The hour following delivery of placenta  is termed Fourth stage of labour
Monitoring of the patient’s Blood pressure and pulse rate during this stage is important
The episiotomy site should be checked for bleeding or development of any hematoma
Check whether the bladder is distended, if so encourage patient to pass urine
If the patient is stable after one hour and has passed urine, she can be transferred to the post natal ward

Oxytocin is a polypeptide hormone synthesised by the supraoptic and paraventricular nuclei of hypothalamus
It is secreted by the posterior pituitary into the blood stream

Actions of oxytocin

Main action is on uterine myometrium

It promotes uterine muscle contraction
The action is greater on pregnant uterus as it has increased number of oxytocin receptors

Contraction of myoepithelial cells in breast cause expression of breast milk
Smooth muscle relaxation and vasodilation
ADH (Anti Diuretic Hormone) like effect in large doses, causes water intoxication

Mechanism of action on uterine myometrium:

It acts by releasing cAMP
This in turn results in the release of …

Partogram is a graphical representation of the progress of labour depicting cervical dilatation and station of head plotted against time
The concept of partogram was first introduced by Friedman

Data recorded in a partogram are:

Patient data – Name, Age, Parity, Hospital identification number, Date of admission, Time of admission
Dilatation of cervix
Station of fetal head
Fetal heart rate
Number of uterine contractions in 10 minutes
Moulding (+ / ++ )
Liquor amni

Intact membranes – I
Clear liquor – C
Meconium staining – M

Oxytocin units, drops/min
Drugs
Oral and IV fluids
Blood pressure, pulse, temperature
Urine for acetone

How to use a partogram in active management …

Artificial rupture of membranes (ARM) is the process in which the foetal amniotic sac is ruptured to facilitate labour
It is usually done once the active stage of labour begins
The membranes are ruptured using Kocher’s forceps
The liquor should be examined for meconium staining

Meconium staining of liquor indicates foetal distress

Once ARM is done, foetal heart rate should be checked

Transient changes may occur due to pressure on the cord by the foetal parts that change position once the liquor is drained
Prolonged changes in foetal heart rate indicates foetal distress
When associated with bleeding, it …

ARM stands for

Artificial Rupture of Membranes (amniotomy)

Part of pelvis above the linea terminalis
Obstetric function – support of gravid uterus during pregnancy

Modified Bishop’s Score is a criterion that can be used as a prognostic index for the success of induction. It takes into consideration factors such as condition of cervix and station of presenting part. It is calculated as follows:

Character
0
1
2

Position of cervix
Posterior
Axial
Anterior

Dilatation of cervix
0cm
1cm
>2cm

Length of cervix
2cm
1cm
<0.5cm

Consistency of cervix
Firm
Soft
Soft and stretchable

Station of head
-2
-1
0

Total score is calculated by adding the individual scores. A value more than 6 indicated that the cervix is favourable for induction (high probability for vaginal delivery). Values less than 3 indicates that caesarian section may be required.