NVD, Routine intrapartum care Flashcards
What are the outcomes of home births vs hospital births?
What can be inferred from this?
Adverse outcomes at home similar to, or significantly higher when compared to hospital birth
Since the hospital population includes women with increased obstetric risk, this finding is concerning
What are the benefits of water immersion in labour? (Cochrane)
- Reduction in the use of pharmacological pain relief and associated side effects
- epidural, regional, paracervical block - Reduction in the duration of the first stage of labour
What does water birth NOT have an effect of?
Assisted vaginal delivery,, CS Oxytocin infusion Perineal trauma Maternal infection APGAR scores, NICU admission, neonatal infection
When should a woman leave the water after a water birth?/
For management of the third stage
Allows for accurate estimation of blood los
Safe skin-to-skin
What should be recorded on the Partogram
Maternal obs Contraction duration / frequency Abdominal palpation findings VE findings Presence / colour of amniotic fluid FHR
What is the advantage of ambulating freely according to comfort in labour?
Reduces first stage of labour by up to 80 minutes
For women who are upright or walk around
(Cochrane)
What are three indications for IVABs in labour?
- GBS prevention
- Chorioamnionitis
- For women with cardiac lesions susceptible to infective endocarditis
What is the benefit of an ARM?
Provides useful information re: liquor volume and colour e.g mec
No evidence that it shortens labour
What are relative contraindications to ARM?
Infection: Hep B, C, HSV, HIV
Presenting part high and mobile
What are the four indications for episiotomy
RANZCOG Intrapartum Care Guideline
High likelihood of severe laceration
- Soft tissue dystocia
- Requirement to accelerate the birth of a compromised fetus
- Need to facilitate operative vaginal birth
- History of FGM
What tissue is involved in a RML episiotomy?
Vaginal epithelium Transverse perineal muscle Bulbocavernosus Perineum Ischiorectal fossa (if deep)
How long should an RML episiotomy be?
3-4cm
What is one situation in which you should be cautious with oxytocic administration for the third stage?
If possibility of second undiagnosed twin (no USS in pregnancy)
What is the benefit of active management of the third stage?
Halves the risk of PPH
Reduces the risk of blood transfusion
What are three benefits of skin-skin
Improved thermal regulation in the neonate
Facilitates mother-infant attachment
Improves rates and duration of breastfeeding
What are two advantages of delayed cord clamping at term?
Increased haematocrit
Reduced iron deficiency at 3-6/12
What are two disadvantages of delayed cord clamping at term?
Increase in early polycythemia
Increased jaundice
- 2 additional babies in 100 will require phototherapy
What are four advantages of delayed cord clamping in preterm fetuses?
Reduced risk of
- requiring transfusion
- infection
- NEC
- IVH
Approximately _____% of the available blood for transfusion is achieved in the first minute after birth
75%
What were the findings of the Cochrane review looking at the effects of having continuous support in labour
More likely to have a
- SVD
- shorter labour
Less likely to have a
- CS
- instrumental birth
- report negative feelings about childbirth experience
- use any intrapartum analgesia, including regional analgesia
- have a baby with low APGAR
No effect on
- admission to NICU
- breastfeeding
What are 8 things that can reduce unnecessary CS
Cochrane Review
2018
Providing childbirth training workshops for mothers and couples
Relaxation training programmes led by nurses
Psychosocial couple-based prevention programmes
Psycho education
Using clinical guidelines combined with mandatory second opinion for CS indication
Using clinical guidelines combined with audit and feedback about CS practices
Opinion leaders provide education to healthcare professionals
Collaborative midwife-labourist model of care
