scope exam Flashcards
What are the four things to cover in a booking appointment?
- social history
- obstetric history
- current pregnancy
- plan going forward
What are some relevant aspects of social history that would need to be ascertained
- Smoker / drinker?
- support network?
- eligibility for maternity care
- cultural needs
- employment?
- routine enquiry
- travelled to other countries? (risk of TB?)
What are some relevant aspects of obstetric history that would need to be ascertained
- is this first pregnancy?
- how many pregnancies? any terminations or miscarriages?
- how was last birth experience?
- previous mode of birth?
- any complications in last pregnancy, birth or postnatal? (for woman or baby)
What are some relevant aspects of the current pregnancy that would need to be ascertained (in a booking visit)
- How has diet been? (if morning sickness, is she getting enough nutrients)
- how has she been feeling in general? (headaches, swelling, visual disturbances? - if after 20 weeks)
- getting enough iron?
- taking iodine? (and folic acid in first trimester)
- any bleeding?
- feeling baby movements? (if later in pregnacy)
- screenings? (blood, MSS1/2, anatomy scan, GDM?)
- would she like to part-take in antenatal education?
What are birth place options of low risk pregnancy?
- home
- primary unit
- hospital (secondary unit)
what are the benefits / risks (or cons) having a home birth?
- own environment - more relaxed - increased endorphins - natural pain relief
- more control of experience (no institutional rules)
- have who ever you like present
- no pharmaceutical pain medication (could be a con but increases chances of normal physiological birth)
- having to transfer into hospital if anything deviates from normal (such as fetal or maternal distress, slow progress etc).
- outcomes may be more adverse due to transfer time depending on where you live?
pros and cons of birthing at the primary unit
- no pharmaceutical pain relief except for entonox (therefore increased chance of physiological birth)
- usually birthing pools available that can be quickly filled
- midwife led instead of doctor led - therefore protects normal birth
- usually 1;1 postnatal care, double beds for partner to stay, pepi pods for baby.
- may be restrictions of support people allowed
- no epidural or opioid pain relief
- long transfer - 1 hour - to secondary unit if anything is out of ordinary
pros and cons of birthing in the hospital
- pain relief on hand when ever (epidural and opioid pain relief)
- obstetricians on site majority of the time or on call to get there fast if needed - reduces adverse outcomes not having to wait.
- increased exposure to interventions - increasing likely hood of non-physiological birth
- institution rules may make you feel like you’re not in control
- may be restrictions on support people allowed
what physical assessments are undertaken in a routine antenatal appointment? (provide rational)
- urinalysis - for protein and glucose in urine ( glucose could be a marker for GDM, protein could be an indication of preeclampsia due to decreased kidney function)
- blood pressure - normal range (100-139 mmHg (sys) / 40-89mmHg (dia) according to MEWS chart. if outside normal range or 20mmHg above booking blood pressure then this may be of concern - could indicate pre-eclampsia if after 20 / 40)
- Abdominal palpation - fundus, fetal lie, position, presentation, engagement, fundal height (if after 26 weeks), fetal heart - rationale - monitor fetal wellbeing and growth of baby .
- measure height and weight if in booking appointment to ascertain BMI and use in creating customised growth chart.
health information and eduction at a booking appointment?
- discuss role and responsibilities of midwife, backup and how to contact
- discuss logistics, frequency and location of visits
- how to meet cultural needs of women
- who will be involved? (partner/support person)
- discuss place of birth options
- community agencies
- code of consumer rights
- antenatal education
- consent for student involvement
- screening information offered in first trimester
What is involved in a labour assessment?
- admission and ID on arrival at unit
- history - pregnancy, relevant medical Hy and allergies
- history of contractions and SROM? colour of liquor?
- abdominal palpation - ascertain lie, position and decent, auscultate FHR post contraction. (110-160bpm norm range)
- assess PV loss regularly. blood? liquor? mucus?
- assess nature of contractions every hour - length, strength, frequency ;10min, maternal response
- baseline maternal obs: pulse 1hrly, BP - 4hrly, temp, O2 sats, resps (document on MEWS)
- review birth plan with woman
- abdo palp 4 hrly
- VE 4 hrly if consent or more frequently if indicated - to assess cervical dilation, effacement, length, decent of baby’s head and confirm position.
what are the benefits of water immersion in labour and what would be considered contraindications for it?
- natural pain relief owing to reduced anxiety and adrenalin. increased endorphins, natural pain relief and enhances flow of oxytocin - could result in a faster, more manageable labour.
-reduces likelihood for needing other methods of pain relief. - bouyancy and increased mobility
- provides protective and secure birthing space
- contraindications: epidural, recent administration of opioid, feeling faint, if continuous fetal monitor was required and couldnt get a good trace of FHR in water, maternal temp more than 37.5, thick meconium in liqour.
- would need to get out of pool if active management of the third stage is required
what is neagales rule?
first day of LMP, minus 3 months, plus 7 days. (add any days for a longer cycle e.g. if they have a 30 day cycle instead of 28, add an extra 2 days to the date).
what would you share with a woman about when to make contact in labour and how will she know t is time to go to the primary unit?
regular contractions - 3:10 minutes lasting 45-60 seconds each.
could contact before this if requiring more support or can let me know if suspected in early labour and its not night time.
contact any time day or night if waters break and liqour is green, black or brown. Or if actively bleeding.
contact if fetal movements reduce
ensure she has the right contact information for me and the backup midwife
benefits of upright positions in labour
Upright positions in labour can be a great way to distract from the pain and to move according to body’s needs
gravity can assist with descent and reduce risk of an instrumental birth
