Intrapartum Care Flashcards
(49 cards)
Where low and high risk NP and MP women deliver
NP low risk: Midwifery unit (not home)
MP low risk: home or midwifery units
any high risk in Obstetrics unit
the most common neontatl problems that require obstetric unit delivery
Neonatal encephalopathy and MEconium aspiration syn. 75%
the only indication for home birth
Multiparous lowrisk
the only indication for obstetric unit delivery
any high risk patient MP, NP
what to use in inhalaation anlagesia
Entonox (50% Oxygen - 50% Nitrous oxide)
s.e: nausea and light head
recommended water temp in water birth
37.5 degrees
and must be checked hourly
Non pharmacological pain relief methods in labour
- transucutanous electric nerve stimulation TENS
- Sterile water Injection
- Inhalation analgesia ENTONOX
- Water birth
Pain relief by sterile water injection, where to inject and it lasts for how long?
- four points around rhombus of michaelis, 0.1 ml intracutaneously or 0.5 ml SC at each point
- it relief back pain for 10 mins to 3 hours
Stages of labor
1st:
- latent: till 4 cm
- established: 4-10 cm
2nd:
-passive: no pushing
- active: pushing
3rd:
- passive
- active: Oxytocin - Clamping after 1 min - CCT
the idea of water birth
increase in uterine perfusion -> promtoe endorphin and oxytocin release
benifits of water birth
- less pain
- reduction in duration of first stage of labour
- less subsequent analgesia needed
what are tupes of pharamcological analgesia we use in labour
- opioids: pethedine, diamorphine + antiemitic
- 40 ug IV Remifentanil PCA
40 ug Remifentanil vs Pethedine
- less: epidural - OVD
- more: spont. vaginal delivery - need supplemental O2
What are prerequisite for PCA?
40 µg remifentanil
1 to 1 care
CEFM
Oxygen easy axis
Respiratory function monitoring (breathing, and pulse oximeter)
Side effects of regional anesthesia
-may cause severe postnatal headache
-No effects on first stage of labor
-prolong second stage of labor
-More OVD
-Mobility may be reduced
What types of regional analgesia we can use during labor
Either epidural or combined spinal epidural (faster)
What drug we use in maintaining epidural or combined spinal spinal epidural during labor
Low concentration of BUPIVACAIN + 2 ug fentanyl
Low: 0.06 to 0.1%, don’t use high dose 0.25
When to adminster regional analgesia in labour
In women in severe pain on latent 1st stage of labor
If woman has ROM at term what to do
Either:
1. Induce now
2. Wait 24 hours (60% of patients commence labour)
Risk of infextion in ROM vs intact membranes
ROM: 1%
Intact: 0.5%
Do we do vaginal examination in ROM
If certain: no PV if no contractions
If not: speculum examination
When to give pump inhibitors in 1st stage of labour
- if you give opioids
- If CS is more likely
Duration of 1st stage of labour
NP: 8-18
MP: 5-12
If there is meconium what to do
- CEFM
- May need ANLS
- Its common at full term but also need assessment
