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Anamnesis
Physical examinations
generally
Obstetrics examinations
Supported investigations
Anamnesis
Grande-multi pregnancy
• All of labor
• Active phase
• All of medical facilities
• All of medical staff
Latent Phase
• CD less than 4 cm
• Record separately (mother care card/KMS)
• FHB: @ ½ hour
• UC: @ ½ hour
• Mother pulse: @ ½ hour
• CD: @ 4 hours
• BP and temp: @ 4 hours
Active Phase
• Use WHO partograph
• A. Mother general information:
– Name, age, gravida (Para? Abortus?), medical record
number, admitted sate, time of ROM
• B. Fetal condition:
– FHB, AF, moulage
• C. Progress of labor:
– CD, descent, alert/action line
– * Time (@hour)
– Time of active phase initiation
– Time of examination
• E. Uterine contraction:
– Frequency and duration (in 10 minutes)
• F. Drugs
– Oxytovin, etc
• G. Mother condition:
– Pulse, BP, temperature
– Urine
• H. Caring, monitoring and clinical management
– Write down in the blank space
Fetal Condition
• FHB
• Record @ 30 minutes, small cubicle=30 minutes
• Number at left of the graphic = FHB
• Fill with dot symbol and connect
• Alert at 120-160x/minutes of FHB
• Colour and AF condition
• Moulage (sagital suture):
– 0 : separately
– 1 : close each other
– 2 : overlap, and can separate manually
– 3 : overlap, can not separate manually
Progress of Labor
• Vertical : 10 cubicle
• 1 cubicle = 1 cm, and
30 minutes
• Cubicle = dilatation
and head descent
• @ 4 hours, mark with
X symbol at the
appropriate graph
• Descent of fetal
presentation:
• Record the lowest part
@ 4 hours.
• Mark with “O” symbol
, exp: if 4/5 write down
at 4 (vertical).
Alert and Action Line
Alert line:
• Started at 4 cm-
complete CD, if the
progress 1 cm/hour
• Record of active phase,
started at alert line
• If the progress
appropriate at right of
alert line carefully
• If the progress cut off
action line need
further management
Uterine Contraction
• Filled in the cubicle
below time column
• Contraction @10
minutes
• 1 cubicle = 1
contraction
• If the contraction
frequency 3 times in
10 menit 3 cubicle
2nd stage of labor
• UC become adequate
• Complete CD
• Powerfull pressure by lowest part of the fetal to
pelvic floor clinically the mother will have
sensation to bear down
• Pressure to the rectum sensation to defecation
• Perineal bulge and opened anal spinchter
• Primigravida ~ 2 hours, multigravida ~ 1 hour
3rd stage of labor