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Intrapartum Monitoring


Admission criteria

  • regular painful contractions

  • spontaneous rupture of membranes

  • any concerns involving foetal movements, abdominal pain, vaginal bleeding

Examination in admission

  • Temperature

  • pulse

  • blood pressure

  • foetal heart rate

  • urine sample

  • abdominal palpation

  • vaginal examination

  • cardiotocograph (CTG)

Labour if regular, painful contractions which lead to progressive cervical change

Partogram

  • foetal heart rate

  • colour of amniotic fluid

  • foetal head level

  • cervical dilatation

  • contraction

  • drugs

  • syntocinon dosage

  • epidural top-ups

  • urine output

  • urine contents

  • degree of moulding

  • maternal BP and pulse

  • maternal temperature

Vaginal Examination

  • every 3-4 hours

  • cervical dilatation

  • degree of effacement

  • presentation

  • position of presenting part

  • degree of caput and moulding

  • state of membranes

  • colour of amniotic fluid

    • Meconium - 30% of post-term foetuses

      • foetal hypoxia if early in labour, thick in consistency and pea green, associated with CTG abnormalities

Descent of foetal head

Uterine contractions

  • normally every 3-4 minutes, lasting 50-60 seconds

Rupture of membranes

  • Indications

    • to encourage progress in labour

    • to examine colour of amniotic fluid

    • for foetal scalp electrode

      • if external monitoring unsatisfactory

      • if meconium staining of amniotic fluid

      • abnormality of external CTG

      • in all high risk women

  • risk of cord prolapse if head is not engaged

Ambulation during first stage may stimulate uterine activity and increases chance of spontaneous vaginal delivery

Second stage labour

  • suspect when woman feels urge to push

  • confirm by vaginal examination

  • without epidural last 1 hour primip, half-hour in multip

  • with epidural, top-up allow 1-2 hours for head to descend before pushing commenced

Intrapartum foetal heart rate monitoring

  • reduces perinatal morbidity and mortality if foetal asphyxia noted early

  • baseline rate 120-160 bpm

  • variability - silent (0-5 bpm), reduced (6-10 bpm), normal (11-25)

  • accelerations and decelerations - >15 bpm, lasting > 15 secs.

    • accelerations are sign of healthy foetus

    • early decelerations - with contractions, associated with foetal head compression, usually benign

    • late decelerations - usually pathological, esp. if associated with reduced variability and tachycardia

    • variable decelerations - may or may not indicate hypoxia

Foetal Blood Sampling

  • pH > 7.25 -normal

  • pH 7.2-7.25 - borderline, repeat in 30 mins

  • ph <7.2 - abnormal, deliver

 


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