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Intrapartum Care > Place Of Birth > Flashcards

Place Of Birth Flashcards

1
Q

Planned birth in obstetric unit for : cardiovascular conditions

A

Confined cardiac disease
HTN disease

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2
Q

Planned birth in obstetric unit for :
Respiratory

A

Asthma requiring an increase in treatment or hospital treatment
Cystic fibrosis

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3
Q

Planned birth in obstetric unit for :
Haematological

A

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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4
Q

Planned birth in obstetric unit for :
Endocrine

A

Hyperthyroidism
Diabetes

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5
Q

Planned birth in obstetric unit for :
Infective

A

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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6
Q

Planned birth in obstetric unit for :
Immune

A

SLE
Scleroderma

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7
Q

Planned birth in obstetric unit for :
Renal

A

Abnormal renal function
Renal disease requiring supervision by a renal Specialist

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8
Q

Planned birth in obstetric unit for :
Neurological

A

Epilepsy
Myasthenia Gravis
Previous CVA

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9
Q

Planned birth in obstetric unit for :
Gastrointestinal

A

Liver disease associated with current abnormal liver function tests

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10
Q

Planned birth in obstetric unit for :
Psychiatric

A

Psychiatric disorder requiring inpatient care

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11
Q

Planned birth in obstetric unit for :
Previous complications

A

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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12
Q

Planned birth in obstetric unit for :
Current pregnancy

A

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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13
Q

Planned birth in obstetric unit for :
Prev gynae history

A

Myomectomy
Hysterotomy

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14
Q

What anaemia requires CLC?

A

> 8.6g/dl

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15
Q

BMI in MLU?

A

<35
30-35 can be in MLU

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16
Q

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

A

MLU

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17
Q

Individual assessment for place of birth:
Cardiovascular

A

Cardiac disease without intrapartum implications

18
Q

Individual assessment for place of birth:
Haematological

A

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

19
Q

Individual assessment for place of birth:
Infective

A

Hepatitis B / C with normal LFTs

20
Q

Individual assessment for place of birth:
Immune

A

Non specific connective tissue disorders

21
Q

Individual assessment for place of birth:
Endocrine

A

Unstable hypothyroidism such that a change in treatment is required

22
Q

Individual assessment for place of birth:
Skeletal / neurological

A

Spinal abnormalities
Precious fractured pelvis
Neurological deficits

23
Q

Individual assessment for place of birth:
Gastrointestinal

A

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

24
Q

Individual assessment for place of birth:
Previous complications

A

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

25
Q

Individual assessment for place of birth:
Current pregnancy

A

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

26
Q

Individual assessment for place of birth:

A

Fetal abnormality

27
Q

Individual assessment for place of birth:
Previous Gynae Hx

A

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

28
Q

Low risk multiparous women transfer from home birth to obstetric unit

A

115/1000
11.5%

29
Q

Caesarean section from home birth?
Multiparty

A

7/1000
0.7

30
Q

AVD from home birth? Multips

A

9/1000
0.9%

31
Q

FMU to CLU multiparty

A

94
9.4%

32
Q

AMU to CLU Multips

A

125/1000
12.5%

33
Q

Home Birth transfer to CLU P0 low risk

A

450/1000
45%

34
Q

Low risk P0 transfer to CLU for AVD

A

126/1000
12.6%

35
Q

Low risk P0 Blood Transfusion

A

1.2%
12/1000

36
Q

Obstetric unit LR P0
CS
AVD

A

12.1%
19.1%

37
Q

Freestanding MU transfer to obstetric unit (Multips)

A

94
9.4%

38
Q

AMU transfer obstetric unit Multips

A

125
12.5%

39
Q

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

A

Babies without serious medical problems
Home - 997
With serious medical problems - 3

997/3

998/2

997/3

40
Q

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

A

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

41
Q

Main reason for transfer to obstetric unit
Home
FMU
AMU

A

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%)

Intrapartum Care (4 decks)

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