Managing Complications in Pregnancy and Childbirth: - IAWG

S-88 Labour with an overdistended uterusMANAGEMENTSINGLE LARGE FETUS• Manage as for normal labour (page C-57).• Anticipate and prepare for prolonged and obstructed labour (pageS-57), shoulder dystocia (page S-83) and postpartum haemorrhage(page S-25).EXCESS AMNIOTIC FLUID• Allow labour to progress and monitor progress using a partograph(page C-65).• If the woman is uncomfortable because of uterine distension,aspirate excess amniotic fluid:- Palpate for location of fetus;- Prepare the skin with an antiseptic (page C-22);- Under aseptic conditions, insert a 20-gauge spinal needlethrough the abdominal and uterine walls and withdraw thestylet;- Aspirate the fluid using a large syringe. Alternatively, attachan infusion set to the needle and allow the fluid to slowly draininto a container;- When the woman is no longer distressed because ofoverdistension, replace the stylet and remove the needle.• If rupture of membranes is indicated for other reasons, rupture themembranes with an amniotic hook or a Kocher clamp (page P-17).• Check for cord prolapse when membranes rupture. If the cordprolapses and delivery is not imminent, deliver by caesareansection (page P-43).