Operational Obstetrics & Gynecology

Labor and Delivery

Initial Evaluation of a Woman in Labor

An initial evaluation is performed to:

• Evaluate the current health status of the mother and baby,

• Identify risk factors which could influence the course or management of labor, and

• Determine the labor status of the mother.

History

Interview the patient as soon as she arrives.

Certain key questions will provide considerable insight into the patient's pregnancy and current status:

• What brought you in to see me?

• Are you contracting? When did they start?

• Are you having any pain?

• Are you leaking any fluid or blood? When did that begin?

• Have there been any problems with your pregnancy?

• Has the baby been moving normally?

• When did you last eat? What did you have?

• Are you allergic to any medication?

• Do you normally take any medication?

• Have you ever been hospitalized for any reason?

Use a form that covers the prenatal history and risk assessment

Vital Signs

Obtain a set of vital signs from the mother, including BP, pulse and temperature.

• Elevated BP suggests the presence of pre-eclampsia.

• Elevated temperature suggests the possible presence of infection.

• While a pregnant pulse of up to 100 BPM or greater may be normal, rapid pulse may also indicate hypovolemia.

Contractions

Check the frequency and duration of any uterine contractions.

In some cases, the patient will have been timing the contractions. Placing your hand on the maternal abdomen, you will be able to feel each contraction as the normally soft uterus becomes firm and rises out of the abdomen. Time the contractions from the beginning of one to the beginning of the next one. Also note the duration of the contractions and their relative intensity (mild, mild-to-moderate, moderate, severe)

Fetal Heart Rate

Record the fetal heart rate.

This can be done with a fetal Doppler device, and electronic fetal monitor, ultrasound visualization of the fetal heart, or a DeLee type stethoscope.

Normal rates are between 120 and 160 BPM at full term. Post term babies may sometimes normally have rates as low as 110 BPM.

Urine for Protein and Glucose

Check the urine for protein and glucose.

• The presence of protein (1+ or greater) can suggest the presence of pre-eclampsia.

• The presence of glucosuria (1+ to 2+ or greater) can suggest the presence of diabetes.

Estimated Fetal Weight

Estimate the fetal weight. An average baby at full term weighs 7 to 7 1/2 pounds.

By feeling the maternal abdomen, an experienced examiner can often predict within a pound the actual birthweight. A woman who has delivered a baby in the past can often do about as well in predicting her current baby's weight if you ask her, "Is this baby bigger or smaller than your last?"

Blood Count

Following admission, the hemoglobin or hematocrit may be useful.

Women with significant anemia are more likely to have problems sustaining adequate uterine perfusion during labor. They also have less tolerance for hemorrhage than those with normal blood counts.

Women with no prenatal care should, in addition, have a blood type, Rh factor, and atypical antibody screen performed.

Other tests may be indicated, based on individual histories.

Home  ·  Introduction  ·  Medical Support of Women in Field Environments  ·  The Prisoner of War Experience  ·  Routine Care  ·  Pap Smears  ·  Human Papilloma Virus  ·  Contraception  ·  Birth Control Pills  ·  Vulvar Disease  ·  Vaginal Discharge  ·  Abnormal Bleeding  ·  Menstrual Problems  ·  Abdominal Pain  ·  Urination Problems  ·  Menopause  ·  Breast Problems  ·  Sexual Assault  ·  Normal Pregnancy  ·  Abnormal Pregnancy  ·  Normal Labor and Delivery  ·  Problems During Labor and Delivery  ·  Care of the Newborn

This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified.

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