6/2012

O&G Senior Clerkship

Labour ward visit
Instructions for students:
1. Go to Queen Mary Hospital K Block 9th floor at 09:30. You must wear your
student ID. Ring the bell of the labour ward (K9 North Wing) to be let into the
labour ward.
2. A doctor or a midwife will show you around the labour ward and demonstrate to
you how to examine a placenta. If there is anything that you do not understand
about the setting of the labour ward or the equipment there, ask him/her.
3. The doctor or the midwife will give you a patients record to read. This record is
the assigned case for brief discussion with your tutor later. If the patient consents,
you may go into the room and talk to her and her husband briefly. (On some days,
there may be no suitable patients in the labour ward, and you will be given a
photocopy record to read.) Do not take any of the patients record or photocopies
outside the labour ward.
4. The form attached is to guide you on what you are expected to learn in the labour
ward visit. Each group needs to fill in one and use it to discuss with the tutor in
the workshop.
5. You will also be given a blank partogram. If you have time, fill this in for the
assigned patient. If there is not enough time, use the partogram in the workshop
with your tutor.
Respect patients confidentiality. Discussion with the tutor and among the group is
for education purposes and the patient need not be identified. Do not discuss the
patient or her condition in public areas.

O&G Senior Clerkship - Labour Ward Visit

Labour ward setting:
How is the labour bed different from an OT bed?
What monitors are installed in the cupboard next to the bed?
What is the advantage of having an operation theatre within the labour and delivery
suite?
The patient assigned_____________________________________________
Age:
Gravida: (the number of pregnancies that she has, including this one):
Parity: (the number of deliveries that she has had)
The gestational age:_____weeks____days
(Do you know how to calculate the gestational age from the LMP?)
Her body height _____cm. Her prepregnant weight (if not available, weight at first
visit ________kg. Was she overweight or underweight?
Past health:
Does she smoke or drink?
Past obstetrics history:

(Why are these relevant?)

_____________________________________________________________________
Antenatal care:
When did she start to have antenatal care? _____weeks gestation
(What is the usual gestational age to start antenatal care?)
What are her antenatal routine blood tests results?
Hb: ______g/dl (Does she have antenatal anaemia?)
MCV: ______fl (Does she have thalassaemia?)
HBsAg positive/negative (Why is this important?)
HIV Ab positive/negative
What screening test had been done for syphilis? _________
The result of the syphilis screening test was reactive/non-reactive.
Rubella immune status: immuned/non-immuned
Did she have hypertension on any of her antenatal visits?
(Why is blood pressure checking important in the antenatal period?)
Did she have an OGTT during her pregnancy?
What was the result of the OGTT if it had been done?
Did she have any ultrasound examinations in the antenatal period?
If she had, when were the ultrasound examinations done?
(What are the purposes of ultrasound examination in the antenatal period?)
Did you identify any risk factors or abnormalities in her pregnancy?
_____________________________________________________________________

Intrapartum care:
Is she in labour?
If she is in labour, what stage of labour is she in? 1st/2nd/3rd
(Do you know the stages of labour?)
If she is not in labour, why is she in the labour ward?
Was the onset of labour spontaneous or induced?
If the onset was spontaneous, what were the first signs of labour that she had?
If the labour was induced, why was it induced?
_____________________________________________________________________
Maternal wellbeing during labour
When was her latest vital signs checked?
At the last check:
BP ____/____mmHg
Pulse ______ bpm
Temp_______0C
Urine ketone: _______ (if checked)
Why are these important?
_____________________________________________________________________
Pain relief during labour
Does she need any pain relief?
What pain relief is she receiving if she needs pain relief?
What pain relief methods do you know?
_____________________________________________________________________
Fetal wellbeing during labour
What is the fetal heart rate (baseline)?
Is the fetal heart rate very constant from beat to beat?
Is her baby OK now?
How do you know that her baby is OK?
_____________________________________________________________________
Progress of labour
Were the membranes intact or ruptured?
Did they rupture spontaneously or were they ruptured artificially?
(Why rupture membranes artificially?)
What were the last abdominal examination findings:
Uterine size:
Presentation of the fetus (the part of the fetus that enters the pelvis first):
Engagement of the fetal head (if cephalic):
What proportion of the fetal head can be palpable on the abdomen:__/5 palpable
Uterine contractions:
Frequency _____/10 minutes (how many contractions in 10 minutes)
Strong/moderate/mild
What were the last vaginal examination findings?
Cervix:
Effacement:
Dilatation:
Presenting part of the fetus: ____
Level of the presenting part: S (cm above or below the ischial spines)
Any moulding of the fetal head?
(Do you know what moulding is?)
Is her labour progressing normally?