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One > Intrapartum Care > Flashcards

Intrapartum Care Flashcards

1
Q

First stage of labour guidelines change from latent to active? (2)

A

4cm dilation
Regular contractions

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2
Q

What happens in latent stage

A

Opening and softening of cervix

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3
Q

Maternal changes in preparation for birth (4)

A

Increase: oestrogen, prostaglandins, cortisol, oxytocin, prolactin, oxytocin receptors
Cervical softening (may lose mucus plug)

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4
Q

Initial assessment in labour (7)

A

Check Notes
Care plan
Risk factors
Length/strength/ frequency contraction
Pain and discuss pain relief
Pulse/BP/temp/ resp
Urinalysis
Any vaginal loss
Group B strep status

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5
Q

Observations at initial assessment baby

A

Baby movements
Palpate position - presentation/position/engagement
Auscultation - 1 min after contraction - check maternal HR to confirm

If uncertainty of position offer VE
If established offer VE

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6
Q

Advice for management early labour

A

Eat and drink as feels
Rest
Breathing
Gentle movement

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7
Q

Length of first stage - nulliparous

A

8-18hr

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8
Q

Length of first stage multiparous

A

6-12 hr

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9
Q

NICE guidelines progression first stage

A

0.5cm per hour

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10
Q

Aiding progression in first stage

A

Descent into pelvic inlet so coxal counternutation - knees out
Emotional support
Calm
Natural oxytocin
Empty bladder
Consider pain relief

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11
Q

Benefits of VE (3)

A

Reassure
Motivate
Orientate

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12
Q

Risks of VE (7)

A

Infection (both)
Subjective/inconsistent
Pain/intrusive
Misleading
Risk membrane rupture
Can disempower
Once started should continue

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13
Q

How often VE in first stage once started?

A

4 hourly

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14
Q

When measure maternal pulse first stage ?

A

Hourly

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15
Q

When IA first stage?

A

Every 15 min for 1 min after contraction

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16
Q

When IA second stage?

A

Every 5 min for 1 min

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17
Q

How often offer VE second stage?

A

Hourly

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18
Q

How often measure frequency of contractions

A

Every 30 min

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19
Q

How often maternal BP.

A

4 hourly

20
Q

How often temperature

A

4 hourly

21
Q

Alternatives to VE

A

US
Purple line
Behaviour cues
Freq/strength contraction

22
Q

Second stage labour - passive

A

Full dilation b4 pushing (approx 2 hr)

23
Q

Second stage labour - active

A

Baby visible
Invol/active pushing with full dilation

24
Q

Perineal trauma prevention

A

Warm wet compress
Guard head a perineum
Spontaneous pushing

25
Q

What happens in 3rd stage

A

Expulsion of placenta and membranes

26
Q

What is active 3rd stage (3)

A

Uteronic drugs
Clamp and cord cut
Controlled cord traction if separates

27
Q

When considered prolonged active management

A

30+ mins

28
Q

When considered prolonged physiological

A

60 min +

29
Q

What is physiological 3rd stage

A

No drugs
Cord not clamped/cut until pulsing stopped or placenta delivered
Spontaneous delivery or by maternal effort

30
Q

Maternal obs in 3rd stage

A

Wellbeing
Vaginal loss

31
Q

Neonate initial obs after birth

A

APGAR
Avoid separation first hour
Encourage BF in first hour
Head /weight ideally first hour

32
Q

Maternal obs post birth

A

Temp/pulse/RR
Uterine condition/Lochia
Placenta/membranes intact .
Emotional/psychological assessment
Voiding bladder (catheter after 6 hr)
Straight leg raise 4 hr after epidural

33
Q

Non pharmacological pain relief (6)

A

Heat
Water
Sterile water injection
Massage
Breathing
TENS

34
Q

Birthing pool risks

A

Infection
Umbilical snap

35
Q

Birthing pool temp

A

Not above 37.5

36
Q

Extra obs in water

A

Monitor maternal and water temp hourly

37
Q

How often bladder care reviewed

A

4 hr

38
Q

What is included in bladder care.

A

Frequency of passing and sensation
Fluid balance monitoring
Catheter

39
Q

Entonox - where and risk?

A

All settings
Nausea/ lightheaded

40
Q

Opioids - where and risks

A

All settings
Limited pain relief
Difficult to breastfeed
No birthpool within 2hr

41
Q

Epidural risk

A

Respiratory depression (if too high)
Decrease BP
Headache if spinal fluid leak

42
Q

When should be pain free after epidural administered

A

30 min

43
Q

Additional care with epidural

A

Sensory block hourly
Straight leg lift
CTG

44
Q

Where locate epidural

A

T8-T10

45
Q

Where locate epidural

A

T8-T10

One (21 decks)

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