Intranatal Care

Intranatal Care Intro - Setting the Stage

• Intranatal Care (INC): Care from true labour onset to placental expulsion.
• Labour (Parturition): Expulsion of foetus & placenta.
  • Eutocia: Normal. Dystocia: Abnormal.
• Labour Onset Signs:
  • Progressive, painful uterine contractions.
  • Show (blood-mucus).
  • Cervical dilatation & effacement.
  • Bag of forewaters.
• True Labour: Regular, progressive contractions; cervical changes; pain radiates; not relieved by sedatives.
• False Labour: Irregular; no cervical change; pain localized; relieved by sedatives.

⭐ Progressive cervical effacement & dilatation signify true labour.

Labour's Journey - Stages & Events

• Stage 1 (Cervical Dilation): True pains to full cervical dilation (10 cm). Effacement & dilation.
  • Latent: 0-4 cm (P: 6-8h, M: 4-6h).
  • Active: 4-10 cm (P: 1.2 cm/hr, M: 1.5 cm/hr).
• Stage 2 (Fetal Expulsion): Full dilation to fetal expulsion. Cardinal movements.
  • Duration: P: 1-2h, M: 30m-1h (longer with epidural).

  ⭐ Crowning: Widest part of fetal head visible at introitus, no recession.

• Stage 3 (Placental Expulsion): Fetal expulsion to placenta expulsion. Separation & expulsion.
  • Duration: 5-15 min (max 30 min).
  • Signs: 📌 CUG (Cord lengthens, Uterus globular, Gush of blood).
• Stage 4 (Observation): 1-4h post-placenta.
  • Monitor: Uterine tone, vitals, PPH.

Partograph Power - Monitoring Labour

• Graphical tool for monitoring labour: FHR, cervical dilatation (X), descent (O), contractions, maternal vitals.
• WHO Modified Partograph: Plotting begins at 4 cm cervical dilatation (active phase).
• Alert Line: Crossed if cervical dilatation is < 1 cm/hr. Signals need for careful reassessment, possible conservative measures (e.g., hydration, amniotomy).
• Action Line: Typically 4 hours to the right of Alert Line. Crossing indicates need for decisive action (e.g., oxytocin augmentation, Caesarean section).

⭐ The partograph is a key tool to prevent prolonged labour, a major cause of maternal/neonatal morbidity.

Safe Arrivals - Newborn & Maternal Care

• Maternal Care (AMTSL - Active Management of Third Stage of Labour): Prevents PPH.
  • Oxytocin 10 IU IM (within 1 min of birth).
  • Controlled Cord Traction (CCT).
  • Uterine massage post-placental delivery.
• Newborn Care:
  • APGAR Score: At 1 & 5 min. Assesses 5 vital signs. Score <7 distress, <4 severe.
  • Neonatal Resuscitation (NRP): See flowchart for initial steps. Golden minute for ventilation.

⭐ AMTSL reduces Postpartum Hemorrhage (PPH) incidence by ~60%.

High‑Yield Points - ⚡ Biggest Takeaways

• AMTSL (oxytocin, CCT, uterine massage) is key to prevent Postpartum Hemorrhage (PPH).
• Partograph monitors labor: alert line for observation, action line for intervention.
• Essential Newborn Care (ENC): immediate drying/warming, early breastfeeding, Vitamin K, cord care.
• Median episiotomy is preferred, performed at crowning to prevent severe tears.
• Six Cleans (hands, surface, perineum, blade, cord tie/clamp, towel) ensure aseptic delivery.
• Magnesium sulfate is the first-line drug for intrapartum eclampsia management.