Intrapartum Care NICE Flashcards
Advise to low risk P0 deciding on location of delivery
MW led unit - lower rate intervention, no difference in outcome for baby
Home - small increase in adverse outcome for baby
most common reason to be transferred to obstetric unit?
Delay in 1st/2nd stage of labour
Around 35&
If low risk multip where has highest rates of SVD
Home birth 984
Freestanding 980
Alongside 967
Obs unit 927
If low risk multips, any difference in outcomes for baby
No - baby without problem around 997/1000
For low risk primip, where has highest SVD rates
Freestanding MW unit 813
Home 794
Alongside 765
Obs unit 688
Rough risk instrumental for primip and multip
Primip 11-19%
Multip 1-4%
Rough risk of CS primip and multip
Primip 8-12%
Multip <1-3.5%
Rate of transfer to obstetric unit for home, freestanding and alongside for primip
Home: 45%
Freestanding 36%
Alongside 40%
Rate of transfer to obstetric unit for home, freestanding and alongside for multiple
Home: 11%
Freestanding 9%
Alongside 12%
Is regional anaesthesia linked to increase risk of EMCS or instrumental
No increased risk of CS
Increased risk of instrumental/ longer 2nd stage
If epidural how long to delay pushing once fully, if head not visible/no urge to push?
Multip 1 hr
Primip 2hr
PROm risk of serious neonatal infection
1% (increases with rise)
What % of women with PROm will deliver within 24hrs
60%
If patient chooses expectant management how often should monitor Temp
every 4 hrs
How often to record observation in 1st stage labour
1/2 hourly contraction
Hourly pulse
4 hourly temp
4 hourly VE
When to expect delay in 1st stage of labour
<2cm in 4hrrs primip
<2cm in 4hrs, slowing progress for multip
Descent and rotation of baby head
Changes in strength/durtation frequency of contractions
If concerned for delay, what to do
Repexamine in 2 hrs if <1cm
Offer ARM and VE 2 hours
Or synto
What is active 2nd stage
Baby is visable
Involuntary or active pushing with full dilatation
For nulliparous women, how long expect baby to be born in active 2nd stage
Take place within 3 hours
Review 1 hour after pushing, to assess signs of slow progress
If not birth after 2 hour, refer to senior
For multiparous women, how long expect baby to be born in active 2nd stage
Birth within 2 hours of active pushing
Revire after 30m mins
Considere a t 1 hour
When to give 10IU IM oxytocin for active 3rd stage
After anterior shoulder & before cord clamped
Delayed in 3rd stage phsioloigal & active
Physiological 60mins
Active 30 mins
Phsiological vs active risk of bleeding >500mls
Phsyiological 188/1000
Active 68
120 Fewer /1000
Phsiological vs active risk of bleeding >1000mls
Phsyiological 29/1000
Active 13/10000
16 less
Phsiological vs active risk of requiring a bloods transfusion
Phsyiological 35/1000
Active 13/1000
Reduction 23/1000
Phsiological vs active risk of requiring further uterotonics
Phsyiological 247
Active 47
200/1000 less
Phsiological vs active risk SE nausea/vomting
Active 186
Phsyiological 90
96 difference
