NICE Intrapartum guidelines 2014 Flashcards
Normal Length of first stage of labour?
Primips - 8-18 hours
Multips - 5-12 hours
Normal length of seconds stage?
Primips - 2 hours
Multips - 1 hour
(Add one hour for epidural)
Care in early labour:
Review notes and identify risk factors.
Do all observations: temp, BP, pulse, Urinalysis
Abdominal palpation for position and measure fundal height
FM’s and FHR (differentiate from maternal pulse)
Monitor length, strength and frequency of contractions.
Monitor PV loss
Disscuss birth plan and expectations
Discuss pain relief options, water, massage, breathing techniques.
NICE recommends the following risk factors have obstetric led care:
GBS Previous LSCS Anaemia IOL malpresentation or SGA Abnormal FH Abnormal liquor
Other risk factors that may cause women to be transferred to obstetric include:
Tachycardia >120bpm on two occasions Hypertension: 160/110 or 2 x 140/90 Proteinuria: 2+ Pyrexia: >38 or two readings of >37.5 FH <110 or >160 Reduced FMs in 24 hours PV loss - sig mec SROM . 24 hours Abnormal presentation IUGR/macrosomia/abnormal liquor
How often are women monitored in first stage of labour?
15minute auscultation/CTG Partogram 30 minute assessment of contractions Hourly Maternal HR 4 hourly temp, BP and VE Bladder care Pain relief as required.
How are women monitored in second stage?
auscultation every 5 minutes/CTG partogram 15 minutes Maternal HR 30 minutes assessment of contractions hourly VE and BP 4 hourly temp Bladder care Ongoing consideration to position, hydration, pain relief.
What does the evidence say about epidural?
If regional analgesia is in situ, delay pushing for one hour to let the baby descend further. If the woman gets the urge to push, she should be encouraged to do so.
What happens when there is a delay in second stage of labour?
In a primip, ARM considered.
In a multip, regular obstetric reviews and possible instrumental.
What is the POA if there is a prolonged bradycardia?
Seek urgent help
Rule out cord prolapse, uterine rupture or placental abruption
Correct hypotension and hyperstimulation with tocolytic or IV fluids
prepare for urgent birth at 6 minutes
Be in theatre at 9 minutes
LSCS in 12 minutes
Normal PH and lactate for FBS:
PH: >7.25
Lactate<4.1mmol/l
Epidural procedure
Call anaesthetist
Secure IV access
AES
Listen to FH throughout procedure
Monitor BP 5:5:5 following epidural
If not pain free 30 minutes after, re-call anaesthetist
Either patient controlled or intermittend bolus
CTG for atleast 30 minutes after epidural
Once full dilated delay active pushing for one hour
What are the drugs in epidural?
Bupivacaine and fentanyl
What is delayed 3rd stage?
> 30 minutes in active management and >60 in physiological management
