10/11) Labour & Delivery - NICE Intrapartum Care

Question 1

Increased risk in perinatal outcome in low risk primp delivering at home

Answer 1

4 per 1000 (9 per 1000 from 5 per 1000)

Question 2

Rates of transfer to CLC from MLU/home

Answer 2

Approx 10% multips, 40% nullips

Question 3

Most common recent for transfer into hospital

Answer 3

Delay in first/second stage

Question 4

When is maternal pulse an indication to transfer to CLC?

Answer 4

• HR >120 on 2 occasions >30 minutes apart

Question 5

When is maternal blood pressure an indication to transfer to CLC?

Answer 5

> 160/110
OR >140/90 on 2 occasions >30 minutes apart consecutively
OR ++ protein and single BP >140/90

Question 6

When is maternal temperature an indication to transfer to CLC

Answer 6

?Temp >38 or >37.5 on 2 readings 1 hour apart

Question 7

When is vaginal loss an indication to transfer to CLC?

Answer 7

Vaginal blood loss other than show
Significant meconium
PROM >24h

Question 8

When is fetal presentation/size an indication for transfer to CLC?

Answer 8

Abnormal presentation/lie
High (4/5-5/5 palpable) or free-floating head in null
Suspected FGR/macrosomia
Suspected anhydramnios/polyhydramnios

Question 9

When is fetal movements an indication for transfer to CLC?

Answer 9

Reduced in last 24 hours

Question 10

When is maternal pain an indication for transfer to CLC?

Answer 10

Pain different from contractions

Question 11

What to do if I/A indicates possible FHR abnormalities?

Answer 11

Offer CTG and if normal after 20 minutes return to I/A

Question 12

Temperature of water in pool

Answer 12

37.5

Question 13

How long to stay out of pool after opiates?

Answer 13

2 hours

Question 14

When to measure BP during epidural?

Answer 14

Every 5 minutes for 15 minutes during epidural establishment or boluses

Question 15

When to recall anaesthetist if not pain free?

Answer 15

30 minutes

Question 16

When to assess level of sensory block?

Answer 16

Hourly

Question 17

CTG monitoring during epidural

Answer 17

30 minutes during establishment and after administration of each further 10mL bolus

Question 18

Medication in epidural

Answer 18

10-15mL 0.0625-0.1% bupivicaine with 1-2microgram/mL fentanyl.

Question 19

When to auscultate FH during labour?

Answer 19

Every 15 minutes in first stage (for 1 minute after contraction)

Question 20

When should contraction frequency suggest CTG required?

Answer 20

lasting >60s or >5:10

Question 21

FBS results

Answer 21

Normal: >7.25 or lactate <4.1
Borderline: 7.20-7.25 and lactate 4.2-4.8
Abnormal: <7.20 or lactate >4.9

Question 22

When to repeat FBS?

Answer 22

1 hour after normal result or 30 minutes after borderline result

Question 23

What to do if you can’t obtain FBS?

Answer 23

• If accelerations in response to stimulation then decide re: continuing labour v expediting
• If no accelerations in response to stimulation then expedite

Question 24

Average length of labour

Answer 24

P0: Average 8 hours, unlikely >18h
Multiple: Average 5 hours, unlikely >12h

Question 25

How frequent ops in first stage of labour?

Answer 25

30 minutes: Contractions Hourly: Pulse 4 hourly: Temp and BP VE: 4 hourly

Question 26

When to diagnose delay in first stage?

Answer 26

<2cm in 4 hours in either primps or multis. In multips, slowing in progress. Descent and rotation of baby's head. Changes in strength, duration and frequency of contractions.

Question 27

How to manage delay?

Answer 27

- Offer ARM if suspecting delay - Whether ARM accepted or not allow a further 2 hours and if <1cm dilated then consider that diagnostic. - Once diagnosed transfer to CLC and offer synt

Question 28

How to titrate synt?

Answer 28

Every 30 minutes until 4-5:10 contractions

Question 29

When to reassess after starting sync for delay in first stage?

Answer 29

4 hours - if <2cm then consider CS, if >2cm then VE again in 4 hours

Question 30

How often to do VE in 2nd stage?

Answer 30

Hourly

Question 31

When to diagnose delay in second stage?

Answer 31

Primip: Active 2nd stage >2h (suspect if progress inadequate after 1h) Multip: Active 2nd stage >1h (suspect if progress inadequate after 30 minutes)

Question 32

How frequent to have obstetric review for delay in second stage?

Answer 32

Every 15-30 minutes

Question 33

Comparison of active v physiological 3rd stage

Answer 33

N&V: 10% v 5% PPH 1.3% v 2.9% Blood transfusion 1.4% v 4%

Question 34

What is an abnormal neonatal RR suggesting review required?

Answer 34

>60

Question 35

Abnormal neonatal sats?

Answer 35

<95%

Question 36

When to do neonatal obs?

Answer 36

Sig mec: 1h, 2h and then 2h to 12h Non-sig mec: 1h, 2h PROM: 1h, 2h, 6h, 12h