Labor: Detailed Guide and Notes

I. Introduction

Labor is the process a pregnant woman goes through to deliver her baby. This process is usually divided into 3 stages:

• Stage 1: Cervical dilation
• Stage 2: Pushing
• Stage 3: Placental delivery

II. Induction of Labor

Oxytocin:

• Contraindications:
  • Acute fetal distress
  • Absolute cephalopelvic disproportion
  • Uterine abnormalities
  • Severe preeclampsia
  • Intrauterine fetal demise
• Dosage maintenance: 3 contractions/10 minutes, each contraction lasting 40 seconds, not exceeding 3-4 contractions/10 minutes.
• Induction of labor:
  • Establish an intravenous glucose 5% 500ml line, adjust the lowest dose (3 mUI/minute).
  • Mix 5 UI of oxytocin in the intravenous fluid (equivalent to 3 mUI/minute).
  • Use an electric pump: 2-2.5 mUI/minute.
  • Adjust the dose every 30 minutes, increasing by 1.5-2.5 mUI/minute each time.
  • If 5 UI is exhausted without labor, consider cesarean section or continuing treatment the next day.

Amniotomy:

• Recommendation: After 40 weeks of gestation.
• Note: Antibiotics should be used after amniotomy to prevent infection.

III. Risks of Using Oxytocin

• Uterine rupture: Rare but can be life-threatening to both mother and baby.
• Postpartum hemorrhage: Due to ineffective uterine contractions.
• Fetal distress: Due to restricted oxygen supply to the fetus.

IV. Medications to Assist in Uterine Contractions

• Oxytocin: The main drug used to treat uterine contractions.
• Misoprostol: A drug with a short half-life (30 minutes) and rapid effectiveness.
• Dinoprostol: A drug with similar effects to misoprostol.
• Carbetocin: An oxytocin analog, high cost, difficult to stock.
• Ergotamine: A drug with a strong vasoconstrictive effect, rarely used.

V. Stages of Labor

• Number of stages: 3 stages.
• Duration:
  • Primipara <= 24h.
  • Multipara <= 18h.
• Placental delivery stage: Should not exceed 1 hour.
  • 30 minutes without pushing, re-examine and treat.
  • If the head is descending well: Monitor.
  • If progression is not good: Treat.

VI. Monitoring Labor

• General condition: Monitor pulse, temperature, blood pressure.
• Uterine contractions:
  • Manual palpation of contractions.
  • Monitoring contractions with a machine.
• Cervical dilation: Internal examination to determine.
• Amniotic fluid: Color, volume, characteristics, smell (suggestive of infection).
• Station: Assess by hand or machine.
• Fetal heart rate: Monitor with a wooden stethoscope or CTG.
• Labor duration: Record the actual labor duration.

VII. Timely Treatment

• Rupture of membranes, cervix almost fully dilated: Prepare delivery instruments.
• Rupture of membranes, cervix not dilated, amniotic fluid and fetus normal: Monitor.
• Rupture of membranes, umbilical cord prolapse: Emergency cesarean section.
• Green amniotic fluid, fetal distress: CTG measurement.

VIII. Diagnostic Examination

Medical history:

• Gestational age
• True labor
• Mother and child’s health.

Internal examination:

• Vagina, cervix.
• Cervical dilation, effacement.
• Presentation, position, station.
• Amniotic fluid.

External examination:

• Cervical palpation/fetal abdomen.
• Leopold maneuvers.
• Amniotic fluid.
• Fetal heart rate.
• Station.

IX. Notes

• Internal examination: Only performed when necessary. Do not perform internal examination during labor.
• Amniotic fluid:
  • Clear: Premature birth.
  • Rice water: Post-term.
  • Green: Early fetal distress.
  • Yellow: Late fetal distress.
  • Black: Intrauterine fetal demise.
  • Red: Abruptio placentae.
• Station: Assess by hand or machine.
• Fetal heart rate: Monitor regularly to detect abnormalities.
• Labor duration: Record the actual labor duration to monitor progress.

X. Risks of Premature Delivery

• Cervical laceration: Due to insufficient cervical dilation.
• Bleeding: Easy bleeding due to incomplete cervical dilation.
• Retained placenta: Easy to retain placenta due to ineffective uterine contractions.

XI. Regular Menstrual Cycle

• Menstrual cycle: 28-32 days.
• Menstrual flow: 40-60 ml.
• Menstrual duration: 4-6 days.

XII. Brass-v Bag

• Do not line the Brass-v bag before placental delivery:
  • Exclude amniotic fluid, urine.
  • Feces mixed in while pushing.
  • Inconvenient for patients.

XIII. Internal Examination Assessment

• Cervical dilation.
• Cervical effacement.
• Cervical consistency: Firm or soft.
• Cervical direction and position.
• Presentation.
• Formation of the amniotic sac: Bulging, flattened.
• Lie.
• Pelvic brim: Transverse diameter, posterior sagittal diameter.

XIV. Conclusion

Labor is a complex process that requires close monitoring to ensure the safety of the mother and baby. Understanding labor knowledge will help the pregnant woman and her family be proactive in monitoring and treating promptly when necessary.