NS /DW. Dilute 1 ampoule drazepam in 10ml NS/DW. Administer 1/5th of each 1/V slowly. 4) Adm. Inj. Tramadol 1mg/kg slow I/V. + by Antispasmodic I/V : I/M. 5) Moniter hourly FHR :LPs. At. 7-8cm by ketamine 0.5mg/kg in 10ml Saline. 6) Last dose after birth of baby.

Management (Mmt) of 3rd stage of labour

10 units oxytocin in 20 cc saline through Umbilical vein. or Inj. Prostodin 125 mg after birth of baby.

Advantages
Short Labour.

Sustained pain relief.

Significant amnesia of labour. Significant reduction of dystocia. Lower incidence of operative delivery. Obstetric management Simplified.

Pitfalls Team approach : difficult to achieve at Nursing home.

Risk of fetal distress : of medication.

Obstetrician distress.