Medical brain notes 11

  Introduction   The successful management of labour depends on good supervision during pregnancy to rule out abnormalities and threat if detected. A good midwife must realize that she is dealing with two lives and she must try her possible best to preserve these lives. Her attitude toward the woman is most important as her approach can reduce the woman’s anxiety considerably.   Their relationship should be that of woman-centered care that assesses the needs and expectation of individual in labour and plan care to meet her specific needs and expectation.   Management of patient in labour Basic Principles of Management   ·                Understanding and meeting the woman’s psychological needs   ·                Provide efficient bedside care   ·            ...

  Indications for vaginal examination 1.             To diagnose labor   2.             To assess progress of labor   3.             To know if the head is engaged e.g.  Obese patient   4.             To exclude cord prolapse – Ruptured membranes   5.             To confirm presentation and positions – Where there  is doubt to insert fetal scalp electrode. To confirm lie, presentation of 2 nd  twin.   6.             To confirm second stage of labor – full dilatation– to ascertain if membranes are still intact. To assess progress or delay of labour.   Points to note on vaginal examination   External genitalia:...

  Subsequent management of labour   If an expectant mother is given some idea in simple language before the labor begins, of what to expect in each states of labour, she is likely to be more co-operative. Patient should never be left alone. Further management include   Observation and recording All observations made must be recorded.   Types of observations .   a. General appearance: The effect of labor on the woman is she taking the labour pain easy or is it making her distress.   b. Vital signs: Blood pressure 1-2hrly Pulse, Respiration.   Hourly early labor 15-30mins in late labour. Infection Ketosis, haemorrhage ruptured uterus. Temperature –  4 hourly. Abnormalities in the observation should be reported. Volume of pulse is important as thready  pulse may indicate pre-eclampsia.   c. Fetal heart Rate; Hourly in graph form rhythm, rate and volume are noted. Normal beat is between 120-160 beats per minute and drop of 20 beats below or ...

  Objectives   1.             To prevent infection of the genital tract by careful attention to asepsis and antisepsis.   2.             To ensure that the child is born alive with no injuries.   3.             To prevent injury to the perineum.   Physiology of the second phase( refer to Module Two Unit One)  Signs of Second stage of labor   The following signs and symptoms will be observed when a woman reaches the second phrase of labor   1.             On vaginal Examination: OS fully dilated   2.             Expulsive uterine contractions   3.             Trickling of blood Repture of membranes   4.  ...