Intrapartum Care NICE

Question 1

Advise to low risk P0 deciding on location of delivery

Answer 1

MW led unit - lower rate intervention, no difference in outcome for baby
Home - small increase in adverse outcome for baby

Question 2

most common reason to be transferred to obstetric unit?

Answer 2

Delay in 1st/2nd stage of labour

Around 35&

Question 3

If low risk multip where has highest rates of SVD

Answer 3

Home birth 984
Freestanding 980
Alongside 967
Obs unit 927

Question 4

If low risk multips, any difference in outcomes for baby

Answer 4

No - baby without problem around 997/1000

Question 5

For low risk primip, where has highest SVD rates

Answer 5

Freestanding MW unit 813
Home 794
Alongside 765
Obs unit 688

Question 6

Rough risk instrumental for primip and multip

Answer 6

Primip 11-19%
Multip 1-4%

Question 7

Rough risk of CS primip and multip

Answer 7

Primip 8-12%
Multip <1-3.5%

Question 8

Rate of transfer to obstetric unit for home, freestanding and alongside for primip

Answer 8

Home: 45%
Freestanding 36%
Alongside 40%

Question 9

Rate of transfer to obstetric unit for home, freestanding and alongside for multiple

Answer 9

Home: 11%
Freestanding 9%
Alongside 12%

Question 10

Is regional anaesthesia linked to increase risk of EMCS or instrumental

Answer 10

No increased risk of CS
Increased risk of instrumental/ longer 2nd stage

Question 11

If epidural how long to delay pushing once fully, if head not visible/no urge to push?

Answer 11

Multip 1 hr
Primip 2hr

Question 12

PROm risk of serious neonatal infection

Answer 12

1% (increases with rise)

Question 13

What % of women with PROm will deliver within 24hrs

Answer 13

60%

Question 14

If patient chooses expectant management how often should monitor Temp

Answer 14

every 4 hrs

Question 15

How often to record observation in 1st stage labour

Answer 15

1/2 hourly contraction
Hourly pulse
4 hourly temp
4 hourly VE

Question 16

When to expect delay in 1st stage of labour

Answer 16

<2cm in 4hrrs primip
<2cm in 4hrs, slowing progress for multip
Descent and rotation of baby head
Changes in strength/durtation frequency of contractions

Question 17

If concerned for delay, what to do

Answer 17

Repexamine in 2 hrs if <1cm
Offer ARM and VE 2 hours

Or synto

Question 18

What is active 2nd stage

Answer 18

Baby is visable
Involuntary or active pushing with full dilatation

Question 19

For nulliparous women, how long expect baby to be born in active 2nd stage

Answer 19

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

Question 20

For multiparous women, how long expect baby to be born in active 2nd stage

Answer 20

Birth within 2 hours of active pushing
Revire after 30m mins
Considere a t 1 hour

Question 21

When to give 10IU IM oxytocin for active 3rd stage

Answer 21

After anterior shoulder & before cord clamped

Question 22

Delayed in 3rd stage phsioloigal & active

Answer 22

Physiological 60mins
Active 30 mins

Question 23

Phsiological vs active risk of bleeding >500mls

Answer 23

Phsyiological 188/1000
Active 68

120 Fewer /1000

Question 24

Phsiological vs active risk of bleeding >1000mls

Answer 24

Phsyiological 29/1000
Active 13/10000
16 less

Question 25

Phsiological vs active risk of requiring a bloods transfusion

Answer 25

Phsyiological 35/1000
Active 13/1000

Reduction 23/1000

Question 26

Phsiological vs active risk of requiring further uterotonics

Answer 26

Phsyiological 247
Active 47

200/1000 less

Question 27

Phsiological vs active risk SE nausea/vomting

Answer 27

Active 186
Phsyiological 90

96 difference