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MANAGEMENT OF THE

FIRST STAGE OF LABOUR.

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Principles

Non interference with watchful

expectancy so as to prepare the

patient for a smooth delivery.

To monitor carefully the progression

of labour, maternal and foetal

wellbeing and to detect any deviation

from the normal at the earliestpossible moment.

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Management

General  – explain the procedure and counsel to eliminate thefear.

Rest  –If the membranes are intact the patient is allowed towalk about and lie down during pain.However if the membrane ruptures early, the patient shouldbe in bed.

Diet  – Keep fasting from the onset of labour for aspontaneous labour and overnight fasting for an inducedlabour.

Bowel and Bladder care  – An enema is given in the earlystage to empty the rectum. This will prevent soiling of theperineum during the 2nd stage.

Patient is encouraged to empty the bladder frequently as fullbladder often inhibits uterine contractions.

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• Progression of labour  – Is assessed byabdominal and vaginal examination.

 Abdominal examinationUterine contractionsPalpation of foetus

Vaginal examination

Cervical dilatationEffacementDescent  

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 Abdominal examination

Uterine contraction can be felt by abdominalpalpation of the uterus when the patient complainsof pain and nature regards to its intensity,

frequency and duration assessed.The contraction increases in frequency and themaximum expected contraction is 3/10 min, withone lasting for 45-60 secs with a 2 min relaxationin between.

Palpation of the foetus while there is no uterinecontraction, to detect the progressive descent ofthe foetal head and this could be expressed in1/5th.

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Vaginal examination

Cervical dilation  – for the first 3cm dilate slowly and for thenext 7cm at the rate of 1cm/hr.

Effacement  – is judged by comparing the current length with

the actual length and can expressed as a percentage.

Descent  –  the station of the presenting part in relation to theischial spines.

Moulding, formation of caput succedaneum, cervical oedemaare some of the other findings that should be obtained by PVexamination.

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Foetal well-being

Foetal heart sound should be monitoredevery ½ hr. Count the rate for 1 min and

observe the rhythm especially after theuterine contractions.

On PV examination, look for cord prolapse,cord presentation and colour of the liquor.

CTG should be performed if there is anysuspicion of foetal distress.

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Maternal well-being

Hydration, temperature, pulse, BP

and RR are monitored at regularintervals.

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Pain relief

Pain in the first stage is due to ischemia ofthe uterine muscle caused by contractions.

Commonly used analgesic drug isPethidine 50-100mg IM when the cervicaldilatation is 3cm and if necessary it isrepeated after 4hrs.

The drug should not be used if delivery isexpected within 2 hrs.