Key things to know Flashcards
What result for pH of a fetal blood sample result is normal?
7.25 or above
Borderline- 7.21-7.25
Abnormal- 7.2 or below
According to NICE
What results for lactate of a fetal blood sample is normal ?
4.1 mmol/l or below is normal
4.2-4.8mmol/l is borderline
4.9 mmol/l or above is abnormal
According to NICE
Pre labour ROM risk to neonate compared to women with intact membranes
Risk of serious infection is 1% compared to 0.5% for women with intact membranes
What percentage of women withe prelabour ROM will go into labour within 24 hours ?
60%
IOL is appropriate how long after ROM ?
24 hours
What to advise women who ROM before labour ?
Report any change in colour or smell of vaginal loss
Bath or shower not associated with increased risk of infection but sexual intercourse may be
If a women’s labour has not started 24 hours after ROM how long should she stay in hospital for after birth?
At least 12 hours
Average length of established labour for primiparous women?
On average 8 hours and unlikely to last more than 18 hours
How long do established labours for parous women last?
Average 5 hours. Unlikely to last over 12 hours
How frequently should we recorded the frequency of contractions in the first stage labour ?
Half hourly
How frequently should we record maternal pulse in the first stage labour ?
Hourly
How often should we record temp and BP in the first stage labour??
4 hourly
How often should a VE be offered in the first stage of labour
4 hourly or If concern about progress in labour - after abdominal palpations and assessment of vaginal loss
Amniotomy offered is delay in first stage of established labour suspected. What should explain about consequences of procedure?
Shorten labour by about an hour and may increase strength and pain of contractions
In the 2nd stage of labour how often should frequency of contractions be documented, how frequently should BP be documented, how frequently should temp be documented and passing of urine should also be recorded?
Half hourly frequency of contractions
Half hourly BP
4 hourly temp
In active second stage how often should VEs be offered ?
Hourly or in response to women’s wishes
During the second stage of active labour how often should the fetal heart rate being auscultation ?
Immediately after contractions for at least a minute , at least every 5 minutes. And palpate the women’s pulse every 15 mins to differentiate between heart rates
For nulliparous women how long after active second stage should the birth be expected to take place ?
Within 3 hours
Diagnose delay in active second stage when it has lasted 2 hours and refer to healthcare professionals.
However after an hour suspect delay in terms of rotation or descent of presenting part
For multiparous women how long after active second stage should the birth be expected to take place ?
2 hours after start of active stage.
Diagnose delay in active second stage when it has lasted 1 hour and refer.
I’d delay is suspected due to rotation or descent or presenting part then suspect delay in progress after 30 mins.
When do u diagnose a prolonged 3rd stage if active management?
30 mins
When do u diagnose a prolonged 3rd stage with physiological management ?
60 minutes
What to explain to some about active management of 3rd stage ?
Shortens the 3rd stage compared to physiological management.
Associated with nausea and colonising in about 1 in 10
Associated with 13 in 1000 haemorrhage more than 1 litre
Associated with 14 in 1000 blood transfusion
What to explain to a women about the physiological management of the 3rd stage?
I’d associated with nausea and committing in 50 in 1000 women compared to 100 in 1000 with active management.
Is associated with 29 in 1000 haemorrhages more than 1 litre compared to 13 in 1000 with active management.
Is associated with 40 in 1000 blood transfusions compared to 14 in 1000 with active management
How much oxytocin is administered for active management of 3rd stage
10IU IM with birth of anterior shoulder or immediately after birth of baby. Before cord is clamped and cut. Oxytocin is associated with fewer side effects than oxytocin plus ergometrine.
When to clamp the cord earlier than 1 minute from birth?
If concern about integrity of cord or the baby has a heart rate below 60 and not getting faster.
When should clamp cord If all is fine?
Before 5 minutes in order to perform controlled cord traction as part of active management.
When do u perform controlled cord traction?
After cord cut. After admin of oxytocin and signs of separation of the placenta.
When to go from physiological management of 3rd stage to active ?
Is haemorrhage or if placenta not delivered within an hour after birth of baby
Antental risk for postpartum haemorrhage
Previous PPH or previous retained placenta
Maternal haemoglobin below 85g/litre at onset of labour
BMI greater than 35 kg/m^2
Antepartum haemorrhage
Overdistention of the uterus ( multiple pregnancy, polyhydramnios or macrosomnia)
Existing uterine abnormalities
Low lying placenta
Maternal age 35 or older
Risk factors for haemorrhage in labour
Induction Prolonged first , second or third stage in labour Oxytocin has Precipitate labour Operative birth of Caesarean section
Management of PPH
Call for help
Empty bladder, uterine massage, uterotonic drugs, IV fluids, controlled cord traction if placement not out
Assess blood loss and identify source of bleeding
Give oxygen
Arrange to transfer for obstetric led unit.
What drugs would you administer a bolus of as first line of treatment for postpartum haemorrhage?
10IU IV oxytocin
Ergometrine 0.5mg IM
Oxytocin (5IU) and ergometrine ( 0.5mg) IM
If there has been significant meconium what observations and when should these observations of the baby take place ?
At 1 hour, at 2 hour, and then 2 hourly until 12 hours of age
If there has been non-significant meconium how frequently should the baby have obs
At 1 hour and 2 hours of age
What respiration rate if any degree of meconium will a neonatologist need to assess the baby ?
Reps above 60
All factors where is any meconium a neonatologist is required
Resps above 60
Grunting
Heart rate below 10 or above 160
Capillary refill time above 3 seconds
Body temp 38 or 37.5 on 2 occasions 30 mins apart
Oxygen sats below 95
Presence Of central cyanosis , confirmed by pulse oximetry if available.
If pre labour ROM more than 24 hours before onset of established labour at term how long obs on baby for
First 12 hours of life. At 1 hour, 2 hour, and 6 hours and 12 hours.
