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1st Stage of Labour

1st Stage of Labour

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Bright Kumwenda
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35 views21 pages

1st Stage of Labour

1st Stage of Labour

Uploaded by

Bright Kumwenda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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FIRST STAGE OF LABOUR

PATRICK R. CHIPUNGU
Malawi College of Health Sciences
Blantyre Campus
DEFINITIONS
First Stage Of Labour
• It begins with onset of regular contractions,
accompanied by cervical effacement and dilatation,
completed with full dilatation of the cervix. First stage
of labour has tow phases: Latent and Active Phase.
Latent Phase
• Is the period from onset of regular uterine contractions
and cervical dilatation to three centimeters. This phase
normally does not last more than 8 hours.
DEFINITIONS
Active Phase
• Is the period from 3cm and end when cervix
is fully dilated. The cervix should dilate at
1cm per hour in primgravidas and 1.5cm in
multigravida. The uterine contractions
increases in frequency and duration.
Admission Procedure

• History Taking - remember to greet the woman and


review of the antenatal card.
• Personal: - Name, Age, Address, Next of Kin etc.
• Obstetric History
– past - gravida, parity, pregnancy problem
– present - LMP, EDD, Problems with pregnancy
• Labour
– - Onset
– - Bleeding/Show
– - Pattern of sleep
– - Membranes whether ruptured or not.
Admission Procedure
• Surgical - Previous section or any uterine
surgery.
Emergency Delivery
PHYSICAL EXAMINATION
General examination
• Vital signs
• Head to toe
Abdominal Examination
• Inspection:
– Shape
– Size
– Scars
– Foetal movement
PHYSICAL EXAMINATION
Palpation
• Fundal height
• Pelvic palpation
• Lateral palpation : Position, attitude
• Fundal palpation
• Contractions

Auscultation - foetal heart, regularity and volume.


PHYSICAL EXAMINATION
Vaginal Examination
• Inspection
– Previous tears and episiotomies
– Scars
– Sores
– Warts
– Show
– Varicose veins
– Liquor
– Oedema
– Bleeding
PHYSICAL EXAMINATION
Examination
• vagina - soft tissues
– State (warm, dry,)
• Cervix - Dilatation
– Effacement
– State of cervix (thick, thin)
– Oedematous
• Membranes
– Ruptured or not
– Check liqour - clear, blood or meconium stained.
– Feel for the cord (prolapse or presentation).
PHYSICAL EXAMINATION
Presenting Part
• Application of the presenting part to the
cervix
• Position of the fontannelles and suture lines
• Station or level in relation to the ischial
spines.
PHYSICAL EXAMINATION
Pelvic Assessment
• Shape of brim - Should be round
• Sacrum - curved
• Sacro spinous ligaments - flexible
• Ischial spines - not prominent but palpable
• Subpubic arch- greater than 90 degrees
• Intertuberous diameter = > 8.5 cm
• Sacral promotary - not tipped
SUBSEQUENT CARE
Subsequent Care
• Although labour is an normal physiological
process, birth is probably one of the most
dangerous events that will take place in the
life of every person. Giving birth is
extremely hazardous to the woman.
SUBSEQUENT CARE
• The most serious being foetal distress, asphyxia,
prolonged labour and haemorrhage. At any time
during labour, chances that something may go
wrong are high. Every woman has to be treated as
an individual. Areas that need careful observation
and intervention:
– Maternal condition - Physical and psychological
– Foetal condition
– Progress of labour.
SUBSEQUENT CARE
Maternal Condition.
(i) Psychological care
– Know the patient by name and also introduce oneself to
establish rapport.
– Explain all procedures and progress of labour.
– Where possible try to stay with the client during labour
– Evaluate her response to pain
– Give praise where it is due.
– Provide encouragement and reassurance on progress of
labour and pain relief.
– Use appropriate language.
SUBSEQUENT CARE
(ii) Physical care - Make sure that the woman
assumes a comfortable position during
labour and the one that doesn’t jeopardise
foetal condition. For example left and right
lateral and not supine or dorsal position.
Also encourage her to be mobile to
facilitate labour.
SUBSEQUENT CARE
Observation of Vital Signs
• Blood Pressure should be checked hourly
not any degree of elevation and
• Pulse rate is recorded hourly , rate above 90
beats/minute could suggest infection not
any dehydration.
SUBSEQUENT CARE
• Respirations to be measured hourly.Note the smell
of the breathe, sweet smell is associated with
acetonuria. This may mean that the woman is
using up fats. Rate should not exceed 40 per
minute. If rate is > 40, the woman may be in pain
or be hyperventilating or in severe pain.
• Temperature should not rise above 37 `C. High
temperature is a sign of infection.
SUBSEQUENT CARE
• Ensure that the bladder is kept empty throughout
labour and delivery. A full bladder delays the
progress of labour , may be injured and cause PPH
during 3rd stage of labour and pueperium. Measure
the volume and test urine for albumin and acetone.
• Any fluid administered during labour should be
recorded. Evaluate fluid balance chart, and act
accordingly. Monitor signs of dehydration, may be
present if labour is prolonged and when atmospheric
temperature is high.
SUBSEQUENT CARE
Signs of dehydration include
• Dry mouth and lips
• Concentrated urine
• Ketones in urine
• A rise in temperature
• Increased respirations

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