LRDR Procedures

LABOR ROOM
• Gravidity & Parity determination

• Obstetrical Scoring
• Computation of EDC
• Computation of AOG
• Leopold’s Maneuver
• Detection & Monitoring of FHB
• Labor Watch
GRAVIDITY & PARITY
DETERMINATION
• GRAVIDITY : the total number of
pregnancies, past & present
irrespective of the outcome.
• PARITY : total number of pregnan-

cies in which the fetus have
reached the age of viability
and subsequently delivered
whether dead or alive at birth.
• the number of pregnancies is counted
and NOT the number of fetuses.
Multiple pregnancy therefore, does
NOT increase the parity.
• abortion is NOT included in parity

count.
• whether the fetus is born alive or still

at birth after viability is reached DOES
NOT AFFECT PARITY.
OBSTETRICAL SCORING
F–P–A-L
• F : FULL TERM born : # of infants born at 37
completed weeks’ gestation.
• P : PREMATURE INFANTS born : # of infants

born before completing the 37 weeks’ gestation.
• A : ABORTION : # of pregnancies ending in

abortion, regardless of the type of abortion,
terminated by any means before the age of viability.
• L : # of child / children currently LIVING

COMPUTATION OF
EDC
• Expected date of • Makes use of
Confinement NAEGEL’S
• Expected date of RULE :
Delivery - 3 + 7 +1
• Expected Date of • Based on the
Birth woman’s LMP
Given the woman’s LMP on Aug.
6, 2007:
8 – 6 – 07
-3 + 7 + 1
5 - 13 – 08 : May 13, 2008
Given the woman’s LMP as Jan.
14, 2008 :
12
1 – 14 – 08 1 – 14 – 08
-3 +7 +1 -3 +7 +1 0
10 – 21 – 08 :
* Applies to the October 21, 2008

months of Jan., Feb.,
March ONLY.
Given the woman’s LMP as April
28,2008 :
4 – 28 – 08 4 – 28 – 08
-3 +7 + 1 -3 +7 + 1
1 – 35 - 09 1 – 35 – 09
- 31
2 – 4 – 09 :
Feb. 4, 2009
• The Naegel’s Rule is just an estimate. It is said that 4%
of all babies arrive “ on time” using this rule, whereas
60% appear 1 – 7 days early or late.
• To count from the 1st day of LMP gives us the

GESTATIONAL AGE OR MENSTRUAL AGE. At the
time of EDD, the baby is 40 weeks. This is the average
gestational or menstrual age.
• To count from the date of ovulation or fertilization gives

OVULATORY AGE OR FERTILIZATION AGE. This
is 2 wks shorter than the gestational age.
EXERCISES :
Given the following LMP, compute for
the EDD:
• Nov. 3, 2007
• Feb. 14, 2008
• March 28, 2008
Solutions :
11 -03- 07 2 – 14 – 08
-3 +7 +1 -3 +7 +1
8 – 09– 08 11 – 21 – 08
• Aug. 9, 2008 • Nov. 21, 2008

12
3 – 28 – 08 12 – 35 – 08
-3 +7 +1 - 31
1 – 4 – 09
12 – 35 - 08
• Jan. 4, 2009
COMPUTATION OF AOG
• In every pregnancy, it is essential to have a
precise knowledge of fetal – gestational
age. This knowledge is exceedingly vital in
the event of a high-risk pregnancy.
Mc Donald’s Rule
• FH in cm X 2 / 7 = • FH in cm X 8 / 7 =
gestational age in gestational age in
months weeks
Computation of AOG:
Given a woman in labor, with an LMP of
November 7, 2006 :
Nov 30
-7
23
Dec 31
Jan 31
Feb 28
Mar 31
Apr 30
May 31
June 30
July 31
Aug 3
269 / 7 = 38.4 : 38 weeks & 4 days
• AOG : 38 4 / 7
LEOPOLD’S
MANEUVER
• Is a systematic abdominal palpation to
determine position and presentation of the
fetus. Are a systemic method of
observation and palpation to determine
fetal position, presentation, lie and
attitude. It is preferably performed after 24
weeks gestation when fetal outline can be
palpated.
FIRST MANEUVER (FUNDAL GRIP) to determine
the presenting part or presentation
• Palpates the upper

abdomen to detect
what lies in the
fundus of the
uterus.
• Normally buttocks:
soft, globular, non
ballotable.
• If head : hard,
round, ballotable.
Second Maneuver (Umbilical
grip)
-to locate/identify the fetal
back in relation to the right
and left sides of the mother
to determine the fetal
position (the relationship of
the presenting part to one of
the quadrants of the mother’s
pelvis)
SECOND MANEUVER
• Palpates the sides of
the abdomen to detect
location of fetal back
and fetal small parts.
• Back : hard, smooth,
resistant plane.
• Small parts :
irregular, nodular with
bony prominences.
Third Maneuver (Pawlik’s
Grip)
-determine if the presenting
part has entered the pelvis
(engagement of presenting
part)
-to find the head at the pelvis
and to determine the
mobility of the presenting
part
THIRD MANEUVER
• Palpates the lower
abdomen just above
the symphysis pubis to
detect what occupies
the pelvic inlet.
• Normally the head :
hard, round and
ballotable.
• Buttocks if breech
presentation : soft,
globular, non-
ballotable.
Fourth Maneuver (Pelvic
grip)
FOURTH MANEUVER
• palpates the lower
abdomen to detect
degree of flexion,
position and station
• facing foot part of
the woman, palpate
fetal head pressing
downward about 2
inches above the
inguinal ligament. Use
both hands
MONITORING OF FETAL
HEART BEAT
• Normal : 120 – 160 beats / min.
• Normal labor : at least every 30 minutes,
immediately after a contraction.
• High risk pregnancy : every 15 minutes
• Should be checked immediately after
contraction.
• In CEPHALIC PRESENTATION, the FHB
is best heard in the lower abdominal
quadrants below the umbilicus.
• In BREECH PRESENTATION, the FHT is

usually found in the upper abdominal
quadrants or above the umbilicus.
• In SHOULDER PRESENTATION, the

FHB is usually at or near the level of the
umbilicus.
EQUIPMENTS USED:
 Wrist watch with a functional second hand.
 ordinary stethoscope.
OR : Fetoscope
Doppler
AUSCULTATION OF
FHB:
• explain the procedure to the mother.
• Perform Leopold’s maneuver.
• with the bell of the stethoscope (or
doppler or fetoscope) placed over the
area of the fetal back, count FHT for 1
whole minute.
• observe care in holding the stethoscope
over the mother’s abdomen.
Differentiate FHT from other sounds:
• FHT : distinct in sound, resembling the ticking a watch placed under
a pillow.
• MATERNAL SOUFFLE / UTERINE BRUIT – a soft murmur caused

by the passage of blood through dilated uterine vessels; it is
synchronous with maternal pulse.
THE IDENTIFICATION OF MATERNAL SOUFFLE DOES NOT
GUARANTEE FETAL LIFE.
• FUNIC SOUFFLE – a hissing sound produced by passage of blood

through the umbilical arteries and is synchronous with FHR.
THE IDENTIFICATION OF FUNIC SOUFFLE INDICATES
FETAL LIFE.
• MATERNAL PERISTALSIS – may also be heard because a woman

in labor is usually hungry.
• encourage the mother (& father too) to
listen too to promote bonding.
• record accordingly.
• report abnormalities of fht.

MONITORING
UTERINE
CONTRACTIONS
Supplied by the fundus which are
implemented by uterine
contractions, which causes the
cervical dilatation and then the
expulsion of the fetus from the
uterus.
Phases of Uterine Contractions:
• Increment : the “building up” of
contraction; period of increasing
contraction; the longest phase.
• Acme : the peak of a contraction.
• Decrement : the period of “letting up”

or decreasing contraction.
CHARACTERISTICS OF
UTERINE CONTRACTIONS :
• Duration : A-B
• Frequency : A-C
• Interval : B-C
• Intensity
LABOR WATCH
DATE/ BP FHB TIME TIME DURATION INTERVAL SIG.

TIME STARTED ENDED
LABOR MONITORING SHEET
DATE / BP FHB TIME TIME DURATIO INTERVA FREQ
TIME STARTE ENDED N L
D
Aug. 3, 130 / 145 8:15’ 40” 8: 16’ 30” X X

2007 80 BPM 10”
8:00 AM
8:30 AM 120 / 138 8: 30’ 30” 8: 31’ 40 1’ 10” 14’ 20” 14’ 50”
80 BPM “
9:00 AM 120 / 140 8:40’ 50” 8:41’ 10” 20” 9’ 10” 10’ 20”
80 BPM
9:30 AM 130 / 148 8: 49 ‘’20” 8:50’ 50” 1’ 30” 8’10” 8’ 30”

90 BPM
LABOR MONITORING SHEET
DATE / BP FHB TIME TIME DURATION INTERVAL SIG.
TIME STARTED ENDED
10: 14’ 40” 10:15’ 10”
10: 24’ 10 10: 25’ 40”
10: 38’ 38” 10: 39’ 55”
10: 59” 29” 11:00’ 10”

DELIVERY ROOM
• preparation of delivery instruments
• positioning & draping
• Perineal care
• immediate NB care
• im injection
• perineal pads / diaper application
• post partum care
Delivery instruments
• DELIVERY PACK :
• kidney basin
• RG
• 2 forceps
• pair of gloves
PRIMI SET
• STRAIGHT
SCISSORS :
used to cut the
fourchette for
EPISIOTOMY.
• FORCEPS WITH
THE LATEX BOND
Used to clamp the

umbilical cord,
FETAL SIDE.
• STRAIGHT
FORCEP
used to clamp the

umbilical cord
MATERNAL SIDE.
• CURVED SCISSORS
used to cut the

umbilical cord
• 5 CC SYRINGE
used for anesthesia

prior to the
suturing.
• NEEDLE HOLDER
used to hold the

suture during the
episiorraphy.
• TISSUE FORCEP
used to hold tissue

during the suturing
• KIDNEY BASIN
used for
placental expulsion
• ROLLED GAUZE /
OS
used as a sponge for

blood.
• STERILE GLOVES
used for
protection.
• SUTURE
PRIMI SET
MULTI SET
MULTI PREPARATION WITH
LACERATION
+ SUTURING SET
• syringe
• Needle holder
• Tissue forcep
• straight scissors
• 1 pair of gloves
• RG
• suture
POST TEST
Given the following LMP, compute for
the EDD and the AOG if date of
admission is NOV. 22, 2006. Encircle
ur final answers :
1. Mar. 7, 2006
2. Feb. 23, 2006
Given the following
contractions, solve for the
DURATION & INTERVAL
(show ur solutions)
DATE / BP FHB TIME TIME DURATI INTERV SIG.
TIME STARTE ENDED ON AL
D
5:15’ 20” 5: 16’ 06” 1
5: 20’ 38” 5”21’ 10” 2 3
5: 30’ 16” 5: 31’ 55” 4 5

LRDR Procedures

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LABOR ROOM

• Gravidity & Parity determination

• PARITY : total number of pregnan-

• abortion is NOT included in parity

• whether the fetus is born alive or still

• P : PREMATURE INFANTS born : # of infants

• A : ABORTION : # of pregnancies ending in

• L : # of child / children currently LIVING

* Applies to the October 21, 2008

• To count from the 1st day of LMP gives us the

• To count from the date of ovulation or fertilization gives

• Aug. 9, 2008 • Nov. 21, 2008

• Palpates the upper

• In BREECH PRESENTATION, the FHT is

• In SHOULDER PRESENTATION, the

• MATERNAL SOUFFLE / UTERINE BRUIT – a soft murmur caused

• FUNIC SOUFFLE – a hissing sound produced by passage of blood

• MATERNAL PERISTALSIS – may also be heard because a woman

• report abnormalities of fht.

• Acme : the peak of a contraction.

• Decrement : the period of “letting up”

DATE/ BP FHB TIME TIME DURATION INTERVAL SIG.

Aug. 3, 130 / 145 8:15’ 40” 8: 16’ 30” X X

9:30 AM 130 / 148 8: 49 ‘’20” 8:50’ 50” 1’ 30” 8’10” 8’ 30”

10: 14’ 40” 10:15’ 10”

10: 24’ 10 10: 25’ 40”

10: 38’ 38” 10: 39’ 55”

10: 59” 29” 11:00’ 10”

Used to clamp the

used to clamp the

used to cut the

used for anesthesia

used to hold the

used to hold tissue

used as a sponge for

5: 20’ 38” 5”21’ 10” 2 3

5: 30’ 16” 5: 31’ 55” 4 5

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