Mom

1. Vitals (Mom + Baby)

2. Abdominal Exam

   • Fetal Movement

   • Tenderness

     • Chorioamnionitis?
     • Uterine rupture?

   • Leopold maneuver labour

   • Palpability of fetal head

     • 0/5 - 2/5: Palpable: Head is entirely above the pelvis (not engaged).

     • 3/5 - 4/5 Palpable: Head is beginning to enter the pelvis.

     • 5/5 Palpable: Head fully in vaginal space (active labour)

     • or less Palpable: Head is considered engaged/deep in the pelvis

3. Pelvic Exam

   • Inspection: water? blood
   • Bimanual Exam
     • Diameter
     • Effacement
   • If unclear if water ruptured → Speculum Exam
     • “Pooling of fluid in posterior fornix”

[…] missed some notes

Pain

• NO gas (30 min)
• PO Pain Med
• Epidural
  • Issue: cannot walk, mom become hypotensive

Fetal Hear Beat

• Epidural → should have CTG
• Intelligent auscultation
  • Normal risk women
  • Not on intervention
  • Progress normally in Labour

Active Labour

• Give 1 hr
• Active stage (valsalva)
• Every valsalva is interruption blood flow to placenta
  • IUGR/FGR : start experiencing comprimised
• Variable deceleration → can tolerate