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Edit Comment Close Premium member Presentation Transcript NORMAL LABOUR : NORMAL LABOUR Ms. Lalith Prasanna, BSN., RN., RM., MT., OUTLINE : OUTLINE Definition of labour Stages of labour Signs of imminent delivery Transport Decision Conduction of Delivery Apgar Assessment Postpartal care LABOUR : LABOUR The time and process beginning with the first uterine muscle contraction until delivery of the placenta Stages of Labour : Stages of Labour 1st stage: Onset of contractions to dilation of the cervix 2nd stage: Complete dilation of cervix to delivery of baby 3rd stage: Delivery of baby to delivery of placenta Signs of Imminent Delivery : Signs of Imminent Delivery Crowning Rupture of the Amniotic Sac Bloody show / presenting part Need to bear down Sensation of needing to move bowels Contractions 1-2 minutes apart Regular cycle Lasting 45-60 seconds TRANSPORT DECISION : TRANSPORT DECISION If delivery is imminent with crowning, contact medical direction for decision to commit to delivery on site. If delivery does not occur within 10 minutes, contact medical direction for permission to transport Transport Decision : Transport Decision If delivery is imminent, prepare for delivery in warm, private location. If delivery is not imminent, transport on left side If the patient was subject to spinal injury, stabilize and prop backboard with towel roll on right side. QUESTION : QUESTION You are transporting a pregnant mother in labor, on examination you find crowning & hair line is seen, the hospital is 15min away from the present location, immediately you will.. A) Stop the vehicle and conduct delivery B) Rapidly transport to conduct institutional delivery C) Continue transport and conduct delivery enroute D) None of the above PREPARING FOR DELIVERY : PREPARING FOR DELIVERY Use proper BSI precautions Contact medical control for a decision to deliver on scene or transport Keep the mother in supine position knees flexed and spread apart or lithotomy position Prepare Obstetric Kit : Prepare Obstetric Kit Surgical scissors Hemostats or cord clamps Umbilical tape or sterilized cord Bulb syringe Towels Gauze sponges (2) Sterile gloves One baby blanket Sanitary napkins Plastic bag INTACT AMNIOTIC SAC : INTACT AMNIOTIC SAC If the amniotic sac does not break or has not broken, use a clamp to puncture the sac and push it away from the infant’s head and mouth as they appear CROWNING : CROWNING 1. Bulging out of the vagina as the presenting part compresses against it 2. Provide adequate perineal support as the head gets delivered : 2. Provide adequate perineal support as the head gets delivered 3. Place fingers on bony part of the skull and exert gentle pressure to prevent expulsive delivery : 3. Place fingers on bony part of the skull and exert gentle pressure to prevent expulsive delivery 4. Examine for cord around the neck, if present ; slip over the shoulder or clamp, cut and unwrap : 4. Examine for cord around the neck, if present ; slip over the shoulder or clamp, cut and unwrap 5. Suction infant’s mouth and then the nose with bulb syringe : 5. Suction infant’s mouth and then the nose with bulb syringe 6. Assist in delivery of shoulders and body : 6. Assist in delivery of shoulders and body Gently guide baby’s head down to upper shoulder Guide the baby’s head up to deliver the lower shoulder Gently assist with delivery of rest of baby: Do NOT pull Note time of delivery Control slippery baby during delivery : Control slippery baby during delivery Support head, shoulders, feet Keep head lower then feet to facilitate drainage of secretions from mouth Dry baby Keep baby warm 7. After cessation of pulsations, double clamp and cut cord between two clamps : 7. After cessation of pulsations, double clamp and cut cord between two clamps 8. If baby is not crying spontaneously… : 8. If baby is not crying spontaneously… Flick baby’s feet, rub back to stimulate Do NOT shake infant Do NOT slap buttocks “Blow by” 02 if: Heart rate < 100 Persistent central cyanosis present Resuscitate if necessary APGAR SCORE : APGAR SCORE Determine the infant’s score at 1 and 5 minutes Postpartum! APGAR ASSESSMENT : APGAR ASSESSMENT question : question Baby cried immediately after birth and appears pink in the body but bluish in the extremities. Baby had a strong cry & active movement of the limbs. Pulse rate is below 100 BPM Identify the APGAR score 9. Watch for signs of placental separation : 9. Watch for signs of placental separation Fresh bleeding Lengthening of the cord Uterus becomes enlarged and globular 10. Let Placenta deliver normally : 10. Let Placenta deliver normally Give controlled cord Traction Do not pull Normally separates within a few minutes to 30 min after delivery 11. Check placenta and place in a bag and transport with the mother : 11. Check placenta and place in a bag and transport with the mother POST PARTAL CARE (Slide 1 of 2) : POST PARTAL CARE (Slide 1 of 2) Place sterile pad over vaginal opening Estimate blood loss Encourage breastfeeding Post Partum Hemorrhage : Post Partum Hemorrhage Average loss is about 500 cc (about 10% of the blood volume) Most cases are caused by the uterus failing to contract effectively Expell clots from the uterus with fundal pressure Uterine massage Oxytocin, on ERCP advice POST PARTAL CARE (Slide 2 of 2) : POST PARTAL CARE (Slide 2 of 2) If mother shows signs & symptoms of shock: 100% 02 by NRB IV of 0.9 Saline Rapid transport QUESTION : QUESTION ESTIMATES BLOOD LOSS DURING POST PARTAL PERIOD IS 500 ml 1000 ml 1500 ml 2000 ml summary : summary Definition of labour Stages of labour Signs of imminent delivery Transport Decision Conduction of Delivery Apgar Assessment Postpartal care THANK YOU !!!! : THANK YOU !!!! You do not have the permission to view this presentation. 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