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DMISSION OF WOM N IN L BOUR

BY

C. PHIRI

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DMISSION OF WOM N IN L BOUR

OBJECTIVES

Collect relevant history from a woman in labour during admission.

Perform a complete physical examination of a woman in labour.

Interpret the gathered information. Develop a plan of care for a woman in labour.

Implement the developed plan of care.

Evaluate the care given to the woman.

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DMISSION OF WOM N IN L BOUR

HISTORY TAKING (see learning guide)

PHYSICAL EXAMINATION (see learning guide)

LABORATORY INVESTIGATIONS (depending on findings)

INTERPRETATION OF FINDINGS / DIAGNOSIS.

DEVELOP PLAN OF CARE

-Individualized to meet clients needs, preferences, life style, cultural

beliefs, socio economic status etc.

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ADMISSION OF A WOMAN IN LABOUR contd

EVALUATE PLAN OF CARE

-evaluate improvement, change in position.

Repeat lab tests.

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ADMISSION OF A WOMAN IN LABOUR

VAGINAL EXAMINATION

OBJECTIVES

Explain the indications for performing a vaginal examination in

pregnancy, labour and puerperium.

Explain contraindications to vaginal examination.

Explain the prerequisites for performing a vaginal examination. Perform a vaginal examination.

Explain the expected findings during a vaginal examination.

Interpret the information obtained on vaginal examination.

Document the findings obtained on vaginal examination.

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VAGINAL EXAMINATION contd

INDICATIONS:

IN PREGNANCY

Diagnose pregnancy in 1sttrimester.

Check cervix

Pelvic assessment in 3rdtrimester.

Assess favourability of cervix before induction.

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VAGINAL EXAMINATION contd

IN LABOUR

To assess if the woman is in labour

To have baseline information of the progress of labour

To assess state of the membranes, presenting part anddilatation of cervix,.

To assess relationship of presenting part to cervix and

pelvis.

To assess engagement of presenting part and the station

of the presenting part.

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VAGINAL EXAMINATION contd

To assess the state of the presenting part-moulding, caput,and position of fetus.

Confirm findings obtained on abdominal palpation. To assess progress of labour.

To rule out cord prolapse after rupture of membranes if head is not engaged, or iffetal distress develops.

To induce labour through ARM.

Before inserting prostaglandins or administration of oxytocin infusion to ascertaindilatation of the cervix.

After birth of 2ndtwin to confirm presentation of subsequent babies.

To confirm full dilatation of the cervix and onset of 2ndstage.

For manual removal of the placenta.

After suturing the perineumto ascertain size of perineum and to ensure no swab has

been left insie the vagina. Before giving analgesia.

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VAGINAL EXAMINATION contd

PUERPERIUM

To ensure complete involution of the uterus.

To check the cervix. and to carry out any treatment for cervicalerosion.

To take a Pap smear. To insert an IUCD.

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VAGINAL EXAMINATION contd

CONTRAINDICATIONS

History of PV bleeding in pregnancy, or PV bleeding presentbefore or during labour.

Placenta preavia or abruptio.

Preterm labour, unstable lie, high presenting part,malpresentation, polyhydramnious, multiple pregnancyuntil lie of 1sttwin is established for fear of rupturingmembranes.

If VE will cause spread of infection e.g. presence ofBartholin gland abscess, abnormal vaginal discharge,

herpes infection. History of abortion in pregnancy, or previous preterm

labours.

Presence of Shirodkars suture in pregnancy.

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VAGINAL EXAMINATION contd

PROCEDURE

Explain to the client.

Position the woman in dorsal position, legs abducted knees flexed.

Wash hands with soap and water and put sterile gloves.

INSPECTION

Perineal scars.

Oedema

Vaginal discharge-colour, odour, consistency and amount.

Varicosities.

Redness. warts, heamorrhoids.feaces,3rddegree tears scar.

Sores Liqour- amount,colour,odour, consistency.

Mucus and blood SHOW amount of bleeding any clots.

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VAGINAL EXAMINATION contd

Do a 6 swab technique using Chlorhexidine solution.

Drape legs and vulva area using sterile towels.

Pour Chlorhexidine on vulval area.

Open labia with fingers of left hand.

Dip index and middle finger in cream for gentle insertion into vagina.

After examination remove fingers, clean the woman and give a sterile pad.

Let the woman lie on her side and reassure her.

Record findings and explain to the woman.

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VAGINAL EXAMINATION contd

FINDINGS

Warm and moist.

Hot and dry. Firm,Rigid,septum.

Dischargecolour, amount, odour.

Liqour

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PELVIC ASSESSMENT

OBJECTIVES

Stat the aims for performing a pelvic assessment.

Explain the prerequisites for performing a pelvic assessment.

Perform a pelvic assessment.

Interpret information gathered on pelvic assessment. Describe the normal findings of a pelvic assessment.

Document findings obtained on pelvic assessment.

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ADMISSION OF A WOMAN IN LABOUR contd

PELVIC ASSESSMENT

AIMS

To detect abnormalities of the bony pelvis.

To measure diameters of the pelvis, inlet, cavity, and outlet.

To predict mode of delivery.

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PELVIC ASSESSMENT contd

PREREQUISITES

Aseptic technique.

Explain to the client.

Collect necessary equipment.

Ensure empty bladder.Do abdominal palpation.

Provide maximum privacy.

Dorsal position legs abducted, knees flexed.

Examine vulva for abnormalities.Know the measurement of the hand.

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PELVIC ASSESSMENT contd

METHOD

DIAGONAL CONJUGATE OR INTERNAL CONJUGATE

Extends from the inferior margin of the symphysis pubis to the

center of the sacral promontory and should measure 12.5cm.

The tip of the middle finger feels for the center of the sacralpromontory.

The site where the bottom of the pubic arch meets the hand is

marked or noted.

If the hand measures less tan 12.5cm, the sacral promontory

should not be reached in the average sized pelvis. Try to follow the brim. In an average sized pelvis the brim

cannot be followed.

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PELVIC ASSESSMENT contd

BITUBEROUS OR INTERTUBEROUS DIAMETER

Remove the fingers from the vaginal orifice.

Make the hand into a fist and place the knuckles between the ischialtuberosities .

NORMAL FINDINGSDIAGONAL CONJUGATE

Measurement 12.5cm measured from the tip of the middle finger to thepoint where the thumb meets the hand.

CURVE OF SACRUM

Smooth and broad

Rounded concave curve.

Narrow sacrum indicates narrow pelvic cavity or canal.

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PELVIC ASSESSMENT contd

COCCYX

Slightly movable

Fixed and projecting coccyx indicates narrow antero

posterior diameter of outlet.

GREATER SCIATIC NOTCHES

Should admit more than 2 fingers

If 2 fingers or lesspelvic cavity and outlet are narrow.

ISCHIAL SPINES

Not easily palpable, not prominent.

If prominent cause delay in second stage of labour or

obstruction in second stage of labour.

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PELVIC ASSESSMENT contd

SUB-PUBIC ARCH

Should accommodate 2 fingers with an angle of about 90 degrees.

Less than 80 indicates reduced transverse diameter of the outlet

leading to difficulty of delivery of the head through the pelvic outlet

leading to trauma.

BITUBEROUS OR INTERTUBEROUS DIAMETER

Width of the knuckles should fit comfortably between the ischial

tuberosities.

This indicates an adequate transverse diameter of the outlet.

Measures about 10.5cm.

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THE END

T H A N K Y O U