GETTING READY
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Prepare the necessary equipment.
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Tell the woman (and her support person) what is going to be done, listen to her and respond attentively to her questions and concerns.
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Provide continual emotional support and reassurance, as feasible.
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Review to ensure that there is a need to correct slow progress of labor.
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Put on personal protective barriers.
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ARTIFICIAL RUPTURE OF MEMBRANES
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Listen to the fetal heart.
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Wash hands thoroughly with soap and water and dry with a clean, dry cloth or air dry.
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Put high-level disinfected or sterile surgical gloves on both hands.
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Clean the vulva with antiseptic solution.
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Use one hand to examine the cervix and note consistency, position, effacement and dilation.
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Use the other hand to insert an amniotic hook or a Kocher clamp into the vagina.
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Guide the hook or clamp along the fingers of the examining hand in the vagina toward the membranes.
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Place two fingers of the examining hand against the membranes and gently rupture the membranes, between rather than during a contraction, with the hook or clamp in the other hand.
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Remove the hook or clamp from the vagina.
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Allow the amniotic fluid to drain away slowly around the fingers of the examining hand.
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Note the color of the fluid (e.g., clear, greenish, bloody).
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Remove the examining hand from the vagina.
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POSTPROCEDURE TASKS
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Before removing gloves, dispose of waste materials in a leakproof container or plastic bag.
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Place all instruments in 0.5% chlorine solution for 10 minutes for decontamination.
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Immerse both gloved hands in 0.5% chlorine solution. Remove gloves by turning them inside out.
If disposing of gloves, place them in a leakproof container or plastic bag.
If reusing surgical gloves, submerge them in 0.5% chlorine solution for 10 minutes for decontamination.
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Wash hands thoroughly with soap and water and dry with a clean, dry cloth or air dry.
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Listen to the fetal heart.
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OXYTOCIN INFUSION
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Continue to monitor progress of labor using the partograph.
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Start an IV infusion of dextrose or normal saline.
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Infuse oxytocin 2.5 units in 500 mL of dextrose or normal saline at 10 drops/ minute:
Increase the infusion rate by 10 drops/minute every 30 minutes until there are three contractions in 10 minutes, each lasting more than 40 seconds.
Maintain the rate until the birth is completed.
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If any contraction lasts longer than 60 seconds or if there are more than four contractions in 10 minutes:
Stop the infusion.
Relax the uterus by giving terbutaline 250 μg IV slowly over 5 minutes, OR
Give salbutimol 10 mg in 1 L IV fluid (normal saline or Ringer’s lactate) at 10 drops/minute.
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If there are not three contractions in 10 minutes, each lasting more than 40 seconds with the infusion at 60 drops/minute:
Increase the oxytocin concentration to 5 units in 500 mL of dextrose or normal saline and adjust the infusion rate to 30 drops/minute.
Increase the infusion rate by 10 drops/minute every 30 minutes until a satisfactory contraction pattern or the maximum rate of 60 drops/minute is reached.
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Consider induction to have failed if labor is still not well established, using the higher concentration of oxytocin, in multigravida and in the woman who has had a previous cesarean section, and arrange for delivery by cesarean section.
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In primigravida, if labor is still not well established using the higher concentration of oxytocin:
Infuse oxytocin 10 units in 500 mL of dextrose or normal saline at 30 drops/minute.
Increase the infusion rate by 10 drops/minute every 30 minutes until good contractions are established.
If good contractions are not established at 60 drops/minute, arrange for delivery by cesarean section.
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