Health Centers
 loading...
if not loaded., try Site map to view all
 
 
 
 
bookmark | print this page | mail to friend | site map | help

Woman and Obstetrics

FONT SIZE

T T T

Active Management of Labor

 

The active management of labor refers to active control over the course of labor. There are three essential elements to active management are careful diagnosis of labor by strict criteria, constant monitoring of labor, and prompt intervention (eg, amniotomy, high dose oxytocin) if progress is unsatisfactory.

Criteria for active management of labor:
  • Nulliparous
  • Term pregnancy
  • Singleton infant in cephalic presentation
  • No pregnancy complications
  • Experiencing spontaneous onset of labor.
Diagnosis of labor

The diagnosis of labor is made only when contractions are accompanied by any one of the following:
  • Bloody show
  • Rupture of the membranes
  • Full cervical effacement
Women who meet these criteria are admitted to the labor unit.

Management of labor :

Rupture of membranes. Intact fetal membranes are artificially ruptured one hour after the diagnosis of labor is made to permit assessment of the quantity of fluid and the presence of meconium. Rupture of the membranes may accelerate labor.

Progress during the first stage of labor

1. Satisfactory progress in the first stage of labor is confirmed by cervical dilatation of at least 1 cm per hour after the membranes have been ruptured.
2. In the absence of medical contraindications, labor that fails to progress at the foregoing rate is treated with oxytocin.
3. Progress during the second stage of labor is measured by fetal descent and rotation.
  • a. The second stage of labor is divided into two phases: the first phase is the time from full dilatation until the fetal head reaches the pelvic floor; the second phase extends from the time the head reaches the pelvic floor to delivery of the infant.
  • b. The first phase of the second stage is characterized by descent of the fetal head. If the fetal head is high in the pelvis at full dilatation, the woman often has no urge to push and should not be encouraged to do so. Oxytocin treatment may be useful if the fetal head fails to descend after a period of observation.
Administration of oxytocin.

Oxytocin is administered for treatment of failure of labor to progress, unless its use is contraindicated. Oxytocin may only be administered if the following conditions are met:
  • 1. Fetal membranes are ruptured
  • 2. Absence of meconium in amniotic fluid
  • 3. Singleton fetus in a vertex position
  • 4. No evidence of fetal distress
Failure to progress (dystocia) is diagnosed when the cervix fails to dilate at least 1 cm per hour during the first stage of labor or when the fetal head fails to descend during the second stage of labor. Three possible causes for failure to progress are possible (excluding malpresentations and hydrocephalus):
  • 1. Inefficient uterine action
  • 2. Occiput-posterior position
  • 3. Cephalopelvic disproportion.
Inefficient uterine action is the most common cause of dystocia in the nulliparous gravida, especially early in labor. Secondary arrest of labor after previously satisfactory progress may be due to an occiput-posterior position or cephalopelvic disproportion. It is often difficult for the clinician to differentiate among these entities, thus oxytocin is administered in all cases of failure to progress (unless a contraindication exists).

In the first stage, progressive cervical dilatation of at least 1 cm per hour should occur within one hour of establishing efficient uterine contractions (five to seven contractions within 15 minutes) with oxytocin.

The second stage is considered prolonged if it extends longer than two hours in women without epidural anesthesia and longer than three hours in women with epidural anesthesia despite adequate contractions and oxytocin augmentation.

 


 
Your feedback?




 
Other navigational links under Woman and Obstetrics
 
 

Rate this page?
Good Average Poor



Rating accepted

Thanks for your note! Suggestion if any, will be taken up by the editor squad on a prority. We appreciate your gesture.
Hecapedia squad
Improve hecapedia - Join the squad


 
 
Nothing on this web site, in any way to be viewed as medical advice. All contents should be viewed as general information only.
All health care decisions should only be made with consultation from your physician.

About us | Link to us | Contact us | Associates | Media Center | Business services | Feedback | Report Bugs | Sitemap | Help
privacy policy | disclaimer | terms and conditions | accessibility | anti-spam policy
© 2006 hecapedia