MANAGEMENT OF LABOUR

1. Role of nurse on management in labor

2. DEFINITION Labor is a process by which the fetus, Placenta and membranes are expelled through birth canal. Series of events that take place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina in to outer world is called labour.

3. STAGE OF LABOUR FIRST STAGE:- It starts from onset of true labor pain and ends with full dilatation of cervix. It’s average duration 12hrs in primigravida and 6hrs in multipara . SECOND STAGE:- It starts from the full dilatation of cervix and ends with expulsion of fetus from the birth canal. THIRD STAGE:- It begins after expulsion of fetus and ends with expulsion of the Placenta & membrane. FOURTH STAGE:- It is the stage of observation for at least one hour after expulsion.

4. MANAGEMENT OF FIRST STAGE LABOUR Enema Perineal shave Food & Fluids by mouth Intravenous infusion Position & Ambulation Medication Monitoring Maternal physiological changes Vital sign Renal system GI changes Haematological changes Monitoring Of Fetal Wellbeing

5. Evaluation Of Maternal Wellbeing Vital sign Bladder care Urine test Hydration Bodily Care Of Progress Of Labour Back rub Abdominal rub Effleurage

6. EVALUTION OF PROGRESS OF LABOUR: Partogram – Partogram is a graphic recording of the salient features of labour status. In the management of women in labour partogram serves to validate the normal progress of labour and to facilitate early identification of deviations from normal pattern. Maternal vital signs Uterine contractions Fetal heart rate Vaginal examination findings Fluid balance Urine analysis Drugs administered

7. MANAGEMENT OF SECOND STAGE OF LABOUR: Vital Sign Bladder care Hydration & General condition Maternal pushing effort Analgesia & Anaesthesia Perineal integrity Episiotomy Evaluation of progress of labor Contraction Pain Length of Second Stage Descend & Station Progress through the mechanism labor

8. PREPARATION FOR THE DELIVERY: Location of the delivery Position for the delivery General preparation CONDUCTION OF DELIVERY: Clamping and cutting the Umbilical cord Immediate care of the Newborn

9. MANAGEMENT OF THIRD STAGE OF LABOUR: Delivery of the Placenta & Membrane. Sign of placental separation Fresh blood loss Lengthening of the cord Fundus becomes rounder,smaller & more mobile in the abdomen Expectant management Assisted expulsion Controlled cord traction Expression by fundal pressure Use of Oxytocic agent. Examination of Placenta & Membrane. Immediate care to mother & baby.

10. MANAGEMENT OF FOURTH STAGE LABOUR: Evaluation & Inspection Evaluation of Uterus Inspection of Cervix Repair Perineal Cleansing & Positioning Of Leg

11. Continuing Case Monitoring: Vital sign check Palpation of the fundus of uterus for contractility Massage of uterus and expression of clots Measurement of fundus Inspection of the perineum Inspection of bladder Inspection and change of perineal pad

12. THANK YOU Mrs. Kalyani Rath Lecturer, KINS