Intrapartum Care Flashcards
First stage of labour guidelines change from latent to active? (2)
4cm dilation
Regular contractions
What happens in latent stage
Opening and softening of cervix
Maternal changes in preparation for birth (4)
Increase: oestrogen, prostaglandins, cortisol, oxytocin, prolactin, oxytocin receptors
Cervical softening (may lose mucus plug)
Initial assessment in labour (7)
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
Observations at initial assessment baby
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
Advice for management early labour
Eat and drink as feels
Rest
Breathing
Gentle movement
Length of first stage - nulliparous
8-18hr
Length of first stage multiparous
6-12 hr
NICE guidelines progression first stage
0.5cm per hour
Aiding progression in first stage
Descent into pelvic inlet so coxal counternutation - knees out
Emotional support
Calm
Natural oxytocin
Empty bladder
Consider pain relief
Benefits of VE (3)
Reassure
Motivate
Orientate
Risks of VE (7)
Infection (both)
Subjective/inconsistent
Pain/intrusive
Misleading
Risk membrane rupture
Can disempower
Once started should continue
How often VE in first stage once started?
4 hourly
When measure maternal pulse first stage ?
Hourly
When IA first stage?
Every 15 min for 1 min after contraction
When IA second stage?
Every 5 min for 1 min
How often offer VE second stage?
Hourly
How often measure frequency of contractions
Every 30 min
How often maternal BP.
4 hourly
How often temperature
4 hourly
Alternatives to VE
US
Purple line
Behaviour cues
Freq/strength contraction
Second stage labour - passive
Full dilation b4 pushing (approx 2 hr)
Second stage labour - active
Baby visible
Invol/active pushing with full dilation
Perineal trauma prevention
Warm wet compress
Guard head a perineum
Spontaneous pushing
What happens in 3rd stage
Expulsion of placenta and membranes
What is active 3rd stage (3)
Uteronic drugs
Clamp and cord cut
Controlled cord traction if separates
When considered prolonged active management
30+ mins
When considered prolonged physiological
60 min +
What is physiological 3rd stage
No drugs
Cord not clamped/cut until pulsing stopped or placenta delivered
Spontaneous delivery or by maternal effort
Maternal obs in 3rd stage
Wellbeing
Vaginal loss
Neonate initial obs after birth
APGAR
Avoid separation first hour
Encourage BF in first hour
Head /weight ideally first hour
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
Non pharmacological pain relief (6)
Heat
Water
Sterile water injection
Massage
Breathing
TENS
Birthing pool risks
Infection
Umbilical snap
Birthing pool temp
Not above 37.5
Extra obs in water
Monitor maternal and water temp hourly
How often bladder care reviewed
4 hr
What is included in bladder care.
Frequency of passing and sensation
Fluid balance monitoring
Catheter
Entonox - where and risk?
All settings
Nausea/ lightheaded
Opioids - where and risks
All settings
Limited pain relief
Difficult to breastfeed
No birthpool within 2hr
Epidural risk
Respiratory depression (if too high)
Decrease BP
Headache if spinal fluid leak
When should be pain free after epidural administered
30 min
Additional care with epidural
Sensory block hourly
Straight leg lift
CTG
Where locate epidural
T8-T10
Where locate epidural
T8-T10
