Place Of Birth Flashcards by Bethany Wildridge

Planned birth in obstetric unit for : cardiovascular conditions

Confined cardiac disease
HTN disease

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Planned birth in obstetric unit for :
Respiratory

Asthma requiring an increase in treatment or hospital treatment
Cystic fibrosis

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Planned birth in obstetric unit for :
Haematological

Haemoglobinopathies - SCD, BTMAJ
History of thromboembolic disorders
Immune thrombocytopenia purpura or other platelet disorder or platelet count below 100x109/l
VW disease
Bleeding disorder in woman / unknown baby
Atypical antibodies which carry risk of haemolytic disease of the new born

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Planned birth in obstetric unit for :
Endocrine

Hyperthyroidism
Diabetes

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Planned birth in obstetric unit for :
Infective

Risk Factors associated with group B streptococcus whereby antibiotics in labour would be recommended
Hepatitis B / C with abnormal liver function tests
Carrier of / infected with HIV
Toxoplasmosis - women receiving treatment
Current active infection or chicken pox / rubella / genital herpes in the woman or baby
TB under treatment

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Planned birth in obstetric unit for :
Immune

SLE
Scleroderma

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Planned birth in obstetric unit for :
Renal

Abnormal renal function
Renal disease requiring supervision by a renal Specialist

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Planned birth in obstetric unit for :
Neurological

Epilepsy
Myasthenia Gravis
Previous CVA

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Planned birth in obstetric unit for :
Gastrointestinal

Liver disease associated with current abnormal liver function tests

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Planned birth in obstetric unit for :
Psychiatric

Psychiatric disorder requiring inpatient care

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Planned birth in obstetric unit for :
Previous complications

Unexplained stillbirth / neonatal death or previous death related to intrapartum difficulty
Previous baby with neonatal encephalopathy
PET requiring preterm birth
Placental abruption with adverse outcome
Eclampsia
Uterine rupture
Primary postpartum haemorrhage requiring additional treatment or blood transfusion
Retained placenta requiring manual removal
Caesarean section
Shoulder dystocia

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Planned birth in obstetric unit for :
Current pregnancy

Multiple birth
Placenta praevia
PET / PIH
preterm labour / PPROM
Placental abruption
Anaemia - haemoglobinopathy <85g/L at the onset of labour
Confirmed IUD
IOL
Substance misuse
Alcohol dependency requiring assessment or treatment
Onset GDM
Malpresentation - breech / transverse lie
BMI booking > 35kg/m
recurrent APH
SGA this pregnancy (below 5th or RGC on USS)
Abnormal FHR / Doppler studies
USS Dx oligo/polyhydramnios

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Planned birth in obstetric unit for :
Prev gynae history

Myomectomy
Hysterotomy

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What anaemia requires CLC?

> 8.6g/dl

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BMI in MLU?

<35
30-35 can be in MLU

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Old infections for VZV / Rubella / HSV can be delivered where?

MLU

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Individual assessment for place of birth:
Cardiovascular

Cardiac disease without intrapartum implications

Individual assessment for place of birth:
Haematological

Atypical antibodies not putting baby at risk of haemolytic disease
Sickle cell trait
Thalassemia trait
Anaemia - haemoglobin 85-105g/litre at onset of labour

Individual assessment for place of birth:
Infective

Hepatitis B / C with normal LFTs

Individual assessment for place of birth:
Immune

Non specific connective tissue disorders

Individual assessment for place of birth:
Endocrine

Unstable hypothyroidism such that a change in treatment is required

Individual assessment for place of birth:
Skeletal / neurological

Spinal abnormalities
Precious fractured pelvis
Neurological deficits

Individual assessment for place of birth:
Gastrointestinal

Liver disease without current abnormal liver function
Crohn’s disease
Ulcerative colitis

Individual assessment for place of birth:
Previous complications

SB / NND with known non recurrent cause
PET at term
Placental abruption with good outcome
History of previous baby > 4.5kg
Extensive vaginal, cervical, 3/4th degree perineal trauma
Previous term baby with jaundice requiring exchange transfusion

Individual assessment for place of birth: Current pregnancy

Antepartum bleeding of unknown origin (single episode after 24/40) BMI at booking 30-35 kg/ M2 Blood pressure of 140 systolic or 90 systolic or more on 2 occasions Clinical or USS suspicion of macrosomia Para 4+ Recreational drug use Under current outpatient psychiatric care >35 years at booking

Individual assessment for place of birth:

Fetal abnormality

Individual assessment for place of birth: Previous Gynae Hx

Major gynaecological surgery Come biopsy or large loop excision of transformation zone Fibroids

Low risk multiparous women transfer from home birth to obstetric unit

115/1000 11.5%

Caesarean section from home birth? Multiparty

7/1000 0.7

AVD from home birth? Multips

9/1000 0.9%

FMU to CLU multiparty

94 9.4%

AMU to CLU Multips

125/1000 12.5%

Home Birth transfer to CLU P0 low risk

450/1000 45%

Low risk P0 transfer to CLU for AVD

126/1000 12.6%

Low risk P0 Blood Transfusion

1.2% 12/1000

Obstetric unit LR P0 CS AVD

12.1% 19.1%

Freestanding MU transfer to obstetric unit (Multips)

94 9.4%

AMU transfer obstetric unit Multips

125 12.5%

Low risk Multips - outcomes for baby Home birth FMU AMU CLU

Babies without serious medical problems Home - 997 With serious medical problems - 3 997/3 998/2 997/3

Low risk nulliparous women Babies without / with serious medical problems Home FMU AMU Obstetric unit

991/9 995/5 995/5 995/5

Main reason for transfer to obstetric unit Home FMU AMU

**Delay 1/2nd stage of labour** Home - 1,144, 32.4% FMU - 912, (37.1%) AMU - 1,548 (35.2%) Meconium staining Home - 432 (12.2%) FMU - 301 (12.2%) AMU - 538 (12.2%) Regional anaesthesia Home - 180 (5.1%) FMU - 163 (6.6%) AMU - 585 (13.3%)