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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.

20
Q

How often temperature

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
What happens in 3rd stage
Expulsion of placenta and membranes
26
What is active 3rd stage (3)
Uteronic drugs Clamp and cord cut Controlled cord traction if separates
27
When considered prolonged active management
30+ mins
28
When considered prolonged physiological
60 min +
29
What is physiological 3rd stage
No drugs Cord not clamped/cut until pulsing stopped or placenta delivered Spontaneous delivery or by maternal effort
30
Maternal obs in 3rd stage
Wellbeing Vaginal loss
31
Neonate initial obs after birth
APGAR Avoid separation first hour Encourage BF in first hour Head /weight ideally first hour
32
Maternal obs post birth
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
Non pharmacological pain relief (6)
Heat Water Sterile water injection Massage Breathing TENS
34
Birthing pool risks
Infection Umbilical snap
35
Birthing pool temp
Not above 37.5
36
Extra obs in water
Monitor maternal and water temp hourly
37
How often bladder care reviewed
4 hr
38
What is included in bladder care.
Frequency of passing and sensation Fluid balance monitoring Catheter
39
Entonox - where and risk?
All settings Nausea/ lightheaded
40
Opioids - where and risks
All settings Limited pain relief Difficult to breastfeed No birthpool within 2hr
41
Epidural risk
Respiratory depression (if too high) Decrease BP Headache if spinal fluid leak
42
When should be pain free after epidural administered
30 min
43
Additional care with epidural
Sensory block hourly Straight leg lift CTG
44
Where locate epidural
T8-T10
45
Where locate epidural
T8-T10

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