Complex intrapartum care Flashcards
Induction of labour, excessive uterine activity, occipitoposterior position, assisted birth, epidural analgesia
List maternal and fetal indications for IOL
MATERNAL
PPROM
Prlonged pregnancy
DFM
FGR
Medical conditions
Maternal request
FETAL
Severe congenital abnormalities
non reassuring fetal surveillance
Describe the Bishops score
Effacement
Dilation
Position
Consistency
Station
Describe the different inducing agents - indication, action, contraindication and potential complication
make table for this
Discuss the risks and benefits associated with IOL for mother and baby
Benefits
- positive birth outcome with complexities
- timing
Risks
- increased pain
-restricted mobidlity
- intervention cascade
Define hypertonus, tachysystole, and uterine hyperstimulation
Describe the midwives role in managing uterine hyperstimulation
Stop synt or turn down
Change positions
Escalate to AMUM
Continue monitoring
tocolytic/tocolysis
Describe the complications of hyperstimulation for the foetus and the woman
Define OP positioning and explain its physiology
Describe the common characteristics which are displayed in an OP labour
- Prolonged
- more painful
- ineffective uterine contraction due to uneven pressure of sinciput
- bachache
- early SROM
- early urge to push- obstructed labour
Describe the midwifery management of OP position and potential maternal positions which can optimise a vaginal birth
- thigh flexion amy increase internal pelvic diameters
- thighs connected to pelvis through ligaments
- reducing back pain eg water injection, massage, tens
- focused breathing
identify the difference in fatal attitude with an OP position
describe the 2 potential mechanisms of an OP position which result in a vaginal birth
Long anterior rotation
- sinciput is presenting part as head comes into contact with pelvic flooe
- 11.5cm occipitofrontal diameter
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entering the pelvis head flexes so PP changes from sinciput to occiupt
occiput comes into contact with pelvic floor
rotates 3/8 to OA positioning
delivered OA
Short posterior rotation
no further flexion as
11.5 diameter remains
sinciput hits pelvic floor
rotates 1/8 and is born OP
Describe the indications and methods for assisted birth
Ventouse - suction to the fetal head to assist in delivery
- to correct a malpositioned fetal head
- same as forceps
requires consent, term birth, empty bladder, membranes ruptured
stopped after 3 pulls with contractions or after 20 minutes
Forceps
- need for a short second stage
- lack of advance of fetal head
- fetal compromise
- placental abruption
- cord prolapse
- infection
requires consent, anaesthesia, full dilation, membranes ruptured, empty bladder, episiotomy
Caesar
- placenta preaevia
- placental abruption
- cord prolapse
- persistent transverse lie
- chorio
- eclampsia and help
- morbid adherence
Describe the midwifery role during an assisted birth
1 midwife
- support to woman
- scribe
- monitoring FGR
1 midwife
- receive baby
- set up rhesus card
- set up birth trolley
- end of feet off bed, into stirrups
- notify paeds
- set up epic scissors
Documentation
- bell was called
- obs enter room
- ‘venture applied’ or ‘first and second blade of forceps applied’
- timing of each pull
- remind if its too many pulls
3rd stage
- PPH prophylaxis - active 3rd stage of syntometrine with absence of BP contraindications
- trauma to fetal head
- peri trauma
- shoulder dystocia
- turn epidural off after suturing
- 2 midwives sight epidural catheter tip
Explain the anatomy and physiology behind epidural analgesia and the mechanism or pathway for transfer of medication
