2. ABC of labour care Yasser Orief By
Lecturer of Obs.& Gyn., Alexandria University.
Fellow, Lübeck University, Germany.
DOGE, Auvergne University, France.

3. Agenda Normal Labour ? Initial Evaluation of a Woman in Labor
Active management of labour
Newborn care

4. Normal Labour ???

5. Normal Labour ? ? Spontaneous Single Full term Viable Vertex
Natural Passages
Reasonable time
Without interference
Without complications

6. Initial Evaluation of a Woman in Labor

7. Initial Evaluation of a Woman in Labor
Performed to:
Evaluate the current health status of the mother and baby,
Identify risk factors which could influence the course or management of labor, and
Determine the labor status of the mother.

8. Initial Evaluation of a Woman in Labor
1 History
2. Examination
3. Investigations

9. Initial Evaluation of a Woman in Labor
History
Personal
Menstrual
Obstetrical
Medical
Surgical
Family

10. Initial Evaluation of a Woman in Labor Examination
Vital signs
Blood Pressure.. > 140/90
Pulse .. > 100 bpm
Temperature .. > 38 C°

11. Initial Evaluation of a Woman in Labor Examination
Contractions
Check the frequency and duration of any uterine contractions.
Manual
electronic fetal monitor

12. Initial Evaluation of a Woman in Labor Examination
Contractions

13. Initial Evaluation of a Woman in Labor Examination
Fetal Heart Rate
How?
Fetal Doppler device,
Electronic fetal monitor,
Ultrasound
Pinard stethoscope.
What?
Tic Tac rhythm
Regular
BPM

14. Initial Evaluation of a Woman in Labor Examination
Fetal Heart Rate
Electronic fetal monitoring

15. Initial Evaluation of a Woman in Labor Abdominal Examination (Leopold's Maneuvers )
1. Using two hands and compressing the maternal abdomen, a sense of fetal direction is obtained (vertical or transverse).

16. Initial Evaluation of a Woman in Labor Abdominal Examination (Leopold's Maneuvers )
2. The sides of the uterus are palpated to determine the position of the fetal back and small parts.

17. Initial Evaluation of a Woman in Labor Abdominal Examination (Leopold's Maneuvers )
3. The presenting part (head or butt) is palpated above the symphysis and degree of engagement determined

18. 4. The fetal occipital prominence is determined..
Initial Evaluation of a Woman in Labor Abdominal Examination (Leopold's Maneuvers )
4. The fetal occipital prominence is determined..

19. Initial Evaluation of a Woman in Labor Vaginal Examination
Fetal Orientation
Cervical dilatation and effacement
Status of fetal membranes
Assessment of maternal pelvis

20. Fetal Orientation Cephalic
Initial Evaluation of a Woman in Labor Abdominal and Vaginal Examination
Fetal Orientation
Cephalic

21. Fetal Orientation Breech
Initial Evaluation of a Woman in Labor Abdominal and Vaginal Examination
Fetal Orientation Breech

22. Fetal Orientation Complex Transverse
Initial Evaluation of a Woman in Labor Abdominal and Vaginal Examination
Fetal Orientation
Complex Transverse

23. Initial Evaluation of a Woman in Labor Vaginal Examination
Cervical dilatation and effacement

24. Initial Evaluation of a Woman in Labor Vaginal Examination
Status of Fetal Membranes
Intact or ruptured

25. Initial Evaluation of a Woman in Labor Vaginal Examination
Status of Fetal Membranes
Intact or ruptured
Vaginal secretions are normally slightly acid, turning Nitrazine paper yellow.
Amniotic fluid, in contrast, is a weak base, and will turn the Nitrazine paper a dark blue.

26. Initial Evaluation of a Woman in Labor Vaginal Examination
Assessment of maternal pelvis
This is frequently performed prenatally, but can also be done at the initial evaluation of a patient in labor.
Android
Anthropoid
Platypoid
Gynecoid

27. Initial Evaluation of a Woman in Labor Investigations
Urine for Protein and Glucose
Proteinura (1+ or greater) can suggest the presence of pre-eclampsia.
glucosuria (1+ to 2+ or greater) can suggest the presence of diabetes.

28. Initial Evaluation of a Woman in Labor Investigations
Ultrasound
Number
Viability
Congenital anomalies
Orientation
Placenta
Amniotic fluid

29. Active management of labour

30. Is she actually in labour ??
progressive cervical changes, in the presence of regular, frequent, painful uterine contractions.
Anything else → False labour

31. Stages of labour 1st stage: Labour pain → Full cx dilatation
From to
1st stage: Labour pain → Full cx dilatation
2nd stage: Full cx dilatation → Fetal expulsion
3rd stage: Fetal expulsion → After birth expul.
4th stage: next 24 hours

32. Ist stage of labour 2 phases
Latent phase
Are less than 4 cm dilated.
Have regular, frequent contractions that may or may not be painful.
Dilate only very slowly
Can usually talk or laugh during their contractions
May find this phase of labor lasting hours to days or longer.

33. Ist stage of labour 2 phases
Active phase
Are at least 4 cm dilated.
Have regular, frequent contractions that are usually moderately painful.
Demonstrate progressive cervical dilatation of at least cm per hour.
Usually are not comfortable with talking or laughing during their contractions.

34. Effacement and dilatation of the cervix
Ist stage of labour
Progress of labour
Effacement and dilatation of the cervix 

35. Ist stage of labour
Progress of labour
Descent

36. Ist stage of labour
Progress of labour
Descent

37. Ist stage of labour USING THE PARTOGRAPH Patient information
Fetal heart rate: Record every half hour.
Amniotic fluid: Record the colour of amniotic fluid at every vaginal examination
Moulding:
Cervical dilatation: Assessed at every vaginal examination and marked with a cross (X). Begin plotting on the partograph at 4 cm.
Alert line: A line starts at 4 cm of cervical dilatation to the point of expected full dilatation at the rate of 1 cm per hour.

38. USING THE PARTOGRAPH
Action line: Parallel and 4 hours to the right of the alert line.
Time: Record actual time.
Contractions: Chart every half hour
Oxytocin
Drugs given: Record any additional drugs given.
Pulse: Record every 30 minutes and mark with a dot (●).
Blood pressure: Record every 4 hours
Temperature: Record every 2 hours.
Protein, acetone and volume:

39. Sample Prtogram

40. Normal Prtogram

41. Abnormal Prtogram

42. Normal Prtogram

43. Normal Prtogram

44. 2nd stage of labour (Baby delivery)
It begins with complete dilatation and ends when the baby is completely out of the mother.
Primigravida → hours
Multipara → 30 minutes

45. 2nd stage of labour (Baby delivery)
Delivery of the head
Ask the woman to pant or give only small pushes with contractions as the baby’s head delivers.
Gently support the perineum as the baby’s head delivers. 
Once the baby’s head delivers, ask the woman not to push.
Suction the baby’s mouth and nose.
Feel around the baby’s neck for the umbilical cord

47. 2nd stage of labour (Baby delivery)
Episiotomy  should be considered only in the case of:
complicated vaginal delivery (breech, shoulder dystocia, forceps, vacuum);
scarring from female genital mutilation or poorly healed third or fourth degree tears;
fetal distress.

48. 2nd stage of labour (Baby delivery)
Clamp and Cut the Umbilical Cord
Once the baby is breathing, put two clamps on the umbilical cord, about an inch (3 cm) from the baby's abdomen. Use scissors to cut between the clamps.
It is better to keep the baby level more or less with the placenta until the cord is clamped.

49. 3rd stage of labour (Placenta delivery)
Primigravida → 30 minutes
Multipara → 10minutes

50. 3rd stage of labour (Placenta delivery)
Signs of placental separation
A sudden gush of blood
Lengthening of the visible portion of the umbilical cord.
The uterus  becomes round and firm.
Carefully inspect the placenta

51. Newborn care

52. Newborn care provide routine initial newborn care
Check for congenital anomalies
skin-to-skin contact with the mother
early breastfeeding.

54. THANK YOU