Patient in labour
history taking aspects
current pregnancy
- For current pregnancy:
- LMP → gestational age/due date?
- Scans so far
- Any problems during pregnancy - maternal, neonatal - congenital abnormalities
- Investigations e.g. Rh status, Down, mid-trimester scan
- Number of babies expected to be delivered
- Parity + gravidity
- Previous terminations: stage, method, problems afterward
- Previous miscarriages
- Maternal infections/fevers
Since start of “labour” symptoms
- Are there contractions? When did contractions start? How long, how strong and how frequent?
- Any leaking of fluid or bleeding PV? (Timings essential – consider normal show vs heavy bleeding e.g. Placenta praevia)
- Have the membranes ruptured? When in relation to start of contractions? (If PROM >24 hours before onset of contractions there is increased risk of neonatal sepsis)
- What is the colour of the amniotic fluid? (Dark green/brown staining may suggest excess meconium)
- When was the last time the patient felt the baby move? How have movements been in the last 24 hours?
- Any alcohol or illicit drug use?
examination
- The pregnant abdomen:
- fundal height (pubic symphysis to fundus)
- foetal lie/position
- presentation?
- PV examination only if delivery imminent or unsure about diagnosis - otherwise can either wosren bleeding (placenta praevia) or introduce infection (PROM)
signs of imminent delivery (get ready to catch)
Crowning (presenting part visible below the labia) – This baby will likely be delivered in the ED!
Complete cervical dilatation and/or effacement
Mother feels delivery is imminent (particularly if multiparous)
Spontaneous pushing
Bloody Show (Bright red blood mixed with mucous plug)
Perineal bulge
Labial separation
Anal relaxation and/or bulging or sensation of impending defecation