obstetric 2

Question 1

APH Mx? (any clinical signs of altered perfusion)

Answer 1

• Place Pt in left lateral tilt position
• Tx to appropriate obstetric hospital with notification in all cases

• Less than adequate perfusion:
- Consider Normal Saline IV (max. 40 mL/kg) titrated to patient response
- Consult for further fluid. If consult unavailable repeat Normal Saline 20 mL / kg IV
• Mx pain as per CPG A0501 Pain Relief

Question 2

breech birth mx - not imminent

Answer 2

• General maternal care

* Tx to booked appropriate maternity service unit with notification

Question 3

breech birth mx - one foot, arm or hand presenting

Answer 3

• Do not attempt to deliver
• Tx urgently to an appropriate maternity service unit with notification
• Consult with PIPER for advice

Question 4

preterm labor - when are tocolytics contraindicated?

Answer 4

They are contraindicated in the setting of
massive maternal haemorrhage (APH) and pregnancy
induced hypertension (pre-eclampsia / eclampsia).

Question 5

preterm labor - birth imminent mx

Answer 5

mx as appropriate cpg - consult piper

Question 6

preterm labor - birth not imminent > = 34 weeks mx

Answer 6

basic care, RR

Question 7

preterm labor - birth not imminent mx < 34 weeks

Answer 7

• Consult for 50 mg GTN patch
(0.4 mg/hr) applied to the abdomen

• A further 50 mg GTN patch (0.4 mg/hr)
may be added after 1 hr if contractions
persist (max. 20 mg / 24 hr)

Question 8

what is the lovesetts maneuver -

Answer 8

used to birth arms of breech baby

sweeping arms down from anterior-posterior when legs have been birthed

Question 9

a mother should be encouraged to push in cord-prolapse in what circumstance?

Answer 9

ONLY applies when
the presenting part is distending the perineum and
the mother is pushing uncontrollably

Question 10

cord prolapse - birth not imminent mx of mother/birth not imminent -mx of cord/birth not imminent mx of of presenting part.

Answer 10

Birth not imminent mx of mother
• Position patient semi-prone with hips elevated over
folded towels
• Provide explanation and reassurance
• High flow O2 therapy

Birth not imminent - mx of cord
• Minimise cord handling
• Keep cord warm and moist. Use 2 fingers to gently
place cord in vagina
• If unsuccessful cover with warm saline packs (if possible)

birth not immiment mx of presenting part
• If there is pressure on the cord by the presenting part insert fingers into vagina and push the presenting part (head) away from the cord
• Maintain pressure until birth commences or advised to release