programmed labour

1. PROGRAMMED LABOUR Dr. BHARTI KALRA

3. Active Management Active Management to prevent � Infection. Exhaustion. Dehydration. Disillusion in mother. Ketosis. Fetal distress. Steps � Amniotomy. � Judicious use of PGs/ oxytocin.

4. Obstetric Analgesia Obstetric analgesia includes - Epidural analgesia. - Combination of analgesic drugs and antispasmodic drugs.

5. Protograph for documentation of labour events (Indian Potogram by Daftory 1977.) Active management of 3rd stage of labour.

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7. Modern Management Of Labour Selection Criteria 1) Primi/ Multi > 38 Weeks 2) Low risk patient. 3) Presence of anaesthetist and neonatologist. 4) Consent. 5) During active phase of labour.

8. Pain Score Pain relief Score Score 0- No appreciable pain No relief. Score 1- pain bearable, relief Pain relief present but not desired. not to desired extent. Score 2 � Severe Pain. Substantial relief. Score 3 � Unbearable pain. Complete relief.

9. Protocol 1) 1/V line c RL/5./. Dext at 20 drops/min. 2) 3-4 sustained pains /10 min. (Primprost /hr. OR Oxytocin 24 min. in drip) 3) Dilute 30 mg Pentazoncine (1 ampoule) in NS /DW. Dilute 1 ampoule drazepam in 10ml NS/DW. Administer 1/5th of each 1/V slowly. 4) Adm. Inj. Tramadol 1mg/kg slow I/V. + by Antispasmodic I/V : I/M. 5) Moniter � hourly FHR :LPs. At. 7-8cm by ketamine 0.5mg/kg in 10ml Saline. 6) Last dose after birth of baby.

10. Management (Mmt) of 3rd stage of labour 10 units oxytocin in 20 cc saline through Umbilical vein. or Inj. Prostodin 125 mg after birth of baby.

11. Advantages Short Labour. Sustained pain relief. Significant amnesia of labour. Significant reduction of dystocia. Lower incidence of operative delivery. Obstetric management Simplified.

12. Pitfalls Team approach : difficult to achieve at Nursing home. Risk of fetal distress : of medication. Obstetrician distress.