ManagementoflabourEssays

A25yearoldwomanpresentsinlabourat5cmdilatationinthe39thweekofherfirst
pregnancy.Fourhourslater,sheis6cmdilatedonvaginalexaminationwithintact
membranes.(a)Justifyyourclinicalassessmentandinitialmanagementplan[10marks].(b)
Justifyyoursubsequentintrapartumcaregiventhatprogressremainsinadequate[10
marks]
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Agoodanswershouldinclude
(a)
Clinicalassessment
Justifysuspecteddelayinfirststage.Needtoidentifypotentialcausesofdelay.(1mark)
Subsequently,youshoulddiscussreasonsforyourassessmentsandinterventionsbelowtoearnfullmarks
History
Frequency,duration&strengthofcontractionsfrompatient,midwife&partogram(1mark)
Reviewantenatalnotesforanysuspicionofmacrosomia(1mark)
Assesspainandneedforpainrelief(1mark)
Examination
Pulse,BP,tempandlevelofhydration(1mark)
Fundalheight,presentationandengagementstrengthandfrequencyofcontractions(1mark)
Fetalheartrateandpatternfrompartogram(1mark)
Initialmanagementplan
Explainfindingstowomanandtakeaccountofherwishes(1mark)
Offeroptionofreassessmentin2horVE+amniotomy(1mark)
Explainthatinterventionmightshortenlabourbutdoesnotaltermodeofdelivery(1mark)
Discussoptionsforanalgesiaandkeepwellhydrated(1mark)

(b)
Subsequentintrapartumcare
Recommendamniotomyifnotyetdone+VEafter2h(1mark)
Ifprogress>1cmin2hthencontinuewith4hourlyassessments(1mark)
Ifprogress<1cmin2hrecommendoxytocinaugmentation(1mark)
Doseshouldbetitratedtoobtain45contractions/10minuteslasting3045s(1mark)
Explainthatoxytocinwouldshortenlabourbutnotproventoaltermodeofdelivery(1mark)
CommenceCTG(1mark)
Provideadequateanalgesiaincludingepidural(1mark)
DocumentplanforVEafter4h(1mark)
Ifprogress<2hin4h,offerCSafterdiscussionwithconsultant(1mark)
Takeaccountofmaternalwishes(1mark)