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    Itrapartum Management

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    daniel
    This document discusses intrapartum management measures taken to ensure maternal and fetal wellbeing during labor. Common maternal problems include pain, dehydration and hunger, while fetal distress is a common problem. Methods of monitoring fetal wellbeing include intermittent auscultation, cardiotocography, phonocardiography, ultrasound, fetal ECG and fetal blood sampling. Management of labor pains includes allowing movement in early stages and lying on the left side in late stages, with analgesics like pethidine, morphine, and epidural blocks also used. Oxygen and fluids are provided as needed.

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    Itrapartum Management

    Uploaded by

    daniel
    26 views8 pages
    This document discusses intrapartum management measures taken to ensure maternal and fetal wellbeing during labor. Common maternal problems include pain, dehydration and hunger, while fetal distress is a common problem. Methods of monitoring fetal wellbeing include intermittent auscultation, cardiotocography, phonocardiography, ultrasound, fetal ECG and fetal blood sampling. Management of labor pains includes allowing movement in early stages and lying on the left side in late stages, with analgesics like pethidine, morphine, and epidural blocks also used. Oxygen and fluids are provided as needed.

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    This document discusses intrapartum management measures taken to ensure maternal and fetal wellbeing during labor. Common maternal problems include pain, dehydration and hunger, while fetal distress is a common problem. Methods of monitoring fetal wellbeing include intermittent auscultation, cardiotocography, phonocardiography, ultrasound, fetal ECG and fetal blood sampling. Management of labor pains includes allowing movement in early stages and lying on the left side in late stages, with analgesics like pethidine, morphine, and epidural blocks also used. Oxygen and fluids are provided as needed.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    26 views8 pages

    Itrapartum Management

    Uploaded by

    daniel
    This document discusses intrapartum management measures taken to ensure maternal and fetal wellbeing during labor. Common maternal problems include pain, dehydration and hunger, while fetal distress is a common problem. Methods of monitoring fetal wellbeing include intermittent auscultation, cardiotocography, phonocardiography, ultrasound, fetal ECG and fetal blood sampling. Management of labor pains includes allowing movement in early stages and lying on the left side in late stages, with analgesics like pethidine, morphine, and epidural blocks also used. Oxygen and fluids are provided as needed.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    of 8

    INTRAPARTUM MANAGEMENT

    These are measures taken to ensure


    maternal and fetal wellbeing during labour.

    Common maternal problems during


    labour

    1) Pain
    2) Dehydration
    3) Hunger

    Common Problems during labour

    1) Fetal Distress

    Methods of monitoring from wellbeing

    1) Intermittent direct Auscultation


    using fetoscope or sonicaid. Suitable
    where there are no risk factors.
    2) Cardiotocograph (continuous fetal
    heart rare, monitoring) suitable in high
    risk pregnancies.

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    a) Safe Pattern
    i. A base line FHR of 120-160
    beats / minute
    ii. No changes in FHR during or
    after contractions
    iii. Baseline variability (beat –to-
    beat variation) of 5 beats minutes or
    more.

    b) Asphyxia patterns
    i. Late decelerations - begins at or
    after the peak of contraction and the
    return to baseline is delayed until
    after the contraction has ceased.

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    ii. Loss of “eat – to beat” variation ie a


    flat CTG. It is characterized by a
    baseline FHR variability of less than
    5 beats minute.

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            60                     60  

    3) Phonocardiography
    Uses a microphone placed on the
    maternal abdomen over the site of
    maximal intensity of the fetal heart
    sounds

    Disadvantage
    Interference caused by environmental
    noise and fetal and maternal movement.

    4) Ultrasound
    Records movement of the heart and
    great blood vessels.

    5) Fetal ECG
    The spiral electrode is applied to the
    fetal scalp through a cm or more dilated
    cervix. Reliable but still a research
    technique.

    6) Fetal blood sampling for pH


    measurement
    Necessary when there are abnormal
    FHR patterns suggestive of asphyxia.
    pH 7.25 or above Normal
    pH 7.20 – 7.25 Pre-acidotic. Repeat
    pH within 30 minutes.
    pH 7.20 or below Deliver

    NB - These invasive procedures are less


    popular these days due to HIV infection.

    MANAGEMENT OF LABOUR PAINS


    In early stages of labour, women can be
    allowed to move about. In late stages
    they should lie on their left side.

    A. Pethidine
    Preferred analgesic drug during
    labour. .. ½ - 4 hours

    - Has analgesic as well as anxiolytic


    action. Dose 50-100mg

    Side Effects
    i). RDS thus should be avoided when
    cervical dilatation is 6cm and above.
    ii). Nausea and vomiting – give
    promethazine as well.

    iii). Habit –forming (addiction)


    B). Morphine
    Not commonly used during labour because
    has more side effects on the mother and
    fetus:-
    i) stronger depressant of the respiratory
    centre.
    ii) Nausea and vomiting are more
    common.

    t½ - 6 hours
    Dose – 10-15mg

    c). Epidural Block


     -Can only be done by experienced
    doctors.
     -Particularly indicated in breech
    presentation, twin pregnancy, trial of
    labour where manipulations are
    expected during delivery.

    D). Entonox
     (50% oxygen + 50% nitrous oxide)
     -It is an inhalational analgesic.
     -Inhalation during contractions.
     Patients in labour are allowed to feed
    preferably light diet and fluids.
     On cases of dehydration, give IV fluids
    (N/Saline or Ringers Lactate)
     Acetonuria should be managed by IV
    5% dextrose.
     Beware of the full bladder which should
    be emptied.
     Routine enemas not longer
    recommended.

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