MANAGEMENT OF NORMAL LABOUR

🔅 FIRST STAGE 🔅
(A)🔅- Preparation : 
1- Antisepsis.
- Vulva shaved & clean.
- Evacuation of bladder & rectum. to prevent reflex uterine inertia by catheter & enema respectively.
- Cover of vagina by sterile cover.
- Avoid un-necessary PV examination.
(B)🔅- Observation:
1- observation of Mother:
- Vital signs. as PR, T, RR, BP.
- Uterine contractions for frequencys. trength. duration. by palm or CTG 
- Cervical dilatation.
- Descent of fetus.
- Engagement.
- Rupture of membranes.
2- Observation of fetus :
- observation of FHS to detect fetal distress either  intermittent by sonicaid or  continuous by CTG .
(C)🔅- Nutrition :
- Oral sugary fluids  allowed in latent phase but avoided  in active phase
- IV fluids if labour prolonged. (125 mg/h) .
(D)🔅- Pain relief :
- pethidine 50mg IM  but stopped 2 hr before 2nd stage .
- epidural analgesia .
(E)🔅- Instructions : 
- If membranes ruptured.
rest in bed lie on left lateral position.
- If intact. walking is allowed  between contractions.
- Straining is avoided because lead to exhaustion of uterus.
(F)🔅- Partogram : graphic recording of  labor for
- Cervical dilatation.
- Contractions.
- Descent of head.
- Rupture of membranes.
- Medications.
- Vital signs.
- FHS.
🔅SECOND STAGE 🔅
Identified by :
- Full cervical dilatation.
- Desire to evacuate rectum.
- Reflex desire to bear down accompanied by grunt.
- Rupture of membranes .
(1)🔅- Preparation :
Patient taken to delivery room.
Put in lithotomy position 
Sterile patient & put sterile towels on her Patient is instructed to bear down during contractions only. 
(2)🔅- Delivery of head & prevention of perineal tear through :
a- Perineal support by sterile dressing when head appears at vulva to prevent extenstion before crowning  (passage of biparietal throygh vulval ring ) before which vulval distension will be with occipitofrontal 11.5cm but after will be with  suboccipito-frontal 10cm.
b- Ritgen maneuver : controlled extension of head slowly in between contrations without bearing down .
c. Episiotomy : when head maximally distend vulva .
(3)🔅- After delivery of head :
d- Clearance of air passages  .
e- Coils of umbilical cord are slipped if one or cut if several.
f- Delivery of shoulders :
g- Handling of fetus from ankles but avoided in preterm & asphyxia.
h- Umbilical cord clamped & cut.
i- Milking of cord except in preterm & Rh incompitability
🔅 THIRD STAGE 🔅
(1)🔅- Conservative method:
- Exclusion of bleeding & uterine atony. by putting ulner border of left hand on fundus.
- Waiting for signs of separation :
a- body of uterus become smaller & harder
b- suprapubic bulge.
c- elongation of cord without  receding.
d- gush of blood.
e- Uterine massage
allow contraction
- Placental expulsion : by asking patient to bear down or by fundal pressure.
- Uterine stimulants.
a- ergometrine  0.25mg IM.
b- oxytocin 5U IV  drip
(2)🔅- Active method:
a- Uterine stimulants:
ergometrine 0.25mg IV to induce strong uterine contractions.
b- Brandt-andrews method : left hand is pushing the uterus up while the other hand pull the cord during uterine contractions but
may cause (rupture of cord acute inversion of uterus). 
(3)🔅- After placental separation:
- Placenta rolled by both hands Inspected for missing parts.
- Repair perineal tears & wash the vulva.
🔅 FORTH STAGE 🔅
1st hour after delivery need carful observation & uterine  massage every 15 min to prevent PPH.
🔅 NEW BORN MANAGEMENT 🔅
a- Warmth 
b- Care of respiration ( suction–stimulation ) 
c- Care of umbilical cord stump.
d- Care of eyes by antibiotics drops
e- Record weight.
f- Detect congenital anomalies.
g- Vitamin K administration.

د/سامي عارف عبدالجليل الشميري.