Operational Obstetrics & Gynecology

Labor and Delivery

 

Labor

Contractions

Electronic Fetal Monitors

Latent Phase Labor

Fetal Heart Rate

Pain Relief

Active Phase Labor

Urine

Second Stage Labor

Progress of Labor

Estimated Fetal Weight

Preparing for Delivery

Delivery of the Baby

Dilatation and Effacement

Managing the Delivery

Delivery of the Placenta

Fetal Orientation

Episiotomy

Managing Labor and Delivery

Leopold's Maneuvers

Anesthesia

Initial Evaluation

Fetal Membranes

Clamp the Cord

History

Blood Count

The Placenta

Risk Factors

Early Labor

Uterine Massage

Vital Signs

Monitor the Fetal Heart

Post Partum Care

Management of Early Labor

If the patient is in early labor, with a normal pregnancy, and intact membranes, she may feel like ambulating and this is very acceptable.

Not all women in early labor feel like walking and she need not be forced out of bed. Some patients, particularly those with ruptured membranes and those with certain risk factors are probably better off staying in bed, even during early labor.

While in bed, it is preferable, in women without continuous electronic fetal monitoring, to have them lie on one side or the other, but to avoid being on their back. Such lateral positioning maximizes uterine blood flow and provides a greater margin of safety for the baby.

Women with continuous electronic fetal monitoring may choose whatever position is most comfortable. If there is a problem with uterine blood flow, it will be demonstrated on the fetal monitoring strip and appropriate position changes can be undertaken.

Recheck the maternal vital signs every 4 hours. Elevation of blood pressure may indicate the onset of pre-eclampsia. Elevation of temperature >100.4 may indicate the development of infection.

Because of the risk of vomiting and aspirating later in labor, it is best to avoid oral intake other than small sips of clear liquids or ice chips. If labor is lengthy or dehydration becomes an issue, IV fluids are administered. Lactated Ringer's or Lactated Ringer's with 5% Dextrose at 125 cc/hour (6-hours for 1 L) are good choices.

Periodic pelvic exams are performed using sterile gloves and a water-soluble lubricant. The frequency of such exams is determined by individual circumstances, but for a normal patient in active labor, an exam every 2-4 hours is common. In active labor, progress of at least 1 cm per hour is the expected pattern. If the patient feels rectal pressure, an exam is appropriate to see if she is completely dilated.

Some women experience difficulty emptying their bladder during labor. Avoiding overdistension of the bladder during labor will help prevent postpartum urinary retention. If the patient is uncomfortable with bladder pressure and unable to void spontaneously, catheterization will be welcomed.


Home  ·  Introduction  ·  Medical Support of Women in Field Environments  ·  The Prisoner of War Experience  ·  Routine Care  ·  Pap Smears  ·  Human Papilloma Virus  ·  Contraception  ·  Birth Control Pills  ·  Vulvar Disease  ·  Vaginal Discharge  ·  Abnormal Bleeding  ·  Menstrual Problems  ·  Abdominal Pain  ·  Urination Problems  ·  Menopause  ·  Breast Problems  ·  Sexual Assault  ·  Normal Pregnancy  ·  Abnormal Pregnancy  ·  Normal Labor and Delivery  ·  Problems During Labor and Delivery  ·  Care of the Newborn

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Obstetrics & Gynecology - 2nd Edition
The Health Care of Women in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMEDPUB 6300-2C
January 1, 2000

This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified.

This formatting © 2006 Medical Education Division, Brookside Associates, Ltd.
All rights reserved

 

Advertise on this Site