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LABOUR
1 women dies
Source: White Ribbon Alliance
Preconception Counseling 4
Institutional delivery
Identification of high risk
pregnancy during antenatal care
5
Multiple pregnancy
Antepartum hemorrhage
Malpresentations, and
Feto-pelvic disproportion
Conditions detected during investigations
8
Severe anemia, thrombocytopenia, hyperglycemia,
Glycosuria & Albuminuria.
Any infections
anomalies
Congenital anomalies
Chromosomal abnormalities
A few primary steps:
I. History-taking
During the first visit, a detailed history of the woman
needs to be taken to:
(i) Confirm the pregnancy (first visit only).
(ii) Identify whether there were complications during
any previous pregnancy/confinement that may have
a bearing on the present one.
(iii) Identify any current medical/surgical or
obstetric condition(s) that may complicate the
present pregnancy.
An admission assessment includes
MEDICAL HISTORY
Surgical, including gynaecological procedures
Anaesthetic difficulties, difficult intubation in
particular
Blood transfusion, where, when and why?
Allergies
Medical disorders
Prescribed medications and drug allergies
Thrombo-embolism
Mental illness
FAMILY HISTORY
Hypertension
Diabetes in 1 st degree relative
Congenital/hereditary disorders
Multiple pregnancy
Thrombo-embolism
SOCIAL HISTORY
Contractions:
5-20 minutes apart
30-45 seconds long
Mild, feel like cramps, back pain,
pressure
ACTIVE LABOR
(4-8 cm.)
Contractions:
2-5 minutes apart
45-60 seconds long
Stronger and more intense
TRANSITION LABOR
(8-10 cm)
Contractions:
1 -2 minutes apart
45-90 seconds long
The strongest they will get
SECOND STAGE LABOR
(10 cm. -Birth)
Contractions:
3-5 minutes apart
60-120 seconds long
Less aware of contractions,
more aware of urge to push and fullness in
vagina as baby moves down
THIRD STAGE Delivery of the
Placenta
Contractions:
Irregular
A feeling of fullness and cramping as
placenta separates
A time for mom to hold and enjoy baby.
Prolonged Latent Phase
A prolonged latent phase is present when the active
phase of labor is not achieved after 14 hours in
multiparous patients and 20 hours in nulliparous
patients.
There are two basic methods for prolonged latent
phase, narcotic analgesia or oxytocin augmentation
of labor.
Prolonged or Protracted Active Phase
A protracted active phase is defined as
progression at less than 1.2 cm an hour in
nulliparous patients and less than 1.5 cm and
hour in parous patients during the active phase.
This disorder is associated with a higher
incidence of occiput posterior and occiput
transverse fetal positions.
It may also be indicative of true cephalopelvic
disproportion or it may result from inhibitory
effects of narcotics analgesia.
Condition is treated by first assessing the
adequacy of labor (i.e., placing an intrauterine
pressure catheter and determining the number of
Montevideo units).
Prolonged or Protracted Active Phase