birth and neonates Flashcards
what is postural hypotension and when dose it occur
After 20 weeks gestation, hypotension may occur in the supine position because the uterus can impede venous return through the inferior vena cava.
to prevent postural hypotension…
To prevent supine hypotension always tilt the patient 30 degrees (or more) to their left by placing a rolled towel or pillow under their right hip. If this cannot be achieved, manually displace the uterus to the left if feasible.
define preterm labour
his is the onset of labour prior to 37 weeks of pregnancy.
steps in normal birth
- Support the baby’s head and shoulders as they appear, without applying traction, and document the time of birth.
- Place the baby skin to skin with the mother and initiate drying.
- Ensure a warm environment and continue to keep the baby skin to skin with the mother provided neither requires immediate resuscitation. Place a hat on the baby if one is available and cover mother and baby with a warm blanket. Continually observe the baby’s activity and breathing.
- Clamp and cut the cord 5 cm from the baby 2-3 minutes after birth, unless this is required earlier to facilitate resuscitation.
- Administer 10 units of oxytocin IM into the mother’s lateral thigh. If multiple babies are present delay administration until after birth of the last baby. Routine administration of oxytocin is controversial, but appears to reduce the incidence of postpartum haemorrhage.
- Allow the placenta to deliver spontaneously, without applying traction, and document the time of placental birth. This usually occurs within 60 minutes. Place the placenta in a plastic bag.
- Following delivery of the placenta, feel for the uterus at approximately umbilical level and rub it using a circular motion until it feels firm.
steps in Sholder dystocia
utilise the mnemonic HELPERR
1. Call for immediate help from an LMC, doctor or ICP.
Evaluate the need for episiotomy. This is not within delegated scopes of practice and personnel must seek urgent clinical advice if this is thought to be required.
2. Legs up. Ask the patient to grab her knees, pull them to her chest and push as hard as she can with the next two contractions.
3.Pressure. With the legs still up (as above), place the heel of your hand directly above the patient’s pubic bone and push slowly but firmly straight back toward the patient’s lower back. This is designed to reposition the baby’s shoulder, which is usually what is preventing delivery.
4. Enter manoeuvres. This refers to internal rotation manoeuvres that are not within delegated scopes of practice and personnel must seek urgent clinical advice if these are thought to be required.
5.Remove the posterior arm. Place the fingers of your hand into the posterior aspect of the vagina (adjacent to the anus), feel for the posterior arm and manipulate it until the arm is able to be pulled through the vagina.
6.Roll. Ask the patient to move on to her hands and knees and push as hard as she can with the next two contractions.
7.If the above actions fail, seek urgent clinical advice and transport urgently. If possible position the mother tilted to the left with pillows/blankets under her pelvis, so that her head is below her pelvis.
The diagnostic criteria for pre-eclampsia are:
A systolic blood pressure of greater than 140 mmHg, and/or a diastolic blood pressure of greater than 90 mmHg, and
More than 20 weeks gestation, and
Proteinuria (protein in the urine).
resusneontal Jesus steps prior to resuscitation,and when to begin resus
1.Place the baby skin to skin with the mother.
2.Provide external stimulation while drying the baby.
3.Maximise the external temperature and place a hat on the baby if possible.
4.Continue to provide stimulation via rubbing/drying if breathing or activity is abnormal.
5.Establish continual heart rate and SpO2 monitoring if breathing or activity remain abnormal.
6.Move to the appropriate section below at approximately one minute.
If breathing is adequate and the heart rate is greater than or equal to 100/minute
Do not provide ventilation.
Clamp and cut the cord at 2-3 minutes.
Move to the appropriate section if there is a sustained change in heart rate.
Administer oxygen only if required to maintain a normal SpO2.
If breathing is inadequate or the heart rate is 60-100/minute
Clamp and cut the cord immediately if this is required to enable ventilation.
Ventilate at a rate of 60/minute, using PEEP set to 5 cmH2O, initially without added oxygen.
Continue to ventilate and add oxygen at 10 litres/minute if the heart rate fails to rise above 100/minute after two minutes.
Move to the appropriate section if there is a sustained change in heart rate.
If the heart rate is less than 60/minute
Clamp and cut the cord immediately if this is required to enable CPR.
Start CPR at a ratio of 3:1.
Focus on ventilation with PEEP set to 5 cmH2O and added oxygen at 10 litres/minute.
Place an LMA.
Consider placing an ETT.
Gain IV access.
in neonates, Administer glucose if the blood glucose concentration is less than
2.5 mmol/litre:
Spread glucose gel on the gums, tongue and inside of the cheeks and repeat this every 5-10 minutes as required.
Administer 10 ml of 10% glucose IV if the blood glucose concentration does not rise 20 minutes after oral glucose.
Repeat the glucose measurement every ten minutes and administer further glucose as required until the glucose concentration is greater than or equal to 2.5 mmol/litre.
what dose Apgar measure
Appearance (skin color)
Pulse (heart rate)
Grimace response (reflexes)
Activity (muscle tone)
Respiration (breathing rate and effort)
