intrapartum Flashcards
intrapartum resus full
Start intrapartum resuscitation in the case of fetal distress
Ask the patient to lay on the left lateral side, stop oxytocin, tocolyses, and administer IV fluids fetal distress
Tocolyse with salbutamol or nifedipine if salbutamol not available
Amnio-infusion (for repetitive early or variable decelerations)
Perform at an institution with fetal heart monitoring facilities, i.e. cardiotocography (CTG)
Method
Connect intrauterine pressure catheter, infant feeding tube, or Nelaton catheter via an infusion set to 1 litre of normal saline
Insert catheter transcervically posterior to the fetal occiput into the amniotic cavity
Ensure the catheter is in the amniotic cavity by allowing backflow
Infuse saline at 10-15mL per minute for 1 hour, then 3mL per minute for the rest of labour
If a large volume of liquor is lost, increase the rate again for 30-60 minutes
Do not administer oxygen to a stable mother with fetal distress – oxygen should only be administered to an unstable mother
step one of intrapartum resuscitation
Ask the patient to lay on the left lateral side, stop oxytocin, tocolyses, and administer IV fluids fetal distress
Tocolyse with salbutamol or nifedipine if salbutamol not available
step two of intrapartum resuscitation
- Amnio-infusion (for repetitive early or variable decelerations)
Perform at an institution with fetal heart monitoring facilities, i.e. cardiotocography (CTG)
Method - Connect intrauterine pressure catheter, infant feeding tube, or Nelaton catheter via an infusion set to 1 litre of normal saline
- Insert catheter transcervically posterior to the fetal occiput into the amniotic cavity.
- Ensure the catheter is in the amniotic cavity by allowing backflow.
- Infuse saline at 10-15mL per minute for 1 hour, then 3mL per minute for the rest of labour.
- If a large volume of liquor is lost, increase the rate again for 30-60 minutes.
when do you give oxygen in intrapartum resuscitation
Do not administer oxygen to a stable mother with fetal distress – oxygen should only be administered to an unstable mother
when in an amino-infusion done
during intrapartum resuscitaion when there are repetitive early or variable decelerations)
where can an amnio-infusion be done
at an institution with fetal cardiac monitoring such as a CTG
Amnio-Infusion Method
- Connect intrauterine pressure catheter, infant feeding tube, or Nelaton catheter via an infusion set to 1 litre of normal saline.
- Insert catheter transcervically posterior to the fetal occiput into the amniotic cavity.
- Ensure the catheter is in the amniotic cavity by allowing backflow
Infuse saline at 10-15mL per minute for 1 hour, then 3mL per minute for the rest of labour. - If a large volume of liquor is lost, increase the rate again for 30-60 minutes
WHEN SHOULD THE PATIENT BE REFERRED (FROM A MIDWIFE OBSTETRIC UNIT/COMMUNITY HEALTH CLINIC TO A HOSPITAL) OR THE DOCTOR CALLED (IN HOSPITAL)?
- The fetal and/or maternal condition is non-reassuring
- Rupture of membranes (ROM) > 12 hours AND patient is still in the latent phase
- Meconium-stained liquor (MSL) AND patient is in the latent phase
- Midwife Obstetric Units (MOUs) must refer a patient in the latent phase of labour to hospital if 5cm of cervical dilatation has not been reached after 12 hours
WHEN SHOULD THE VAGINAL EXAMINATION BE REPEATED EARLIER THAN THE 6-HOURLY INTERVAL?
LATENT PHASE
- The frequency, intensity, and/or duration of contractions have changed
- The healthcare worker has a subjective impression that the patient is in the active phase of labour
- Opiate analgesia is needed
- The patient has an urge to bear down
- The fetal and/or maternal condition is non-reassuring
he patient may be discharged home (or to a maternity waiting home) IF:
- The maternal AND fetal condition are reassuring
- There is no increase in contractions, irregular contractions, or contractions have ceased entirely
- No ruptured membranes (ROM)
- No cervical changes since admission, with no further descent of the fetal head
- The patient has been appropriately counseled and understands the warning signs:
Increased pain
Rupture of membranes (ROM)
Vaginal bleeding
Reduced fetal movement
WHEN SHOULD THE VAGINAL EXAMINATION BE REPEATED EARLIER THAN THE 4- OR 2-HOURLY INTERVAL?
ACTIVE PHASE
- The fetal and/or maternal condition is non-reassuring
- The patient has an urge to bear down
WHEN SHOULD THE PATIENT BE REFERRED (FROM A MIDWIFE OBSTETRIC UNIT/COMMUNITY HEALTH CLINIC TO A HOSPITAL) OR THE DOCTOR CALLED (IN HOSPITAL)?
ACTIVE PHASE
- The fetal and/or maternal condition is non-reassuring
- There is meconium-stained liquor AND delivery is NOT imminent
- There is poor progress of labour, defined as: 2-hour refer line is crossed (at MOU/CHC-level), No progress on the next vaginal examination.
- Refer to a hospital with 24/7 Caesarean delivery facilities if the patient is at an MOU, CHC or a district hospital with no 24/7 Caesarean delivery facilities
- Review by a doctor at a hospital with 24/7 Caesarean delivery facilities to exclude poor contractions and cephalo-pelvic disproportion (CPD)
- Signs of cephalo-pelvic disproportion (CPD), i.e. 2+ or 3+ sagittal moulding, or severe generalized caput
Patient with poor contractions
PROLONGED SECOND STAGE OF LABOUR: INTERVENTIONS
- Exclude cephalo-pelvic disproportion (CPD)
- It must be completed during every labour at all facilities considered suitable to provide obstetric and delivery services
- If a nullipara does not have the urge to bear down after 1 hour, consider an oxytocin infusion
- Using an oxytocin infusion for a multipara during the second stage of labour should be on the advice of a doctor only
- Perform assisted vaginal delivery
