NUMBER TITLE EFFECTIVE DATE APPLIES TO 1.

One Active management of labour

Personnel of OB&GYN department, Zagazig University

STATEMENT OF PURPOSE : ( I.E OBJECTIVES): 1.1 diagnosis of labour 2.1 optimal management of stages of labour REVISION HISTORY : Revision History: New. Revision After : one year

2.0

3.0

ABBREVIATION : ROM: rupture of membranes

4.0

RELATED REFERENCES :

Royal College of Obstetricians and Gynaecologists guidelines

Williams Obstetrics 23rd edition, 2010 5.0

PROTOCOL : 6.1 The value of active management:

1- avoid prolonged labour and its complications 2- good psychological effects 3- nursing, medical staff benefit

6.2 Steps
Are you sure that the patient is in labour? Certainly because:
1- contractions at regular intervals 2- gradually decreasing intervals 3- gradually increasing intensity 4- dilating cervix 5- discomfort in the back not stopping by sedation

Uncertain
Keep her in hospital& if she lives not far from hospital, let her go home and come back if she has more pains

Admit the patient and evaluate for the following Laboratory Maternal assessment History General examination Vaginal examination Fetal assessment -FHR -Presentation -size
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-Hematocrit, Hb% -ABO/Rh typing -Voided urine for glucose and protein

Active management of the first stage Clinical ly partogra m Maternal: her data vital signs every 4 hours ( if feverish or prolonged ROM every one hour). antibiotic : if ROM > 18 hours to prevent streptococcal inf.( amoxicillin 1.2gmIV to be repeated 4 hourly till delivery) periodic vag. Examination: according to stage of labour, in PG every 2-3 hours, in MG every2 hours in the 1st stage, avoid betadine and cidex as lubricant oral intake only ice chips, no food IV fluids 60- 120 ml/ h ( one bottle of saline /4-6 h.) to avoid dehydration and acidosis. enema, encourage bladder evacuation contractions: frequency, intensity and duration. cervicogram: dilatation, effacement, position, pelvic capacity electronic External cardiotocography

2- Fetal 1-heart rate monitoring by Pinard or sonicaide 2-presenting part( position, station, caput and moulding), 3-membranes, amniotic fluid( colour, amount, odour and mechonium)

If the progress is unsatisfactory after 2 hours of admission Do amniotomy and reevaluate after 2 hours Cervical dilatation < 1 cm / hour Start oxytocin: as protocol If mechonium Monitor the baby before syntocinon
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Active management of the second stage

Inform the pediatrician on duty to attend to any CS delivery, in cases of fetal distress, meconium stained liquor, vacuum or forceps delivery, breech and twin deliveries, IUGR and preterm cases of antepartum hemorrhage, RhD isoimmunization. Prepare delivery set, if episiotomy is indicated include suturing set. Duration of 2nd stage is generally h for multipara and 1-2 h for primipara provided the FHR is normal. Fundal pressure is not an acceptable practice. Episiotomy and its repair

Active management of the third stage

Give methergine one ampule IV( if not contraindicated) Dosage is 0.5 mg IM/IV or syntocinon 5 units IV. Active delivery of placenta by controlled cord traction, check the placenta for completeness of membranes, cotyledon and presentation. Delivery of placenta should take no more than 30 minutes. Watch time closely and notify the assistant lecturer when needed. Quick clinical assessment of patient's condition, blood loss, vital signs and feel the uterus if relaxed. Do gentle uterine massage. IV methergine one ampule and 10-20 units syntocinon in 500 ml of IV fluid. Check for any lacerations and tears. Do catheterization, position patient in supine position (flat position).

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6.0

RESPONSIBILITY:

The responsible for the application of this protocol is the resident on duty (ROD) under the supervision of the assisstent lecturer on duty
RECOMMENDED BY REVIEWED BY APPROVED BY

Obstetrics And Gynecology Department 15/10/2010

QUALITY MANAGEMENT UNIT DATE

THE DEAN DATE

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