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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