CBL 7_Third Stage Management, Placentas, Newborn Innocent Heart Murmur Flashcards
Recs on VEs and PROM?
Don’t do till active labour or IOL = the increased risk of infection
Risk rises with the number of examinations done.
Baths with PROM?
There is no evidence that bathing or showering increases the risk of infection. (8) But at the same time, AOM patient handout: Recommends NO baths until active labour!
Does PROM alone as a risk factor merit CEFM?
Fetal monitoring and PROM: No research literature was found to suggest that PROM or prolonged ROM in the absence of any evidence of fetal compromise is an indication for continuous electronic fetal monitoring”
What is considered a normal Apgar score?
7-10
What APGAR needed for transfer of care to peds?
Lower than 7 at 10 mins
Supporting PMTSL? (9)
- supporting psychosocial, emotional, and spiritual needs, including cultural and traditional practices of the woman/person’s choice (see also Cultural Safety and Cultural Humility and Beliefs and Practices)
- presence of support person(s) of the woman/person’s choice to promote feelings of comfort and safety (12)
- comfortable and warm environment conducive to feelings and sensations of calm, relaxation, mindfulness, and safety (see also Birth Options and Practices that Promote Healthy Birthing and Planned Place of Birth)
- encouraging an upright position to facilitate birth of the placenta, with or without bearing down with contractions
- no fundal massage prior to expulsion of the placenta
- watching for signs of excessive blood loss
- observing for direct and indirect signs of placental separation, including signs observed by the woman/person
- occasionally lifting or easing the cord to bring out the placenta once separation has occurred
- facilitating immediate skin-to-skin care and early breast/chest feeding (see Lactation and Newborn Feeding Support [Postpartum], Safer Infant Sleep, and Golden Hour for Healthy Late Preterm and Term Babies)
How much oxy for AMTSL IV?
3 IU now
Is CCT necessary for AMTSL?
Not a fundamental component but may aid quicker delivery of the placenta with skilled provider
Does not significantly reduce occurrence of PPH
When should CCT be done if done at all?
After admin of oxy
How does delayed cord clamping support newborn transition? (6)
- Increases RBCs and Hgb
- Improves iron stores
- Increase blood volume
- Improves transitional circulation
- Decreases need for transfusion
- Does not increase risks PPH
Mechanics/Impact of cutting cord too early? (4)
Early cord clamping prior to onset of lung aeration:
- restricts flow to the ventricles.
- failure to establish ventilation
- pulmonary vascular resistance (PVR) remains high and compromises pulmonary blood flow (increased right to left DA shunt) and venous return to the left ventricle.
- Decreased filling of the left ventricle (preload) and increased afterload (due to removal of low-resistance placenta) compromise cardiac output. DA, ductus arteriosus; LA, left atrium
How long should you delay cord clamping?
1) Most guidelines recommend 60s; controversy about >60sec for possible jaundice, but
2) timing of CC and association with hyperbilirubinemia is not evidence-based
3) new research is emerging for benefits for >120s for preterm babes with ventilation at 30sec that may change future practice for term babes
Explain jaundice and DCC?
Benefits of DCC = reduced risk of anemia
Risk of jaundice needing phototherapy if >60 s (but need more research) - this appears to no longer be evidence based
ONTARIO data has shown NO increased risk of neonatal jaundice in midwifery clients who have had DCC
How long is reccomended time for DCC the new research for preterm infants?
120 seconds from 60 seconds
Technique for cord gas collection?
There are two possible approaches to sampling
1. Draw samples as soon as possible after birth.
* The care provider double clamps the cord and takes the two samples using heparinized syringes.
* Draw the arterial sample first, as these are the smaller vessels and are easier to visually identify when compared to the plump vein vessel. If only one sample can be obtained, take the blood sample from the umbilical artery.
* Avoid drawing air bubbles and/or carefully expel any air from the syringe
* Cap the heparinized syringes and place on ice to stop the glycolysis.
* Samples are stable at room temperature for 60 minutes (Manor, et al., 1998). If not analyzed within 60 minutes, the sample should be stored at 4−8°C and the time of analysis documented.
2. Set aside a double-clamped segment of the cord for blood to be drawn later after the baby’s condition is assessed.
* The umbilical cord can be doubly clamped and cut to isolate a 20–30 cm segment and set aside for later sampling and analysis, collecting samples as described above.
* Lynn & Beeby (2007) found that when a segment of cord was obtained and set aside for sampling, there was a continuous fall in both pH and BE/BD by 30 minutes after birth and ongoing to further sampling at 60 and 90 minutes post birth. They concluded that sampling should be done as soon as possible following birth to best reflect the neonatal acid-base status at the time of birth.
* A sample taken from an unclamped cord is unreliable for pH, base deficit or lactate by 2 minutes (Armstrong & Stenson, 2006).
Based on current evidence and pending further research, it would appear prudent to obtain the sample as soon as possible after birth. If delays in sampling occur, this should be noted on the medical record for interpretation and quality assurance review’
