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Management of 1st Stage of Labor

Prepared by:

Dr. Kasturi Malla

Senior Consultant Gynecologist & Obstetrician: Government of Nepal


Visiting Professor: CTGU
February,2009
Principles
1. Watch for natural birth

2. Monitor
 Progress
 Mother’s condition
 Fetal condition

3. Be prepared for intervention if necessary

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1st Hand Job
 Take H/O labor

 Examine pt.
1. General
2. Obstetric

 Establish diagnosis

 Obtain antenatal records

 Order necessary tests if needed


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2nd step
 Perineal cleaning

 Mobility:-
1. If EFM or epidural analgesia 
keep on bed

2. If not  Ambulate for comfort,


decrease venacaval pressure
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3rd Step
 Evacuation of
1. Bladder
2. Bowel(Enema)

 Only liquid in active labor

 NPO/IV fluid if intervention needed

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4th Step
 Analgesics
Pethidine prn,50-100mg 3-4hrly for
pain
+
Prochlorperazine 25-50mg or
Metoclopramide 10mg for vomiting

 No Pethidine within 2-3 hrs of


expected delivery
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5th Step
 Assess progress abdominally by:
1. contraction
2. pelvic grip
 Assess FHR:
1. q15-30min
2. if non-assuranceq5min
 EFM for high risk pt

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6th Step : P/V exam

1. Dilatation,  If no membrane

2. station,
1. liquor colour,
3. Position,
2. moulding,
4. membrane
3. caput

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Fetal distress
Normal  Irregular FHR

 Persistent bradycardia
 FHR=120-160/min
 Meconeum stained
liquor
 Liquor=Clear  Excessive fetal
movement

 Low fetal scalp blood


PH<7.2

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Maternal distress
1. Signs of dehydration Normal
1. Allow adequate
2. Tachycardia hydrating fluid

3. Scanty concentrated 2. Assure urine


urine output=25-50ml/hr

4. Feverish 3. Give Glucose p/o or


i/v to prevent ketosis
5. Ketosis
4. Administer adequate
analgesics
6. Unbearable pain
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