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