Intrapartum care- NICE guidlines Flashcards
Transfer to obstetric unit
from different facility by %
- Home: 20.1 %
- FS midwifery: 16.2 %
- AS midwifery: 16.3 %
Transfer to obstetric unit
The most common cause
from different facility by %
Delay in 1st & 2nd stage of labour
- Home: 32 %
- FS midwifery: 37 %
- AS midwifery: 35 %
Transfer to obstetric unit
Due to Meconium staining
from different facility by %
- Home: 12.2 %
- FS midwifery: 12.2 %
- AS midwifery: 12.2 %
Transfer to obstetric unit
due to neonatal concerns
from different facility by %
- Home: 5.1 %
- FS midwifery: 2.6 %
- AS midwifery: zero
Transfer to obstetric unit
Due to abnormal fetal heart
from different facility by %
- Home: 7 %
- FS midwifery: 10 %
- AS midwifery: 10 %
Transfer to obstetric unit
Retained placenta & perineal trauma repair
from different facility by %
- Home: 7 % 10 %
- FS midwifery: 7 % 7 %
- AS midwifery: 4 % 8 %
Transfer to obstetric unit
Due to request of regional anagesia
from different facility by %
- Home: 5 %
- FS midwifery: 6 %
- AS midwifery: 13 %
Nulliparous home delivery, risk of baby having serious medical problem and other facility
4 more per 1000 births for home
Same for other 3 facility
what serious medical problems in baby by %
should u provide information
- Neonatal encephalopathy & MAS: 75 %
- Still births & first week death: 13 %
- Fractured humerus & clavicle: < 4 %
- if requested
place of birth for multi
- home + FS midwifery particularly suitable
Spontaneous vaginal birth
- home + FS midwifery > AS midwifery
- home + FS midwifery + AS midwifery >obstetric unit
- obstetric unit higher intervention
place of birth for nulli
midwifery led unit particularly suitable
- home delivery, risk of baby having serious medical problem 4 more per 1000 births for home
- obstetric unit higher intervention
what obstetric unit higher intervention
- instrumental
- CS
- episiotomy
Non-reassuring features on CTG
- baseline
- baseline variability
- Variable decelerations
- Late decelerations
- 100 to 109 (Although non-reassuring feature, continue usual care if normal baseline variability & no variable or late decelerations.)
- 161 to 180
- < 5 : 30 - 50 minutes
- > 25 : 15 - 25 minutes
- 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 > 50% of contractions < 30 minutes, with no maternal or fetal clinical risk factors such as vaginal bleeding or significant meconium
Abnormal features on CTG
- baseline
- baseline variability
- Variable decelerations
- Late decelerations
- < 100
- > 180
- < 5, > 50 minutes
- > 25, > 25 minutes
- Sinusoidal
- Variable decelerations with any concerning characteristics* in over 50% of contractions for 30 minutes (or less if any maternal or fetal clinical risk factors)
- Late decelerations for 30 minutes (or less if any maternal or fetal clinical risk factors)
- Acute bradycardia, or a single prolonged deceleration lasting 3 minutes or more
Variable decels difference b/w nonreassuring and abnormal feature
30 minutes margin
ABNORMAL: > 50 %, =30 minutes
with any concerning characteristics* in over 50% of contractions for 30 minutes (or less if any maternal or fetal clinical risk factors)
NONREASSURING:
- no concerning characteristics* for 90 minutes or more
- any concerning characteristics* in
– up to 50% of contractions for 30 minutes or more
= 50 %, =30 minutes
– over 50% of contractions for less than 30 minutes
> 50 %, < 30 minutes
Late decels difference b/w nonreassuring and abnormal feature
30 minutes margin
ABNORMAL: = 30 minutes
- Late decelerations for 30 minutes (or less if any maternal or fetal clinical risk factors)
NONREASSURING: < 30 minutes
- Late decelerations > 50% of contractions < 30 minutes, with no maternal or fetal clinical risk factors such as vaginal bleeding or significant meconium
Baseline variability
- nonreassuring and
- abnormal
low or high , which one more bad
- < 5 : 30 - 50 minutes
- > 25 : 15 - 25 minutes
- < 5, > 50 minutes
- > 25, > 25 minutes
high more bad
Advise continuous cardiotocography if any of the following risk factors are present at initial assessment or arise during labour:
1 - maternal pulse > 120 beats/minute on 2 occasions 30 minutes apart
2 - temperature of > = 38°C single reading, or 37.5°C or above on 2 consecutive occasions 1 hour apart
3 - suspected chorioamnionitis or sepsis
4 - pain reported differs from pain normally contractions
5 - significant meconium
6 - fresh vaginal bleeding develops in labour
7 - severe HTN: single reading of either systolic or diastolic,> = 160 or 110 b/w contractions
8 - HTN: either systolic or diastolic > = 140 or 90 on 2 consecutive readings taken 30 minutes apart, measured between contractions
9 - 2+ of protein on urinalysis and a single reading of either raised systolic (140 mmHg or more) or diastolic (90 mmHg or more)
10 - confirmed delay in first or second stage of labour
11 - contractions that last longer than 60 seconds (hypertonus) (new TOG resting increased pressure), or more than 5 contractions in 10 minutes (tachysystole)
12 - oxytocin use.
PLACEOF BIRTH/Previous complications
A - Unexplained stillbirth/neonatal death or previous death related to intrapartum difficulty
B - Previous baby with neonatal encephalopathy
C - Stillbirth/neonatal death with a known non‑recurrent cause
A - planned birth at an obstetric unit
B - planned birth at an obstetric unit
C - individual assessment when planning place of birth
PLACE OF BIRTH/Previous complications
A - Placental abruption with adverse outcome
B - Placental abruption with good outcome
A - planned birth at an obstetric unit
B - individual assessment when planning place of birth
PLACE OF BIRTH/Previous complications
A - Pre‑eclampsia requiring preterm birth
B - Pre‑eclampsia developing at term
A - planned birth at an obstetric unit
B - individual assessment when planning place of birth
PLACE OF BIRTH /Previous complications
History of previous baby more than 4.5 kg
Extensive vaginal, cervical, or third‑ or fourth‑degree perineal trauma
Previous term baby with jaundice requiring exchange transfusion
individual assessment when planning place of birth
PLACE OF BIRTH /Previous complications
Eclampsia
Uterine rupture
Primary postpartum haemorrhage requiring additional treatment or blood transfusion
Retained placenta requiring manual removal in theatre
Caesarean section
Shoulder dystocia
planned birth at an obstetric unit
PLACE OF BIRTH /Current pregnancy
BMI at booking of greater than 35 kg/m2
BMI at booking of 30–35 kg/m2
planned birth at an obstetric unit
individual assessment when planning place of birth
PLACE OF BIRTH /Current pregnancy
Para 4 or more
Age over 35 at booking
individual assessment when planning place of birth
PLACE OF BIRTH /Current pregnancy
A - Substance misuse
B - Alcohol dependency requiring assessment or treatment
C - Recreational drug use
D - Under current outpatient psychiatric care
A - planned birth at an obstetric unit
B - planned birth at an obstetric unit
C - individual assessment when planning place of birth
D - individual assessment when planning place of birth
PLACE OF BIRTH /Current pregnancy
A - Recurrent antepartum haemorrhage
B - Placenta praevia
C - Placental abruption
D - Antepartum bleeding of unknown origin (single episode after 24 weeks of gestation)
A - planned birth at an obstetric unit
B - planned birth at an obstetric unit
C - planned birth at an obstetric unit
D - individual assessment when planning place of birth
PLACE OF BIRTH /Current pregnancy
A - Pre‑eclampsia or pregnancy‑induced hypertension
B -Blood pressure of 140 mmHg systolic or 90 mmHg diastolic or more on 2 occasions
planned birth at an obstetric unit
individual assessment when planning place of birth
PLACE OF BIRTH /Current pregnancy
Onset of gestational diabetes
Clinical or ultrasound suspicion of macrosomia
planned birth at an obstetric unit
individual assessment when planning place of birth
PLACE OF BIRTH /Current pregnancy
Multiple birth
Malpresentation – breech or transverse lie
planned birth at an obstetric unit
PLACE OF BIRTH /Current pregnancy
Small for gestational age in this pregnancy (less than fifth centile or reduced growth velocity on ultrasound)
Abnormal fetal heart rate/doppler studies
Ultrasound diagnosis of oligo‑/polyhydramnios
planned birth at an obstetric unit
PLACE OF BIRTH /Current pregnancy
Confirmed intrauterine death
Induction of labour
planned birth at an obstetric unit
PLACE OF BIRTH /Current pregnancy
Preterm labour or
preterm prelabour rupture of membranes
planned birth at an obstetric unit
PLACE OF BIRTH /Current pregnancy
Anaemia – haemoglobin less than 85 g/litre at onset of labour
planned birth at an obstetric unit
