Maternal And Fetal Wellbeing In Labour Flashcards
What are the following observations that should be recorded in the first stage of labour.
Half hourly documentation of frequency of contractions
Hourly pulse
4 hourly temperature, bp and resp rate
Offer a VE 4 hourly or if there is concern about progress or in response to woman’s wishes (after abdominal palpation and assessment of vaginal loss)
What does review bladder care for women at least every 4 hours include?
-Frequency of passing urine and bladder sensation
-Fluid balance monitoring if sensation is abnormal or absent, if there is an inability to pass urine, or the woman is receiving intravenous fluids (including oxytocin)
- Offering to insert catheter if there are any ongoing concerns over the woman’s ability to pass urine.
What is the NHS long term plan?
Reiterates the NHS’s commitment to a 50% reduction in stillbirty, maternal mortality, neonatal mortality and serious brain injury and a reduction in preterm brith rate, from 8% to 6% by 2025
What does the monitoring of babies in labour aim to do?
Identify hypoxia before it is sufficient to lead to damaging acidosis and long term neurological adverse outcomes for the baby.
During feral life what is oxygen supply dependent on?
Maternal respiration and circulation, placenta perfusion, gas exchange across the placenta, and umbilical and fetal circulations.
Why can contractions lead to fetal hypoxia?
Contractions compress the maternal blood vessels running inside the myometrium, decreasing placental perfusion. This can result in a temporary reduction of maternal- fetal gas exchange.
What can happen if the umbilical cord is compreseeed between fetal parts in contractions?
Interference with blood circulation.
What can affect the determinants of the magnitude of and effects of these disturbances in contractions?
The frequency, duration and intensity of uterine contractions.
How should you carry out effective fetal monitoring in labour?
4.2 At the onset of every labour, there is a structured riskassessment undertaken which informs the cliniciansrecommendation of the most appropriate fetal monitoringmethod at the start of labour.This risk assessment should be revisited throughout labour aspart of a holistic review.
4.3 Regular (at least hourly) systematic review of maternal andfetal wellbeing should be agreed and implemented. This shouldbe accompanied by a clear guideline for escalation if concernsare raised using this structured process.All staff to be trained in the review system and escalationprotocol.
4.4 A buddy system should be used to help provide an objectiveholistic review for example ‘Fresh Eyes’ – this should beundertaken at least hourly when CTG monitoring is used and atleast four hourly when IA is utilised, unless there is a trigger toprovide a holistic review earlier.
What are two methods of monitoring?
Intermittent and continuous
What should all women have on admission?
Should be risk assessed to determine the method of intrapartum fetal monitoring to be used.
What does uterine rupture refer to?
The complete division of all three layers pf the uterus: the endometrium (inner epithelial layer), myometrium (smooth muscle layer), and perimetrium (serosal outer surface)
What can happen in a uterine rupture?
A part of the fetus, amniotic fluid or the umbilical cord can enter the peritoneal cavity or broad ligament.
What are some symptoms of uterine rupture?
Abdominal pain, vaginal bleeding, a change in contrition pattern, or a non reassuring fetal heart rate tracing.
What is uterine dehiscence?
Characterized by incomplete division of the uterus that does not penetrate all layers. Can produce a uterine window- a thinning of the uterine wall that may allow the fetus to be seen through the myometrium.
