NOTA LABOUR ROOM

Di hospital saya, biasanya pesakit yang ingin bersalin, akan datang ke PAC. 

Bergantung pada bukaan os nya, kita akan decide samadia akan naik ke wad antenatal ataupun terus dimasukkan kedalam labour room. Ibu yang os nya 4 cm dan keatas akan terus ke labour room manakala yang kecil daripada itu akan menunggu di wad sahaja. 

Ini contoh situasi yang saya reka: 

Patient came with active phase of labour, di PAC (patient assessment centre), selepas selesai clerking…

 1. IMPRESSION - Active Phase of Labour ( atau Latent Phase of Labour)

 - Os 4cm  - Cx (cervix) 1 cm

2. INVESTIGATIONS - Full Blood Count, GSH (Group Save & Hold)

3. PLAN - Admit Labour Room For ARM (Artificial Rupture of Membrane) and Delivery.

Time : 11pm 

Kita buat labour room entry.

                                                 < Labour Room Entry >

29 year old Malay Lady, G2P1 at 39w POA  (verified at 11w POG)

 1. Problem : Active Phase of Labour 

2. Other issue : GDM, HPT 

3. Currently, 

comfortable under room air, 

regular pain 3 in 10 for 20 seconds,

 no SOB, no chest pain

 4. On examination – alert conscious, not pale, good hydration 

BP/PR/Temp 

5. Vaginal Examination  : 

VV NAD, 

Os,

 Cx,

 Station, 

Membrane Intact etc

 6. Bladder catheterized 100cc Clear Urine

 7. ARM (artificial rupture of membrane) done at 11 pm - Clear Liqour

 Plan 

• To Plot Partogram (Os 4cm, Station -2, action line, alert line, Blood Ix, Last meal, Ht,Wt, BMI)

 • CTG post ARM - If reactive, to give IM Nubain 10mg stat (analgesic) 

• IV Hydration 

• Confirm GSH (trace blood group dan rhesus setelah blood tadi diproses blood bank)

• NRC (Next Review Contraction) in 2 Hour at 1am, aim contraction 4 in 10 min (>45s), if suboptimised to give IV pitocin augmentation 3cc/ H (primid max 96cc/H, others 48cc/H, grandmultip and 1 Previaous Scar max 24cc/H) 

• NRVE (Next Review Vaginal Examination) in 4 Hour at 3 am 

• CTG monitoring with intermittent tracing.

Others 

• Patient GDM - CBS 2 Hourly, to start insulin sliding scale if CBS >7

 • PROM - If patient not delivered by 7 am (leaking pada 7 pm : 12 jam leaking ), to give IV ampicillin 1 g stat then 500mg QID 

• GBS positive  - Give IV Ampicillin 2g stat then 1g 4 Hourly

 • PROM - Watchout signs and symptoms of chorioamnionitis

 • 1 previous scar - Watch out signs and symptoms of scar dehisences (fetal distress, vaginal bleeding, severe abdominal pain)

 • Preeclampsia -Watch out sign and symptom Impending Eclampsia (headache, nausea, epigastric pain, visual disturbance etc)

Kita pun tulislah PARTOGRAM. Kemudian kita update di whiteboard.

Labor Room 1 

33 yo G2P1 at 39w POA, 

Aanaemia in pregnancy,

 os 4 cm, ARM Clear Liqour, NRC at 1 am, NRVE at 3 am

* Kita perlu update whiteboard sebab tak semestinya kita yang ada masa nak review patient tersebut pukul 1 am dan 3 am kelak, masa tu mungkin kita sedang suture orang lain, conduct atau clerk pesakit lain, so mana-mana HO atau MO yang free ketika itu akan review patient berdasarkan time yang tertera di whiteboard.

Kemudian 2 hour later at 1 am kita akan time contraction dia, how frequent contraction dalam masa 10 minit. Kita aim 4 in 10 for 45 seconds. 

Kalau contraction masih 3 in 10 minutes, kita start IV pitocin augmentation 

(Kita tulis dalam plan, Misi tolong start IV infusion) 

Setiap setengah jam, Misi akan naikkan sampai tahap maxima yang kita dah tulis dalam plan. Mereka akan mulakan dengan 3cc/Hour dose using drop mat (mereka akan masukkan 1 ampule pitocin yang mengandungi 10 unit pitocin dalam 1 pint normal saline), then titrate accordingly.

 • 3cc/ Hour • 6cc/Hour • 12cc/Hour • 24cc/Hour • 48cc/Hour • 98cc/Hour

 4 jam kemudian (at 3 am) kita akan tulis VE REVIEW.

<VE Review>

Check VE, banyak mana dah bukaan Os. Kemudian plot partogram bacaan os yang terbaru, juga decend of the head. 

Kalau os baru 6 cm, NRVE in 4 Hour later 

Kalau 7 Cm, NRVE in 3 Hour 

Kalau 8 Cm, NRVE in 2 Hour

*4, 3 or 2 Hour later, kita pun buat entry baru. Update new VE finding.