The Labour Ward Handbook

Description

This succinct manual provides detailed clinical practice guidelines for the care of women in labour, this is designed to be a ready guide for use in the delivery suite by the busy clinician. The third edition has been updated to include new developments in clinical practice and governance and new guidelines. So far as is possible, the differences in care scenarios internationally have been addressed to provide a reliable guide to safe delivery. Key Features *Provides detailed clinical practice guidelines for the care of women in labour. *Offers a ready guide for use in the delivery suite by the busy obstetric clinician and all members of the team. *Focuses on the clinical relevance of the problem points arising. Cover Half Title Title Copyright Dedication Contents Preface Acknowledgements About the Author Abbreviations Glossary Bleep/crash calls Part I Approach to care 1 The biopsychosocial approach to care of the woman in labour 1.1 Assessing women’s satisfaction with intrapartum care 2 Communication between care providers 2.1 Early identification and communication of risk 2.2 Handover 2.3 Communication with anaesthetists 3 Documentation 4 Admission to, and discharge home from, the delivery suite 4.1 Admission 4.2 Discharge 5 Learning from clinical incidents 5.1 What is a clinical incident? 5.2 Why do we need clinical incident analysis? 5.3 Reporting clinical incidents 5.4 Learning from clinical incidents 5.5 Confidentiality 6 Transfer of care between professionals 6.1 Background 6.2 Handover by clinical staff 6.3 Transfer of emergencies from primary care 6.4 Transfer between hospitals with the fetus in utero 6.5 Transfer of care between consultants 6.6 Transfer back to the community or GP care 6.7 Transfer to ICU and HDU 6.8 Who is in charge while the woman is in ICU or HDU? 6.9 Return to delivery suite from ICU 7 Reviewing what happened Further reading for Part I Part II Normal and Low-Risk Labour 8 Vaginal examination 8.1 Before vaginal examination 8.2 During vaginal examination 8.3 Details to be recorded 9 Intravenous cannulation 10 Management of normal labour 10.1 Criteria for normal labour 11 Prelabour rupture of membranes at term (37–42 weeks) 11.1 Further management 11.2 Expectant management 11.3 Active management 12 Management of the first stage of labour 12.1 Diagnosis 12.2 Monitoring progress of labour 12.3 Birth plans 12.4 Support person 12.5 Positioning 12.6 Nutrition 12.7 Antacids (including H2-receptor antagonists) 12.8 Pain relief 12.9 Entonox (50% O2 and 50% N2O) 12.10 Opioids (pethidine, diamorphine or other) 12.11 Epidural analgesia 12.12 Bladder care 13 Fetal monitoring 13.1 Intermittent auscultation 13.2 Electronic fetal monitoring 13.3 Suspicious or abnormal trace 13.4 Classification of cardiotocograph (Table 13.1) 13.5 Management of suspicious or pathological cardiotocograph 13.6 Management of fetal tachycardia 13.7 Note 13.8 Management of fetal bradycardia 13.9 Schedule 13.10 Reduced variability (2–5 beats/min) 13.11 Late deceleration 14 Fetal scalp blood sampling 14.1 Contraindications to FBS 14.2 Interpretation of pH result 14.3 Scalp blood lactate 14.4 Documentation 14.5 FBS at full cervical dilatation 15 Augmentation of labour 15.1 Artificial rupture of fetal membranes (ARM) 15.2 Augmentation with Syntocinon 15.3 Syntocinon infusion 15.4 Second stage of labour 15.5 Uterine hyperstimulation 15.6 Management 16 Cord-blood sampling 17 Epidural analgesia in labour 17.1 Indications for epidural analgesia 17.2 Contraindications to epidural analgesia 17.3 Coagulopathy 17.4 Therapeutic/prophylactic anticoagulation 17.5 Setting up 17.6 Procedure 17.7 Method of administration 17.8 Epidural infusion 17.9 Epidural top-up 17.10 Protocol for top-ups 17.11 General care of the woman with an epidural 17.12 In the second stage of labour 17.13 Complications of epidural analgesia 17.14 Dural tap 17.15 Local anaesthetic toxicity (IV injection) 17.16 Total spinal 17.17 Dense motor block 17.18 Bladder distension 17.19 Discontinuation of epidural 18 Management of the second stage of labour 18.1 Duration 18.2 Passive phase 18.3 Active phase 18.4 Immediate versus delayed pushing 18.5 Delayed second stage 18.6 Management of delayed second stage 18.7 Calling the paediatrician 19 Criteria for paediatric attendance at delivery 20 Management of the third stage of labour 20.1 Active management 20.2 If the placenta is not delivered within 30 minutes, refer to the obstetrician 20.3 Physiological management 21 Immediate postpartum care 21.1 Care of the mother 21.2 Bladder care 21.3 Care of the baby 21.4 The placenta 21.5 Documentation 22 Care of the newborn 22.1 Skin-to-skin contact 22.2 Prevention of hypothermia 22.3 Vitamin K 22.4 Identification of the baby 22.5 Breastfeeding 22.6 Management of hypoglycaemia 22.7 Preventive care 23 Meconium-stained amniotic fluid 23.1 Risk to baby 23.2 Note 23.3 Meconium-stained fluid in labour 23.4 Meconium-stained fluid at vaginal delivery 23.5 Meconium-stained fluid at caesarean section 24 Neonatal resuscitation 24.1 Principles 24.2 Avoid thermal stress 24.3 Airway 24.4 Evaluation 24.5 Breathing 24.6 Chest compression 24.7 Drugs used in neonatal resuscitation 24.8 Volume replacement 25 Babies born before arrival at hospital 25.1 Mother 25.2 Baby 26 Episiotomy 27 The woman with a history of childhood sexual abuse 27.1 General measures 27.2 Communication 27.3 Physical examination and procedures 27.4 Flashbacks 28 Use of birthing pool 28.1 Inclusion criteria 28.2 Exclusion criteria 28.3 Conduct of labour 28.4 Support in labour 28.5 Indications for asking the woman to leave the pool 28.6 Delivery 28.7 General Further reading for Part II Part III Abnormal and high-risk labour Section 1 Powers, passenger, passage 29 Caesarean section 29.1 Preparations 29.2 Medication to reduce the risk of aspiration syndrome 29.3 Classification of urgency of CS 29.4 Elective CS 29.5 Workplace noise 29.6 Emergency CS 29.7 Surgical procedure 29.8 Prophylactic antibiotics 29.9 High-risk cases 29.10 Delayed elective CS 29.11 Postoperative care 29.12 Thromboprophylaxis 30 Recovery of obstetric patients 31 High-dependency care 31.1 Early warning score 32 Failed intubation drill 33 Instrumental delivery 33.1 Non-operative interventions which reduce instrumental delivery rates 33.2 Avoiding harm 33.3 Indications for instrumental delivery 33.4 Conditions to be fulfilled before instrumental delivery 33.5 Classification of instrumental vaginal delivery 33.6 Communication 33.7 Choice of instrument 33.8 Pre-application assessment: abdominal and vaginal examination 33.9 Vacuum-assisted delivery 33.10 Procedure 33.11 Contraindications to vacuum-assisted delivery 33.12 Forceps delivery 33.13 Checking for proper application of the forceps 33.14 Kjelland forceps 33.15 Trial of instrumental delivery 33.16 The principle of abandonment 33.17 Post-delivery 33.18 Documentation 33.19 Errors in instrumental vaginal delivery 34 Trial of vaginal delivery after a previous caesarean section 34.1 Contraindications 34.2 Action plan for trial of vaginal delivery 34.3 Use of Syntocinon 34.4 Signs of scar rupture or imminent rupture 34.5 Post-delivery 35 Induction of labour 35.1 Methods 35.2 Artificial rupture of fetal membranes 35.3 Prostaglandin induction of labour 35.4 Monitoring following insertion of prostaglandin 35.5 Precautions 35.6 Hyperstimulation 35.7 Syntocinon infusion 35.8 Uterine hyperstimulation 36 Antenatal corticosteroid therapy 36.1 Indications 36.2 Dose 36.3 Contraindications 36.4 Beta-sympathomimetics 36.5 Repeated doses 37 Preterm prelabour rupture of membranes 37.1 Action plan 37.2 Conservative management 37.3 Mode of delivery, in the absence of other complications 37.4 Induction of labour 37.5 Labour 38 Preterm uterine contractions 38.1 Diagnosis 38.2 Action plan 38.3 Fetal fibronectin test 38.4 Management of established preterm labour (when it is too late to suppress labour) 38.5 Suppression of labour 38.6 Contraindications to suppression of labour 38.7 Nifedipine 38.8 Indomethacin (prostaglandins synthetase inhibitor) 38.9 Atosiban 38.10 Magnesium sulphate for neuroprotection 38.11 Monitoring 39 Deliveries at the lower margin of viability 39.1 Pregnancy under 22 weeks 39.2 Pregnancy over 22 weeks 39.3 Post-delivery care if the baby does not survive 39.4 Support group 40 Multiple pregnancy 40.1 First stage of labour 40.2 Second stage of labour 40.3 Delivery of the second twin 40.4 Third stage of labour 40.5 Indications for CS for second twin 41 Abnormal lie in labour 41.1 Intact membranes 41.2 Ruptured membranes 41.3 Caesarean section 41.4 Difficult cases 41.5 Uterodistension 42 Occipito-posterior position 42.1 Persistent occipito-posterior position 43 Malpresentation 43.1 Brow presentation 43.2 Face presentation 43.3 Compound presentation 44 Breech presentation 44.1 Undiagnosed breech in labour 44.2 Preterm breech in labour 44.3 Breech vaginal delivery 44.4 Caesarean section for breech presentation (elective or emergency) 45 External cephalic version 45.1 Risks of ECV 45.2 Contraindications to ECV 45.3 Cautions 45.4 Action plan 46 The woman with genital cutting 46.1 WHO classification of female genital cutting 46.2 Action plan 46.3 Female Genital Mutilation Act 2003 47 The obese woman in labour 47.1 WHO classification of BMI 47.2 Woman who had bariatric surgery 48 Perineal tear 48.1 Classification of perineal tears 48.2 First- and second-degree tears: episiotomy 48.3 Third- and fourth-degree tears Section 2 Medical conditions 49 Heart disease in labour 49.1 Principles of management 49.2 Action plan 50 Peripartum cardiomyopathy 50.1 Diagnosis 50.2 Risk factors 50.3 Symptoms and signs 50.4 Action plan 51 Pre-eclampsia 51.1 Classification 51.2 Action plan 51.3 Measurement of blood pressure 51.4 Severe pre-eclampsia 51.5 Delivery 51.6 Watch for PPH 51.7 Post-delivery 51.8 Antihypertensive therapy in pre-eclampsia 51.9 Labetalol 51.10 Hydralazine 51.11 Nifedipine 51.12 Anticonvulsant prophylaxis in pre-eclampsia 51.13 Magnesium sulphate blood levels 51.14 Management of magnesium toxicity 51.15 Postpartum 51.16 Post-delivery ward round (days 0–3) 51.17 Fluid management in pre-eclampsia 51.18 Management of oliguria (