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intrapartum care Flashcards

1
Q

initially what qs would you ask the pregnant woman when she comes into hospital

A

Review the antenatal notes (including all antenatal screening results) and discuss these with the woman.

Ask her about the length, strength and frequency of her contractions.

Ask her about any pain she is experiencing and discuss her options for pain relief.

Record her pulse, blood pressure and temperature, and carry out urinalysis.

Record if she has had any vaginal loss.

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2
Q

what examination would u do in a pregnant woman

A

Ask the woman about the baby’s movements in the last 24 hours.

Palpate the woman’s abdomen to determine the fundal height, the baby’s lie, presentation, position, engagement of the presenting part, and frequency and duration of contractions.

Auscultate the fetal heart rate for a minimum of 1 minute immediately after a contraction. Palpate the woman’s pulse to differentiate between the heartbeats of the woman and the baby.

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3
Q

what observations of the pregnant woman might trigger you to transfer her to obstetrics

A

pulse over 120 beats/minute on 2 occasions 30 minutes apart

a single reading of either raised diastolic blood pressure of 110 mmHg or more or raised systolic blood pressure of 160 mmHg or more

either raised diastolic blood pressure of 90 mmHg or more or raised systolic blood pressure of 140 mmHg or more on 2 consecutive readings taken 30 minutes apart

a reading of 2+ of protein on urinalysis and a single reading of either raised diastolic blood pressure (90 mmHg or more) or raised systolic blood pressure (140 mmHg or more)

temperature of 38°C or above on a single reading, or 37.5°C or above on 2 consecutive readings 1 hour apart

any vaginal blood loss other than a show

rupture of membranes more than 24 hours before the onset of established labour (see recommendation 1.15.25)

the presence of significant meconium (see recommendation 1.5.2)

pain reported by the woman that differs from the pain normally associated with contractions

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4
Q

what observations of the unborn baby might trigger you to transfer mother to obstetrics

A

any abnormal presentation, including cord presentation

transverse or oblique lie

high (4/5–5/5 palpable) or free‑floating head in a nulliparous woman

suspected fetal growth restriction or macrosomia

suspected anhydramnios or polyhydramnios

fetal heart rate below 110 or above 160 beats/minute

a deceleration in fetal heart rate heard on intermittent auscultation

reduced fetal movements in the last 24 hours reported by the woman.

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5
Q

fetal monitoring with a woman in susp or established labour

A

Use either a Pinard stethoscope or doppler ultrasound.

Carry out auscultation immediately after a contraction for at least 1 minute and record it as a single rate.

Record accelerations and decelerations if heard.

Palpate the maternal pulse to differentiate between the maternal and fetal heartbeats.

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6
Q

options for pain relief/analgesia in labour

A
  • water immersion
  • TENS machine
  • having a birth partner

Ensure that Entonox (a 50:50 mixture of oxygen and nitrous oxide)

  • nauseous
  • light‑headed.
IV/IM opiods
- pethidine
- diamorphine
RISKS
(drowsiness, nausea and vomiting) and her baby (short‑term respiratory depression and drowsiness which may last several days)
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7
Q

what observations should be done for women with regional analgesia/ epidural

maternal complications

CI

A

During establishment of regional analgesia or after further boluses (10 ml or more of low‑dose solutions), measure blood pressure every 5 minutes for 15 minutes.

If the woman is not pain‑free 30 minutes after each administration of local anaesthetic/opioid solution, recall the anaesthetist.

Assess the level of the sensory block hourly.

Risks

  • epidural abscess
  • hypotension
  • temporary loss of bladder control/urinary retention
  • delayed second stage due to inability to push effectively
  • nausea
  • headache
  • nerve damage
  • procedure failure
  • inability to move freely
  • increased chances of instrumentation delivery

CI

  • abnormal bleeding
  • skin infection at or near site
  • hypovolaemia
  • neurological disorders
  • CVS disease
  • anatomical abnormalities of the vertebral
  • pt refusal
  • lack of adequately trained staff
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8
Q

when to perform CTG in regional analgesia

A

least 30 minutes during establishment of regional analgesia and after administration of each further bolus of 10 ml or more.

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9
Q

if rapid analgesia is required which one do u use

A

combined spinal-epidural analgesia

bupivacaine

fentanyl

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10
Q

epidural v spinal anaesthetic

A

epidural is inseted into th epotential space that lies between the dura matter and the periosteum lining the inside of the vertebral canal

spinal anaesthesia is induced by injecting small amounts of local anaesthetic is induced by injecting small amounts of local anaesthetic into the CSF after having pierced the dura matter

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11
Q

when to advise continous CTG

A

maternal pulse over 120 beats/minute on 2 occasions 30 minutes apart

temperature of 38°C or above on a single reading, or 37.5°C or above on 2 consecutive occasions 1 hour apart

suspected chorioamnionitis or sepsis

pain reported by the woman that differs from the pain normally associated with contractions

the presence of significant meconium (as defined in recommendation 1.5.2)

fresh vaginal bleeding that develops in labour

severe hypertension: a single reading of either systolic blood pressure of 160 mmHg or more or diastolic blood pressure of 110 mmHg or more, measured between contractions

hypertension: either systolic blood pressure of 140 mmHg or more or diastolic blood pressure of 90 mmHg or more on 2 consecutive readings taken 30 minutes apart, measured between contractions

a reading of 2+ of protein on urinalysis and a single reading of either raised systolic blood pressure (140 mmHg or more) or raised diastolic blood pressure (90 mmHg or more)

confirmed delay in the first or second stage of labour (see recommendations 1.12.14, 1.13.3 and 1.13.4)

contractions that last longer than 60 seconds (hypertonus), or more than 5 contractions in 10 minutes (tachysystole)

oxytocin use.

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12
Q

when reviewing a CTG trace what should u document

A

baseline rate

baseline variability

presence or absence of decelerations (and concerning characteristics of variable decelerations* if present)

presence of accelerations.

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13
Q

normal HR for fetus

A

110-160

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14
Q

abnormal baseline in CTG

A

Below 100

OR

Above 180

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15
Q

Abnormal baseline variability in CTG

A

Less than 5 for more than 50 minutes

OR

More than 25 for more than 25 minutes

OR

Sinusoidal

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16
Q

abnormal decelerations seen in CTG

A

Variable decelerations with any concerning characteristics* in over 50% of contractions for 30 minutes (or less if any maternal or fetal clinical risk factors [see above])

OR

Late decelerations for 30 minutes (or less if any maternal or fetal clinical risk factors)

OR

Acute bradycardia, or a single prolonged deceleration lasting 3 minutes or more

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17
Q

baseline in non reassuring CTG

A

100 to 109†

OR

161 to 180

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18
Q

non reassuring baseline variability CTG

A

Less than 5 for 30 to 50 minutes

OR

More than 25 for 15 to 25 minutes

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19
Q

non-reassuring decelerations in CTG

A

variable decelerations with no concerning characteristics for 90 minutes or more

variable decelerations with any concerning characteristics in up to 50% of contractions for 30 minutes or more

variable decelerations with any concerning characteristics in over 50% of contractions for less than 30 minutes

late decelerations in over 50% of contractions for less than 30 minutes, with no maternal or fetal clinical risk factors such as vaginal bleeding or significant meconium

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20
Q

when is CTG suspicious

A

1 non-reassuring feature

AND

2 reassuring features

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21
Q

Mx for suspicious CTG

A

Correct any underlying causes, such as hypotension or uterine hyperstimulation

Perform a full set of maternal observations

Start 1 or more conservative measures*

Inform an obstetrician or a senior midwife

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22
Q

pathological feature criteria in CTG

A

1 abnormal feature

OR

2 non-reassuring features

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23
Q

Mx of pathological CTG

A

Obtain a review by an obstetrician and a senior midwife

Exclude acute events (for example, cord prolapse, suspected placental abruption or suspected uterine rupture)

Correct any underlying causes, such as hypotension or uterine hyperstimulation

Start 1 or more conservative measures*

Talk to the woman and her birth companion(s) about what is happening and take her preferences into account

If the cardiotocograph trace is still pathological after implementing conservative measures:

obtain a further review by an obstetrician and a senior midwife

offer digital fetal scalp stimulation and document the outcome

If the cardiotocograph trace is still pathological after fetal scalp stimulation:

consider fetal blood sampling

consider expediting the birth

take the woman’s preferences into account

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24
Q

need fo urgent intervention criteria

A

Acute bradycardia, or a single prolonged deceleration for 3 minutes or more

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25
Q

Mx for need for urgent intervention

A

Urgently seek obstetric help

If there has been an acute event (for example, cord prolapse, suspected placental abruption or suspected uterine rupture), expedite the birth

Correct any underlying causes, such as hypotension or uterine hyperstimulation

Start 1 or more conservative measures*

Make preparations for an urgent birth

Talk to the woman and her birth companion(s) about what is happening and take her preferences into account

Expedite the birth if the acute bradycardia persists for 9 minutes

If the fetal heart rate recovers at any time up to 9 minutes, reassess any decision to expedite the birth, in discussion with the woman

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26
Q

concerning characterisitcs of variable decelerations

A

lasting more than 60 seconds

reduced baseline variability within the deceleration

failure to return to baseline

biphasic (W) shape

no shouldering

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27
Q

conservative measures for heart fetal

A

encourage the woman to mobilise or adopt an alternative position (and to avoid being supine)

offer intravenous fluids if the woman is hypotensive

reduce contraction frequency by:

reducing or stopping oxytocin if it is being used and/or

offering a tocolytic drug (a suggested regimen is subcutaneous terbutaline 0.25 mg).

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28
Q

when to offer fetal blood sampling

A

if CTG is stilkl pathological regardless of fetal scalp stimulation

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29
Q

what is fetal blood sampling

A

measure the level of acid in the baby’s blood, which may help to show how well the baby is coping with labour.

when taking a sample a small scratch may be formed on the baby’s scalp
- small risk of infection

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30
Q

classification of pH of fetal blood

A

normal: 7.25 or above
borderline: 7.21 to 7.24
abnormal: 7.20 or below

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31
Q

classification of lactate of fetal blood

A

normal: 4.1 mmol/l or below
borderline: 4.2 to 4.8 mmol/l
abnormal: 4.9 mmol/l or above. [2017]

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32
Q

if fetal blood sample is borderline - no accelerations in response to fetal scalp stimulation

A

second fetal blood sample no more than 30 minutes later if this is still indicated by the cardiotocograph trace

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33
Q

if fetal blood sample is normal - no accelerations in response to fetal scalp stimulation

A

second fetal blood sample no more than 1 hour later if this is still indicated by the cardiotocograph trace

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34
Q

what advise should be given to women presenting with prelabour rupture of the membranes

A

the risk of serious neonatal infection is 1%, rather than 0.5% for women with intact membranes

60% of women with prelabour rupture of the membranes will go into labour within 24 hours

induction of labour[4] is appropriate approximately 24 hours after rupture of the membranes

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35
Q

what observations are recorded during the first stage of labour

A

half‑hourly documentation of frequency of contractions

hourly pulse

4‑hourly temperature and blood pressure

frequency of passing urine

offer a vaginal examination 4‑hourly or if there is concern about progress or in response to the woman’s wishes (after abdominal palpation and assessment of vaginal loss).

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36
Q

delay in first stage what to take into account

A

parity

cervical dilatation and rate of change

uterine contractions

station and position of presenting part

the woman’s emotional state

referral to the appropriate healthcare professional.

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37
Q

what aspects should be assessed when diagnosing delay

A

cervical dilatation of less than 2 cm in 4 hours for first labours

cervical dilatation of less than 2 cm in 4 hours or a slowing in the progress of labour for second or subsequent labours

descent and rotation of the baby’s head

changes in the strength, duration and frequency of uterine contractions.

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38
Q

if delay is established what might be done

A

amniotomy - rupturing of membranes artificially

repeat vaginal examination 2 hours later whether her membranes are ruptured or intact

39
Q

what would amniotomy do

A

shorten her labour by about an hour and may increase the strength and pain of her contractions

40
Q

role of oxytocine in first stage labour

A

ncrease the frequency and strength of her contractions and that its use will mean that her baby should be monitored continuously.

vaginal examination 4 hours after stating oxytocin

41
Q

define passive second stage of labour

A

the finding of full dilatation of the cervix before or in the absence of involuntary expulsive contractions.

42
Q

define onset of the active second stage of labour

A

the baby is visible

expulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation of the cervix

active maternal effort following confirmation of full dilatation of the cervix in the absence of expulsive contractions.

43
Q

observations done during the second stage

A

partogram

half‑hourly documentation of the frequency of contractions

hourly blood pressure

continued 4‑hourly temperature

frequency of passing urine

offer a vaginal examination hourly in the active second stage, or in response to the woman’s wishes (after abdominal palpation and assessment of vaginal loss).

Perform intermittent auscultation of the fetal heart rate immediately after a contraction for at least 1 minute, at least every 5 minutes. Palpate the woman’s pulse every 15 minutes to differentiate between the two heartbeats

44
Q

duration of second stage of labour in a nulliparous woman

A

birth would be expected to take place within 3 hours of the start of the active second stage in most women

diagnose delay in the active second stage when it has lasted 2 hour undertake an operative vaginal birth if birth is not imminent

45
Q

duration of second stage of labour in a nulliparous woman

A

birth would be expected to take place within 2 hours of the start of the active second stage in most women

diagnose delay in the active second stage when it has lasted 1 hour undertake an operative vaginal birth if birth is not imminent

46
Q

when to suspect delay in progress in a nulliparous woman second stage

A

in terms of rotation and/or descent of the presenting part) is inadequate after 1 hour of active second stage. Offer vaginal examination and then offer amniotomy if the membranes are intact

47
Q

when to suspect delay in progress in a nulliparous woman second stage

A

(in terms of rotation and/or descent of the presenting part) is inadequate after 30 minutes of active second stage. Offer vaginal examination and then offer amniotomy if the membranes are intact

48
Q

when to consider oxytocin in the second stage

A

Consideration should be given to the use of oxytocin, with the offer of regional analgesia, for nulliparous women if contractions are inadequate at the onset of the second stage.

49
Q

intervention to recuse perineal trauma

A

Either the ‘hands on’ (guarding the perineum and flexing the baby’s head) or the ‘hands poised’ (with hands off the perineum and baby’s head but in readiness) technique can be used to facilitate spontaneous birth.

50
Q

what advise to give to women who have had third or fourth degree trauma

A

current urgency or incontinence symptoms

the degree of previous trauma

risk of recurrence

the success of the repair undertaken

the psychological effect of the previous trauma

management of her labour

51
Q

if episiotomy has to be performed which method might be recommended

A

mediolateral episiotomy originating at the vaginal fourchette and usually directed to the right side. The angle to the vertical axis should be between 45 and 60 degrees at the time of the episiotomy

52
Q

when to offer instrumental birth

A

baby’s wellbeing or there is a prolonged second stage]]advise the woman to ahve tested effective anaesthesia

if anaesthesia declines offer a pudendal block

53
Q

assessments that needs to be done when expediting birth

A

the degree of urgency

clinical findings on abdominal and vaginal examination

choice of mode of birth (and whether to use forceps or ventouse if an instrumental birth is indicated)

anticipated degree of difficulty, including the likelihood of success if instrumental birth is attempted

location

any time that may be needed for transfer to obstetric‑led care

the need for additional analgesia or anaesthesia

the woman’s preferences

54
Q

define third stage of labour

A

time from the birth of the baby to the expulsion of the placenta and membranes.

55
Q

what does active Mx of the third stage of labour involves

A

routine use of uterotonic drugs

deferred clamping and cutting of the cord

controlled cord traction after signs of separation of the placenta.

shortens the third stage compared with physiological management

is associated with nausea and vomiting in about 100 in 1,000 women

is associated with an approximate risk of 13 in 1,000 of a haemorrhage of more than 1 litre

is associated with an approximate risk of 14 in 1,000 of a blood transfusion.

56
Q

what does physiological Mx of the third stage involves

A

Gold standard is active
-no routine use of uterotonic drugs
- IM Injection with oxytocin, usually as birth is taking place
- Cord is clamped and cut, 1-5mins after birth
- Placenta is pulled out by the midwife once it has separated from the wall of the uterus, usually happens within 30 mins
REDUCED risk of PPH, need for blood transfusion and postnatal anaemia

is associated with nausea and vomiting in about 50 in 1,000 women

physiological
- delivery of the placenta by maternal effort.
- no clamping of the cord until pulsation has stopped
is associated with an approximate risk of 29 in 1,000 of a haemorrhage of more than 1 litre

is associated with an approximate risk of 40 in 1,000 of a blood transfusion

57
Q

when can prolonged third stage be diagnosed

A

if it is not completed within 30 minutes of the birth with active management or within 60 minutes of the birth with physiological management.

58
Q

what is recorded in the third stage labour

A

her general physical condition, as shown by her colour, respiration and her own report of how she feels

vaginal blood loss.

59
Q

what is injected in active management

A

administer 10 IU of oxytocin by intramuscular injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut. Use oxytocin as it is associated with fewer side effects than oxytocin plus ergometrine

60
Q

when to clamp cord

A

Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heart rate below 60 beats/minute that is not getting faster.

Clamp the cord before 5 minutes in order to perform controlled cord traction as part of active management.

If the woman requests that the cord is clamped and cut later than 5 minutes, support her in her choice

61
Q

when to perform controlled cord traction

A

active management only after administration of oxytocin and signs of separation of the placenta.

62
Q

when do u move from physiological to active Mx

A

haemorrhage

the placenta is not delivered within 1 hour of the birth of the baby.

shorten the third stage

63
Q

if placenta is retained

A

IV access

examine vagina

needs to be removed

64
Q

antenatal RFs for postpartum haemorrhage

A

previous retained placenta or postpartum haemorrhage

maternal haemoglobin level below 85 g/litre at onset of labour

BMI greater than 35 kg/m2

grand multiparity (parity 4 or more)

antepartum haemorrhage

overdistention of the uterus (for example, multiple pregnancy, polyhydramnios or macrosomia)

existing uterine abnormalities

low‑lying placenta

maternal age of 35 years or older.

65
Q

risk factors in labour for postpartum haemorrhage

A

induction

prolonged first, second or third stage of labour

oxytocin use

precipitate labour

operative birth or caesarean section

66
Q

Mx of postpartum haemorrhage

A

all for help

give immediate clinical treatment:

emptying of the bladder and

uterine massage and

uterotonic drugs and

intravenous fluids and

controlled cord traction if the placenta has not yet been delivered

continuously assess blood loss and the woman’s condition, and identify the source of the bleeding

give supplementary oxygen

arrange for transfer of the woman to obstetric‑led care

67
Q

first line treatment for postpartum haemorrhage

A

oxytocin (10 IU intravenous) or

ergometrine (0.5 mg intramuscular) or

combined oxytocin and ergometrine (5 IU/0.5 mg intramuscular).

68
Q

second line treatment for postpartum haemorrhage

A

repeat bolus of:

oxytocin (intravenous)

ergometrine (intramuscular, or cautiously intravenously)

combined oxytocin and ergometrine (intramuscular)

misoprostol

oxytocin infusion

carboprost (intramuscular).

69
Q

other treatment for postpartum haemorrhage

A

tranexamic acid (intravenous)

rarely, in the presence of otherwise normal clotting factors, rFactor VIIa, in consultation with a haematologist

70
Q

initial assessment of the newborn baby

A

Record the Apgar score routinely at 1 and 5 minutes for all births.

Record the time from birth to the onset of regular respirations.

71
Q

mother baby bonding

A

skin to skin contact

breastfeeding within first hour if possible

72
Q

observations of baby born due to PROM

A

(more than 24 hours before the onset of established labour) at term for the first 12 hours of life (at 1 hour, 2 hours, 6 hours and 12 hours) in all settings. Include assessment of:

temperature

heart rate

respiratory rate

presence of respiratory grunting

significant subcostal recession

presence of nasal flare

presence of central cyanosis, confirmed by pulse oximetry if available

skin perfusion assessed by capillary refill

floppiness, general wellbeing and feeding.

73
Q

observation of the woman after birth

A

record her temp, pulse, BP

Uterine contraction and lochia.

Examine the placenta and membranes: assess their condition, structure, cord vessels and completeness.

successful voiding of the labour

74
Q

define first degree

A

injury to skin only

75
Q

define second degree

A

injury to the perineal muscles but not the anal sphincter

76
Q

define third degree

A

injury to the perineum involving the anal sphincter complex:

3a – less than 50% of external anal sphincter thickness torn

3b – more than 50% of external anal sphincter thickness torn

3c – internal anal sphincter torn.

77
Q

define fourth degree

A

injury to the perineum involving the anal sphincter complex (external and internal anal sphincter) and anal epithelium

78
Q

what is induction of labour

A

starting labour artificially.

79
Q

when will IOL is indicated

A

prolonged gestation -> between 41-41w

premature rupture of membranes, infection, bleeding

maternal health problems - HTN, pre-eclampsia, diabetes, obstetric cholestasis

fetal growth restiriction or
fetal macrosomia

intrauterine fetal death

previous c section

80
Q

when to offer IOL in PROM

A

less than 37 weeks gestation

or

offer expectant management for a maximum of 24 hours

81
Q

when to offer IOL in P-PROM

A

<34 weeks’ gestation – delay IOL unless obstetric factors indicate otherwise e.g. fetal distress.
>34 weeks’ gestation – the timing of IOL depends on risks vs benefits of delaying pregnancy further e.g. increased risk of infection.

82
Q

Absolute contraindications of IOL

A

Cephalopelvic disproportion
Major placenta praevia

Vasa praevia

Cord prolapse

Transverse lie

Active primary genital herpes

Previous classical Caesarean section

83
Q

Relative contraindication of IOL

A
  1. Breech presentation
  2. Triplet or higher order pregnancy
  3. Two or more previous low transverse caesarean sections
84
Q

main methods of induction

A

vaginal PGs

amniotomy

membrane sweep

85
Q

method of vaginal PGs

A

prepare the cervix for labour by ripening it, and also have a role in the contraction of the smooth muscle of the uterus. They come as either a tablet, gel or a controlled-release pessary:

Tablet/gel regimen: 1 cycle = 1st dose, plus a 2nd dose if labour has not started 6 hours later.
Pessary regimen: 1 cycle = 1 dose over 24 hours.

There is a recommended maximum of one cycle in 24 hours

86
Q

define amniotomy

A

membranes are ruptured artificially using an instrument called an amnihook.

releases prostaglandins in an attempt to expedite labour. It is only performed when the cervix has been deemed as ‘ripe’ (see Bishop Score below).

Often, an infusion of artificial oxytocin (Syntocinon) will be given alongside an amniotomy, acting to increase the strength and frequency of contractions. The aim is to start low and titrate upwards until there are 4 contractions every 10 minutes.

87
Q

when is membrane sweep offered

A

40 and 41 weeks’ gestation to nulliparous women, and 41 weeks to multiparous women.

procedure is performed by inserting a gloved finger through cervix and rotating it against the fetal membranes, aiming to separate the chorionic membrane from the decidua. The separation helps to release natural prostaglandins in an attempt to kick-start labour.

88
Q

what is the bishop score

A

‘cervical ripeness‘ based on measurements taken during vaginal examination. It is checked prior to induction, and during induction to assess progress (6 hours post-table/gel, 24 hours post-pessary):

Score of ≥ 7 – suggests the cervix is ripe or ‘favourable’ – this means that there is a high chance of a response to interventions made to induce labour (i.e. induction of labour is possible).

Score of <4 – suggests that labour is unlikely to progress naturally and prostaglandin tablet/gel/pessary will be required

89
Q

what must be done prior to IOL

A

CTG

After initiation of IOL, when contractions begin assess fetal heart rate using continuous CTG until a normal rate is confirmed. Subsequently assess using intermittent auscultation.

90
Q

complications of IOL

A

Failure of induction (15%) – offer a further cycle of prostaglandins, or a caesarean section.

Uterine hyperstimulation (1-5%) – contractions last too long or are too frequent, leading to fetal distress. Can be managed with tocolytic agents (anti-contraction) such as terbutaline.

Cord prolapse – can occur at time of amniotomy, particularly if the presentation of the fetal head is high.

Infection – risk is reduced by using pessary vs tablet/gel, as fewer vaginal examinations are required to check progress.

Pain – IOL is often more painful than spontaneous labour. Often epidural analgesia is required.

Increased rate of further intervention vs spontaneous labour – 22% require emergency caesarean sections, and 15% require instrumental deliveries.

Uterine rupture (rare)

91
Q

what is the optimal head position for delivery

A

occiput anterior

92
Q

what is looked for in a vaginal examination

A

consistency, effacement and dilatation of the cervix

  • whether the membranes are intact
  • colour of the amniotic fluid
  • nature and presentation of the presenting part and its relationship to the ischial spine
  • size of pelvic outlet
93
Q

RFs for GBS mx

A

Suspected or confirmed infection in another baby in the case of a multiple pregnancy
Parenteral antibiotic treatment given to the woman for confirmed or suspected invasive bacterial infection (such as septicaemia) at any time during labour, or in the 24-hour periods before and after the birth [This does not refer to intrapartum antibiotic prophylaxis]
Respiratory distress starting more than 4 hours after birth
Seizures
Need for mechanical ventilation in a term baby
Signs of shock

repro (28 decks)

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