INTRAPARTUM MANAGEMENT

These are measures taken to ensure

maternal and fetal wellbeing during labour.

Common maternal problems during

labour

1) Pain
2) Dehydration
3) Hunger

Common Problems during labour

1) Fetal Distress

Methods of monitoring from wellbeing

1) Intermittent direct Auscultation

using fetoscope or sonicaid. Suitable
where there are no risk factors.
2) Cardiotocograph (continuous fetal
heart rare, monitoring) suitable in high
risk pregnancies.

        200                  
                           
                           
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a) Safe Pattern
i. A base line FHR of 120-160
beats / minute
ii. No changes in FHR during or
after contractions
iii. Baseline variability (beat –to-
beat variation) of 5 beats minutes or
more.

b) Asphyxia patterns
i. Late decelerations - begins at or
after the peak of contraction and the
 return to baseline is delayed until
after the contraction has ceased.

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ii. Loss of “eat – to beat” variation ie a

flat CTG. It is characterized by a
baseline FHR variability of less than
5 beats minute.

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3) Phonocardiography
Uses a microphone placed on the
maternal abdomen over the site of
maximal intensity of the fetal heart
sounds

Disadvantage
Interference caused by environmental
noise and fetal and maternal movement.

4) Ultrasound
Records movement of the heart and
great blood vessels.

5) Fetal ECG
The spiral electrode is applied to the
fetal scalp through a cm or more dilated
cervix. Reliable but still a research
technique.

6) Fetal blood sampling for pH

measurement
Necessary when there are abnormal
FHR patterns suggestive of asphyxia.
 pH 7.25 or above Normal
pH 7.20 – 7.25 Pre-acidotic. Repeat
pH within 30 minutes.
pH 7.20 or below Deliver

NB - These invasive procedures are less

popular these days due to HIV infection.

MANAGEMENT OF LABOUR PAINS

In early stages of labour, women can be
allowed to move about. In late stages
they should lie on their left side.

A. Pethidine
Preferred analgesic drug during
labour. .. ½ - 4 hours

- Has analgesic as well as anxiolytic

action. Dose 50-100mg

Side Effects
i). RDS thus should be avoided when
cervical dilatation is 6cm and above.
ii). Nausea and vomiting – give
promethazine as well.

iii). Habit –forming (addiction)

B). Morphine
Not commonly used during labour because
has more side effects on the mother and
fetus:-
i) stronger depressant of the respiratory
centre.
ii) Nausea and vomiting are more
common.

t½ - 6 hours
Dose – 10-15mg

c). Epidural Block

 -Can only be done by experienced
doctors.
 -Particularly indicated in breech
presentation, twin pregnancy, trial of
labour where manipulations are
expected during delivery.

D). Entonox
 (50% oxygen + 50% nitrous oxide)
 -It is an inhalational analgesic.
 -Inhalation during contractions.
 Patients in labour are allowed to feed
preferably light diet and fluids.
 On cases of dehydration, give IV fluids
(N/Saline or Ringers Lactate)
 Acetonuria should be managed by IV
5% dextrose.
 Beware of the full bladder which should
be emptied.
 Routine enemas not longer
recommended.