Intrapartum care Flashcards
If low risk (birth setting)
Advise home or MW led unit
If multip-
lower rate of interventions for mum +
No difference in outcome for baby
If P0,
Home- small increase risk in adverse outcome for baby
Reasons for transfer to obs led unit
Delay in 1st/2nd stage
Non-Pharm analgesia
- Shower/Bath
- Massage
- Subcut sterile water injections for back pain
Pt own use (do not offer but they can use)
TENS
Yoga
Accupuncture
Aromatherapy
Pharm options of analgesia
- Entonox
- Pethedine/diamorphine- Cannot use pool for 2h
- PCA
- Epidural
SROM
- Speculum if unsure if SROM, if confirmed SROM on pads, no need for speculum
- Expectant mx for 24h
- Baths/showers do not inc infection risk
- Sex inc risk of infection
Transfer to LW
- Maternal obs- HR>120, high BP, Febrile, low or high RR
- Mec/bleeding
- SROM >24h
- Fetal
- SGA/IUGR
- Oligo
- RFM
- Non-cephalic lie
First stage observations
- 30min contractions
- hourly pulse
- 4h temp, BP, RR and VE
Delay in 1st stage
- <2cm in 4h
- Offer ARM + VE in 2h
- If <1cm in 2h, then synto
Delay in 2nd stage (no epidural)
P0- 1h decent, 3h pushing.
Review every hour
Obs rv after 2h
P1 < - Birth in 2h from active stage
Review in 30min from pushing
Obs rv after 1h
Delay in 2nd stage w epidural
P0- 2h decent
Birth within 3h of pushing
Review every 1h
Obs rv in 2h
P1 >- 1h decent
Delivery in 2h
Review every 30min
Obs rv in 1h
Active vs physiological 3rd stage
Bleed >500ml-
68/1000 vs 188/1000
Bleed >1L-
13/1000 vs 29/1000
Same outcome for retained placenta
Active 3rd stage
Ocytocin 5u IV, 10u IM
Or
Syntometrine
Oxytocin vs syntometrine (oxytocin+ergo)
Syntometrine is more effective in PPH
More likely to have N+v
Contraindication- severe HTN, PET, cardiac, renal or hepatic disease
Delayed 3rd stage
30min for active
60min for physiological
Risk factors for PPH
Advise pt to be on LW
- Prev PPH
- Accreta
- PET
- Anaemia
- BMI>35
- Grandmultip (P4 <)
- APH
- Multiple preg
- Fibroids
- LLP
SSRI can inc risk of PPH
