👏 رائع! سأجهز لك محطة OSCE متكاملة عن الـ Normal Labour و Management of Normal Labour كما لو كنتَ في الامتحان، بأسلوب واضح وسهل للمراجعة: ⸻ 📝 OSCE Station — Normal Labour & Its Management ⸻ 💬 Scenario You are the junior doctor on the labour ward. A 26-year-old primigravida woman is in spontaneous labour at 39 weeks gestation. The examiner asks you to: ✅ Take a focused history. ✅ Explain how you would manage normal labour. ⸻ 🔹 Focused history (أسئلة تسألها للمريضة) ✅ Labour onset: • When did the contractions start? • How often do they come? • How strong are they? ✅ Fluid loss: • Has the water broken? What colour was it? ✅ Bleeding: • Any vaginal bleeding? ✅ Baby movements: • Is the baby moving normally? ✅ Obstetric history: • First baby? • Any medical or pregnancy complications? ✅ Other: • Birth plan preferences (pain relief, position, companion)? ⸻ 🔹 Management of normal labour (نقاط تقولها للممتحن) ⸻ 🌟 General supportive care: • Ensure privacy and emotional support. • Encourage fluids and mobility. • Encourage bladder emptying every 2–4 hours. • Continuous presence of birth companion if desired. ⸻ 🌟 Monitoring: ✅ First stage • Maternal vitals (BP, pulse, temp): at least every 4 hours. • Fetal heart: every 15–30 minutes. • Contractions: every 30 minutes (frequency, duration). • Vaginal exam: every 4 hours or if progress is in doubt → check dilatation, effacement, station, position. ✅ Second stage • Fetal heart: every 5 minutes or after every contraction. • Encourage effective pushing when fully dilated. • Assist delivery gently → control delivery of head, check for cord, deliver shoulders. ✅ Third stage • Active management: • 10 IU oxytocin IM after birth of baby. • Controlled cord traction. • Uterine massage after placenta delivery. • Check placenta and membranes are complete. • Monitor bleeding, uterine tone. ⸻ 🌟 Postpartum care: • Check maternal vitals. • Examine perineum and repair if needed. • Promote skin-to-skin contact, early breastfeeding. ⸻ 🔹 Common examiner questions (OSCE traps) ❓ When would you do an episiotomy? ➡ Only if indicated (e.g. fetal distress, instrumental delivery, rigid perineum). ❓ When would you escalate? ➡ If there is slow progress (failure of dilatation or descent), fetal distress, excessive bleeding. ❓ What is active management of 3rd stage? ➡ Oxytocin IM + controlled cord traction + uterine massage. ⸻
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