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Bushra's obstetrics > Intrapartum care- NICE guidlines > Flashcards

Intrapartum care- NICE guidlines Flashcards

1
Q

Transfer to obstetric unit

from different facility by %

A
  • Home: 20.1 %
  • FS midwifery: 16.2 %
  • AS midwifery: 16.3 %
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2
Q

Transfer to obstetric unit
The most common cause
from different facility by %

A

Delay in 1st & 2nd stage of labour

  • Home: 32 %
  • FS midwifery: 37 %
  • AS midwifery: 35 %
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3
Q

Transfer to obstetric unit
Due to Meconium staining
from different facility by %

A
  • Home: 12.2 %
  • FS midwifery: 12.2 %
  • AS midwifery: 12.2 %
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4
Q

Transfer to obstetric unit
due to neonatal concerns
from different facility by %

A
  • Home: 5.1 %
  • FS midwifery: 2.6 %
  • AS midwifery: zero
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5
Q

Transfer to obstetric unit
Due to abnormal fetal heart
from different facility by %

A
  • Home: 7 %
  • FS midwifery: 10 %
  • AS midwifery: 10 %
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6
Q

Transfer to obstetric unit
Retained placenta & perineal trauma repair
from different facility by %

A
  • Home: 7 % 10 %
  • FS midwifery: 7 % 7 %
  • AS midwifery: 4 % 8 %
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7
Q

Transfer to obstetric unit
Due to request of regional anagesia
from different facility by %

A
  • Home: 5 %
  • FS midwifery: 6 %
  • AS midwifery: 13 %
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8
Q

Nulliparous home delivery, risk of baby having serious medical problem and other facility

A

4 more per 1000 births for home

Same for other 3 facility

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9
Q

what serious medical problems in baby by %

should u provide information

A
  • Neonatal encephalopathy & MAS: 75 %
  • Still births & first week death: 13 %
  • Fractured humerus & clavicle: < 4 %
  • if requested
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10
Q

place of birth for multi

A
  • home + FS midwifery particularly suitable

Spontaneous vaginal birth

  • home + FS midwifery > AS midwifery
  • home + FS midwifery + AS midwifery >obstetric unit
  • obstetric unit higher intervention
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11
Q

place of birth for nulli

A

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
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12
Q

what obstetric unit higher intervention

A
  • instrumental
  • CS
  • episiotomy
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13
Q

Non-reassuring features on CTG

  • baseline
  • baseline variability
  • Variable decelerations
  • Late decelerations
A
  • 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
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14
Q

Abnormal features on CTG

  • baseline
  • baseline variability
  • Variable decelerations
  • Late decelerations
A
  • < 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
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15
Q

Variable decels difference b/w nonreassuring and abnormal feature
30 minutes margin

A

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

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16
Q

Late decels difference b/w nonreassuring and abnormal feature
30 minutes margin

A

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

17
Q

Baseline variability

  • nonreassuring and
  • abnormal

low or high , which one more bad

A
  • < 5 : 30 - 50 minutes
  • > 25 : 15 - 25 minutes
  • < 5, > 50 minutes
  • > 25, > 25 minutes

high more bad

18
Q

Advise continuous cardiotocography if any of the following risk factors are present at initial assessment or arise during labour:

A

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.

19
Q

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

A - planned birth at an obstetric unit

B - planned birth at an obstetric unit

C - individual assessment when planning place of birth

20
Q

PLACE OF BIRTH/Previous complications

A - Placental abruption with adverse outcome

B - Placental abruption with good outcome

A

A - planned birth at an obstetric unit

B - individual assessment when planning place of birth

21
Q

PLACE OF BIRTH/Previous complications

A - Pre‑eclampsia requiring preterm birth

B - Pre‑eclampsia developing at term

A

A - planned birth at an obstetric unit

B - individual assessment when planning place of birth

22
Q

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

A

individual assessment when planning place of birth

23
Q

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

A

planned birth at an obstetric unit

24
Q

PLACE OF BIRTH /Current pregnancy

BMI at booking of greater than 35 kg/m2

BMI at booking of 30–35 kg/m2

A

planned birth at an obstetric unit

individual assessment when planning place of birth

25
Q

PLACE OF BIRTH /Current pregnancy

Para 4 or more

Age over 35 at booking

A

individual assessment when planning place of birth

26
Q

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

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

27
Q

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

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

28
Q

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

A

planned birth at an obstetric unit

individual assessment when planning place of birth

29
Q

PLACE OF BIRTH /Current pregnancy

Onset of gestational diabetes

Clinical or ultrasound suspicion of macrosomia

A

planned birth at an obstetric unit

individual assessment when planning place of birth

30
Q

PLACE OF BIRTH /Current pregnancy

Multiple birth

Malpresentation – breech or transverse lie

A

planned birth at an obstetric unit

31
Q

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

A

planned birth at an obstetric unit

32
Q

PLACE OF BIRTH /Current pregnancy

Confirmed intrauterine death

Induction of labour

A

planned birth at an obstetric unit

33
Q

PLACE OF BIRTH /Current pregnancy

Preterm labour or

preterm prelabour rupture of membranes

A

planned birth at an obstetric unit

34
Q

PLACE OF BIRTH /Current pregnancy

Anaemia – haemoglobin less than 85 g/litre at onset of labour

A

planned birth at an obstetric unit

Bushra's obstetrics (54 decks)

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