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Summary: Intrapartum Care
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1 Intrapartum Care
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Movement of head in labour
Engagement
Descent & flexion
Rotation (90 degrees internal rotation so face is facing sacrum)
Further decent
Extension & delivery
Restitution (external rotation) -
Food & Water in Pregnancy
Avoid food in case of anaesthetic (Mendelson's syndrome)
Encourage to drink water -
Urinary tract in labour
Retention can damage detrusor muscle.
Epidural removes bladder sensation
Catheter if needed -
Define primary postpartum haemorrhage
Loss of > 500ml blood within 24hrs of delivery (or 1L after C-section) -
What are the rare causes of PPH?
Uterine rupture
Cervical tear
High vaginal tear
Coagulopathy
- DIC
- Congenital
- Anticoagulation therapy -
What are the risk factors for a PPH? (10)
Previous history
Previous C-section
Coagulation defect or anticoagulant therapy
Instrumental/C-section delivery
Retained placenta
Antepartum haemorrhage
Polyhydramnios/muliplpregnancy
Grand multiparity
Uterine malformation or fibroids
Prolonged and induced labour -
What can be done to prevent a PPH?
Routine we give oxytocin which reduces the incidence by 60%
As effective as ergometrine (this can cause vomiting)
Contraindicated in hypertension -
What are the clinical features of a PPH?
Blood loss
Enlarged uterus = uterine cause (above level of umbilicus)
Inspect vagina and cervix -
What are the 4 T's of causes for PPH?
Tone
Tissue
Trauma
Thrombin -
What are the 4 R's of management of PPH?
Remedy the cause
Replace volume
Replace O2
Replace clotting factors
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