Intrapartum care

O80.0-1/O80.8-9

For the comprehensive management of women in labour refer to the most recent National Maternity Care Guidelines.

DESCRIPTION

Labour is divided into 4 stages:

  • First stage
    • onset of regular painful uterine contractions at term to full dilatation of cervix.
  • Second stage
    • full dilatation to delivery of the baby.
  • Third stage
    • delivery of the baby to delivery of the placenta.
  • Fourth stage
    • 1 hour post-delivery of the placenta.

GENERAL MEASURES

  • Encourage companion support.
  • Ensure that the mother is adequately hydrated (can be done orally).
  • Monitor progress of labour on partogram.

MEDICINE TREATMENT

First stage with cervical dilatation <10 cm:

Analgesia: O62.9 + (Z51.2)

  • Morphine, IM, 0.1 mg/kg to a maximum of 10 mg, 4 hourly.

LoEIII [35]

OR

Especially in advanced first stage of labour:

  • Nitrous oxide 50% mixed with oxygen 50%, given by mask.

AND

For nausea and sedation, if needed:

  • Promethazine, IM, 25 mg 4 hourly.

Second stage

If episiotomy is needed, local anaesthetic: O62.9 + (R10.2+Z51.2)

  • Lidocaine 1%.
    • Do not exceed 20 mL.

Fetal distress during labour (O75.9)

Place the woman in the left lateral position.

  • Salbutamol, IV, 0.5 mg/mL, 250 mcg administered slowly over 2 minutes and refer.
    • Reconstitute the tocolytic as follows:
      • Salbutamol 1 mL (0.5 mg/mL) added to 9 mL of water for injection, to make a 50 mcg/mL solution. Monitor pulse.
      • Inject 5 mL (250 mcg) over at least 2 minutes. Monitor pulse.
      • If pulse increases to > 120 beats/minute, discontinue the injection.
      • Do not administer if mother has cardiac disease.

Third stage

Prevention of post-partum haemorrhage (PPH): Z29.2

  • Check for twins.
  • Oxytocin, IM, 10 units.
  • Clamp and cut cord after 1 minute.
  • Controlled cord traction of the placenta.

If >500mL blood loss, manage as postpartum haemorrhage (see Postpartum haemorrhage (PPH) ).

Rh-negative mother (O36.0)

Administer to Rh-negative mother, if baby is Rh-positive or baby's Rh group is unknown:

  • Anti-D immunoglobulin, IM, 100 mcg, preferably within 72 hours but can be given up to 7 days after delivery.

Care of the newborn baby

If baby not crying/breathing well, see Neonatal Resuscitation .
For routine care of the neonate, see Care of the neonate .
Observe mother and neonate for 1–2 hours before transfer to the postnatal ward.

For pain after delivery

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum dose: 4 g in 24 hours.

OR

Ibuprofen, oral, 400 mg 8 hourly with or after a meal as needed for up to 5 days

LoEIII

REFERRAL

  • Prolonged labour according to charting on partogram.
  • Post-partum haemorrhage.
  • Retained placenta.
  • Other complications of mother or baby.