Admission of a Woman in Labour
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
Cardiotocography (CTG) on admission
Women transferred from clinics and other hospitals
Enter all relevant clinical findings in the maternity file, and enter labour findings on the partogram if the woman is in the active phase of labour.
HISTORY TAKING
- Carefully review the antenatal card. Clearly note all risk factors. Interview unbooked women as if they were attending antenatal clinic for the first time
- Note the nature of labour pains, vaginal bleeding, fetal movements, passage of liquor & any other relevant symptoms
PHYSICAL EXAMINATION
- General examination includes psychological state, heart rate, temperature, BP, oedema & pallor
- Abdominal examination:
- Inspection
- SFH in cm
- Lie, presentation, position, & attitude
- Level of the presenting part in fifths above the pelvic brim
- Uterine tone, & strength and frequency of contractions
- Auscultation of the fetal heart rate between, during and after contractions
- Estimation of fetal weight
- Vaginal examination:
- Vulva & vagina: abnormal discharge, warts or sores
- Cervix: length (effacement), position, consistency, & dilatation in cm
- Membranes: ruptured or not
- Liquor, if the membranes have ruptured: meconium staining & grade
- The presenting part: its position, the degree of moulding & caput
- Station in relation to the ischial spines (this does not replace careful abdominal assessment of descent of the head in fifths)
SPECIAL INVESTIGATIONS
- Test the urine for glucose, protein & ketones
- Take blood for RPR & rhesus group in unbooked women & in those whose results are not available. Offer HIV testing after appropriate pre-test counseling
- Measure Hb level, or repeat the test if the last Hb was done >4 weeks ago. A ward haemoglobinometer result is acceptable
CARDIOTOCOGRAPHY (CTG) ON ADMISSION
Ideally, women who present to a referral hospital in labour should have specific risk factors, & need continuous CTG in labour. Run an admission tracing for 20 minutes, to screen for abnormalities before transferring the woman to labour ward. Self-referred low-risk women do not require CTG monitoring. Intermittent auscultation using a hand-held Doppler instrument or a fetal stethoscope should be used for women not on CTG.
WOMEN TRANSFERRED FROM CLINICS AND OTHER HOSPITALS
These women need careful attention on admission, as they are being transferred for a problem or risk factor. The most common reasons for transfer are poor labour progress, hypertension, & suspected fetal distress (fetal heart rate abnormalities or thick meconium staining of the liquor). Carefully read the notes from the clinic & assess the progress of labour from the time the woman first presented.
Enter progress on the partogram from the clinic, not on a new partogram.