As soon as possible after admittance, the remainder of a general examination is completed. Whether a pregnancy is normal can best be determined when all examinations, including record and laboratory review, are completed. A rational plan for monitoring labor can then be established based on the needs of the fetus and the mother. Because labor lengths vary markedly among individuals, precise statements regarding anticipated labor duration are unwise.
In general, pain relief should depend on the needs and desires of the woman. The American College of Obstetricians and Gynecologists (2017) has speciied optimal goals for anesthesia care in obstetrics. his is discussed in detail in Chapter 25. In some units, women can choose to spend part of irststage labor in a large water tub. isks and benefits are described in Chapter 27 (p. 524).
This is discussed in detail in Chapter 24. Briely, the American Academy of Pediatrics and American College of Obstetricians and Gynecologists (2017) recommend that during irst-stage labor, in the absence of any abnormalities, the fetal heart rate should be checked immediately after a contraction at least every 30 minutes and then every 15 minutes during the second stage. If continuous electronic monitoring is used, the tracing is evaluated at least every 30 minutes during the irst stage and at least every 15 minutes during second-stage labor. For women with pregnancies at risk, fetal heart auscultation is performed at least every 15 minutes during irst-stage labor and every 5 minutes during the second stage. Continuous electronic monitoring may be used with evaluation of the tracing every 15 minutes during the first stage of labor, and every 5 minutes during the second stage.
Temperature, pulse, and blood pressure are evaluated at least every 4 hours. If membranes have been ruptured for many hours before labor onset or if there is a borderline temperature elevation, the temperature is checked hourly.
Although uterine contractions are usually assessed with electronic monitoring, they can be quantitatively and qualitatively evaluated manually (Chap. 24, p. 478). With the palm of the hand resting lightly on the uterus, the time of contraction onset is determined. Its intensity is gauged from the degree of irm ness the uterus achieves. At the acme of efective contractions, the finger or thumb cannot readily indent the uterus during a "irm" contraction. he time at which the contraction disap pears is noted next. his sequence is repeated to evaluate the frequency, duration, and intensity of contractions.
During the first stage of labor, the need for subsequent vaginal examinations to monitor cervical change and present ing part position will vary considerably. When the membranes rupture, an examination to exclude cord prolapse is performed expeditiously if the fetal head was not deinitely engaged at the previous examination. he fetal heart rate is also checked immediately and during the next uterine contraction to help detect occult umbilical cord compression. At Parkland Hos pital, periodic pelvic examinations are typically performed at 2-to 3-hour intervals to evaluate labor progress. Evidence implicating the number of vaginal examinations in infection related morbidity is conlicting (Cahill, 2012; Soper, 1989).