Best Practice in Labour and Delivery

 

Description:

In light of new recommendations for intrapartum care, this fully updated second edition offers a review of best practice in all aspects of labour and delivery. This authoritative guide incorporates revised recommendations from the latest MBRRACE-UK Report, NICE guidelines, Cochrane Reviews and RCOG Green-top Guidelines to provide advice that is in line with the latest research and practice. New chapters cover the aspects of non-technical skills, ranging from leadership and team work to situational awareness and decision making. This edition also emphasises the problem of adherent placenta and discusses how it should be managed. With its modern, evidence-based approach, Best Practice in Labour and Delivery is the ideal textbook for those training in labour ward practice and studying for postgraduate examinations. Offering clear and practical guidance, this comprehensive book will help all obstetricians, obstetric anaesthetists, midwives and nurse practitioners to understand and deliver the best clinical care to patients.

 

Table of Contents:

 

Chapter 1 Pelvic and Fetal Cranial Anatomy and the Stages and Mechanism of Labour

Introduction

Anatomy of the Female Pelvis

Anatomy of the Fetal Skull

The Uterus During Pregnancy

Uterine Size

Uterine Shape and Position

Uterine Vascular Adaptations

Uterine Contractility

Length of Pregnancy and Initiation of Labour

Length of Pregnancy

Initiation of Labour

Maternal Endocrine and Genetic Influence

Fetal Influence

Clinical Assessment During Pregnancy and Labour

Abdominal Palpation

First Manoeuvre

Second Manoeuvre

Third Manoeuvre

Fourth Manoeuvre

Symphysio-Fundal Height

Presentation

Engagement

Lie

Position

Attitude

Asynclitism

Pelvic Examination

Clinical Pelvimetry

Cervical Assessment

Cervical Effacement

Cervical Dilatation

Cervical Position

Cervical Consistency

The Station

Stages and Duration of Normal Labour

First Stage

Second Stage

Third Stage

Mechanism of Labour

Engagement

Descent

Flexion

Internal Rotation

Extension

External Rotation (Restitution)

Expulsion

Maternal Pushing in Labour

References

Chapter 2 The First Stage of Labour

Normal Labour

Nomograms of Cervical Dilatation

Diagnosis of Labour

Management of the First Stage of Labour

Initial Assessment

General Examination

Abdominal Examination

Vaginal Examination

Investigations

Observations During the Established First Stage of Labour

Mobility and Posture in Labour

Use of Analgesia and Anaesthesia

Meconium

Diagnosis of Poor Progress of Labour

Management Options: Augmentation Indications

When to Augment Labour

Practical Aspects of Labour Management

Augmentation in the Latent Phase of Labour

Augmentation in the Active Phase of Labour

The Role of Artificial Rupture of the Membranes (Amniotomy – or ARM)

Oxytocin Dosage and Time Increment Schedules

Achievement of Optimal Uterine Activity

The Measurement of Uterine Contractions

Duration of Augmentation

Summary

References

Chapter 3 Analgesia and Anaesthesia in Labour

The Pain of Labour

Why Labour Hurts

The Effects of Pain and Pain Relief

Supporting Women's Choices During Childbirth

Preparing for Childbirth

Midwife-led Pain Relief

Relaxation Techniques

TENS (Transcutaneous Electrical Nerve Stimulation)

Inhaled Analgesia

Pethidine (Meperidine) and Other Intramuscular Opioids

Methods Not Based in Evidence

Invasive Methods for Pain Relief

Lumbar Epidurals

Technique for Lumbar Epidural

Effect on the Progress and Outcome of Labour

PDPH (Post-Dural Puncture Headache)

Intrapartum Fever

Other Complications

Combined Spinal-Epidural

Intravenous Opioids

Remifentanil

Other Opioids

Anaesthesia in Labour

Choice of Technique and Preparation

Lumbar Epidural Anaesthesia

Spinal Anaesthesia

Height of Block Required

Principal Complications of Regional Anaesthesia

Pain

High Block

General Anaesthesia (GA)

Caesarean Section Considerations

Following up Mothers After Regional Blocks or GA

Further Reading

References

Chapter 4 Intrapartum Fetal Monitoring

Introduction

Monitoring During Initial Assessment

Intermittent Auscultation

Meconium-stained Amniotic Fluid

Intermittent Electronic Fetal Monitoring

Admission Test (AT) Cardiotocography

Continuous Electronic Fetal Monitoring

Interpretation of CTG

Baseline Rate

Baseline Variability

Accelerations

Decelerations

Early Decelerations

Late Decelerations

Variable Decelerations

Prolonged Decelerations

Sinusoidal Pattern

Categorization of CTGs Based on the Features of the Trace

Conservative Measures

Testing Fetal Well-being by Adjunct Technology

Fetal Stimulation

Fetal Scalp Blood Sampling

Fetal Electrocardiogram (ECG): ST Waveform Analysis

Fetal Pulse Oxymetry (FPO)

Conclusion

References

Chapter 5 Uterine Contractions

Introduction

Physiological Basis of Uterine Contractions

Measurement of Uterine Activity: The Need and the Methods

Maternal Perception

Contraction Assessment by Manual Palpation

Contraction Assessment by External Tocography

Contraction Assessment by Internal Tocography

Uterine Electromyography (EMG)

Quantification of Uterine Activity

Uterine Activity Measurement

Uterine Activity in Normal Labour

Uterine Contractions and Parity

Maternal Characteristics that Affect Uterine Contractions

Uterine Contractions and Previous Caesarean Section (CS)

Uterine Contractions and Induced Labour

Abnormal Contraction Patterns (In-Coordinate Uterine Contractions)

Conclusion

References

Chapter 6 The Management of Intrapartum ‘Fetal Distress’

Introduction

Fetal Asphyxia and ‘Fetal Distress’ in Labour: Definitions

Perinatal Mortality and Morbidity

The Consequences of Intervention for Fetal Distress

Management of ‘Fetal Distress’: Decision Making

The Fetal Reserve

Assessment of Fetal Reserve: Preparation Before Labour

The Cause of Fetal Distress in Labour

Contractions and Placental Blood Flow

Cord Compression

Failure to Progress or Dystocia

Maternal Positioning

Sudden Dramatic Events

Vasa Praevia

Cord Prolapse

Abruption

Uterine Rupture

Intrauterine Resuscitation

Maternal Positioning in Left Lateral

Stopping the Contractions

Tocolysis

Intravenous Fluids

Amnioinfusion

Oxygen

Delivering the Fetus

Caesarean Section or Operative Delivery

Forceps or Vacuum Delivery

Managing Fetal Distress: Non-technical Skills

How Do We Make the ‘Right’ Decisions?

The Nature of High-Velocity Decision Making

Filtering of Information is Crucial

Conclusions

References

Chapter 7 Nutrition and Hydration in Labour

Introduction

Practical Obstetric Considerations

Changes in Obstetric Anaesthetic Practice

General Anaesthesia

Diminishing Rates of General Anaesthesia

Regional Anaesthesia and Analgesia

Oral Intake in Labour

Unrestricted Diet in Labour

Restricted Diet in Labour

Low-Carbohydrate ‘Sport Drinks’

Patient Choice

Conclusion

References

Chapter 8 Prolonged Second Stage of Labour Including Difficult Decision Making on Operative Vaginal Delivery and Caesarean Section

Introduction

Duration of the Second Stage of Labour

Outcomes of Prolonged Second Stage of Labour

Causes of Prolonged Second Stage of Labour

Epidural Anaesthesia and Prolonged Second Stage of Labour

How to Avoid Prolonged Second Stage of Labour

Support in Labour

Women's Position in the Second Stage of Labour

Pushing in the Second Stage of Labour

Oxytocin Augmentation

Role of Episiotomy in Prolonged Second Stage of Labour

Operative Delivery in the Second Stage of Labour

Assessment Prior to Operative Delivery

Vacuum vs. Forceps

Deciding Between Operative Vaginal Delivery and Caesarean Section

Conclusion

References

Chapter 9 Instrumental Vaginal Deliveries

Introduction

Indications

Contraindications

Prerequisites for Safe IVD

Vacuum-assisted Deliveries

Forceps Deliveries

Delivery in Malposition of the Fetal Head

Complications

Maternal Injuries

Fetal Injuries

Scalp Bruises and Lacerations

Cephalhaematoma

Subgaleal Haemorrhage and Cranial Trauma

Intracranial Trauma

Nerve Injury

Choice of Instrument

Conclusion

References

Chapter 10 Caesarean Deliveries

Introduction

Classification of CS

Indications for CS

The Incidence of CS

Techniques

Complications

Early Maternal Complications

Conclusions

References

Chapter 11 Breech and Twin Delivery

Breech Birth

Breech Birth at Term

External Cephalic Version (ECV)

Efficacy

Techniques to Improve Success

Safety

Uptake

Conduct of ECV

Vaginal Breech Birth

Selection for Vaginal Breech Birth

Conduct of Labour

Conduct of Breech Birth

Assisted Breech Delivery

Bracht Technique

Manoeuvres for Delay in Delivery of the Arms

Lovset's Manoeuvre

Classical Arm Development

Nuchal Arms

Head Entrapment

Multiple Birth

Multiple Birth at Term

Vaginal Twin Birth

Selection

Conduct of Labour

Fetal Monitoring

Analgesia

Oxytocin Augmentation

Birth of Twin 1

Birth of Twin 2

Twin 2 Cephalic

Twin 2 Non-cephalic

Inter-Twin Delivery Interval

Preterm Breech and Twin Birth

References

Chapter 12 Cord Prolapse and Shoulder Dystocia

Umbilical Cord Prolapse

Definition

Pathophysiology of Cord Prolapse

Neonatal Morbidity and Mortality Associated With Cord Prolapse

Incidence and Risk Factors

Prediction

Prevention

Management

Recognition of Cord Prolapse

Call for Help

Prepare for Immediate Delivery and Minimize Cord Compression

Reducing Cord Compression

Digital Elevation

Maternal Positioning

Bladder Filling

Assess Fetal Well-being

Prepare for Immediate Delivery

Delivery

Neonatal Resuscitation

Documentation

Shoulder Dystocia

Definition and Incidence

Pathophysiology of Shoulder Dystocia

Antenatal Risk Factors for Shoulder Dystocia

Macrosomia

Previous Shoulder Dystocia

Maternal Diabetes Mellitus

Instrumental Delivery

Maternal Obesity

Parity

Gestational Age

Intrapartum Risks

Prediction

Prevention

Management

Recognition of Shoulder Dystocia

Call for Help

Clearly State the Problem

McRoberts’ Position

Suprapubic Pressure

Evaluate the Need for an Episiotomy

Internal Manoeuvres

Delivery of the Posterior Arm

Internal Rotational Manoeuvres

All-fours Position

Additional Manoeuvres

Cephalic Replacement Followed by Caesarean Section

Symphysiotomy

What Not To Do

Do Not Pull Hard, Do Not Pull Quickly, Do Not Pull Down

Do Not Apply Fundal Pressure

Documentation

After the Birth

Maternal Morbidity Associated With Shoulder Dystocia

Neonatal Morbidity and Mortality Associated With Shoulder Dystocia

Brachial Plexus Injury

Risk of Brachial Plexus Injury

Classification of Brachial Plexus Injury

Erb's Palsy

Klumpke's Palsy

Total Brachial Plexus Injury

Other Fetal Injuries

Lessons for Training

References

Chapter 13 Antepartum Haemorrhage

Introduction

Aetiology

Diagnosis and Management

History

Physical Examination

Initial Management and Investigations

Placenta Praevia

Clinical Implication

Maternal Risks

Fetal Risks

Diagnosis

Clinical

Screening for Low-Lying Placenta

Management Options

Immediate Delivery

Expectant Management

Mode of Delivery

Vasa Praevia

Placenta Percreta/Accreta

Placental Abruption

Risk Factors and Aetiopathogenesis

Clinical Implication

Maternal Risks

Fetal Risks

Diagnosis

Clinical

Ultrasonography

Management Options

Expectant Management

Immediate Delivery

Management of complications

Haemorrhagic Shock

Disseminated Intravascular Coagulation

Renal Failure

Postpartum Haemorrhage

Subsequent Pregnancy After Placental Abruption

References

Chapter 14 Management of the Third Stage of Labour

Physiology of the Third Stage of Labour

Placental Separation

Signs of Placental Separation

Haemostasis

Vaginal Examination and Assessment of the Perineum After the Birth of the Baby

Third Stage Management

Expectant Management

Active Management

Uterotonic Drugs Used in the Third Stage of Labour (Table 14.2)

Delayed Cord Clamping

Controlled Cord Traction

Management at Caesarean Section

Retained Placenta

Aetiology of Retained Placenta

Risk Factors for Retained Placenta

Management of Retained Placenta

Technique of Manual Removal of the Placenta

Retained Placenta Under Special Circumstances

Women at Risk of Postpartum Haemorrhage

Risk Factors for PPH [6]

Antenatal risk factors

Intrapartum risk factors

Prevention of Postpartum Haemorrhage is Much Easier than its Treatment

Postpartum Care

Errors in the Management of the Third Stage and their Sequelae

Conclusion

References

Chapter 15 Postpartum Haemorrhage

Pathophysiology

Risk Factors for PPH

Causes of PPH

Role of the ‘Rule of 30’ and ‘Obstetric Shock Index’ in Estimation of Blood Loss

Management

Resuscitation

A and B: Assess Airway and Breathing

C: Circulation

Pharmacological Treatment of Postpartum Haemorrhage

Surgical Management of Intractable Postpartum Haemorrhage

Uterine Tamponade

Compression Sutures

Systematic Pelvic Devascularization

Selective Arterial Embolization

Subtotal or Total Abdominal Hysterectomy

Current Concepts and New Developments

Systemic Haemostatic agents

Tranexamic Acid

Recombinant Activated Factor VII

Cell Salvage

Non-pneumatic Anti-shock Garment (NASG)

Blood and Blood Products

The Triple P Procedure for Morbidly Adherent Placentae

Conclusion

References

Chapter 16 Management of Morbidly Adherent Placenta

What is Morbidly Adherent Placenta?

What Causes MAP?

Why is MAP Important?

Can MAP be Prevented or Predicted?

Antenatal Care of Women with MAP

How is MAP Diagnosed?

Antenatal Monitoring and Place of Care

Management of Delivery in Patients With MAP

Peripartum Hysterectomy

Uterine Conserving Measures

Intentional Retention of the Placenta (IRP)

Triple P Procedure

Other Uterine Conserving Approaches

Role of Interventional Radiology

Management of Significant Bladder or Ureteric Invasion

Key Learning Points

References

Chapter 17 Acute Illness and Maternal Collapse in the Postpartum Period

Introduction

Incidence

Causes

Presentation

Management

Immediate Management

Resuscitation and Stabilization

Assessment

Subsequent Management

Specific Conditions

Hypertensive Disorders

Postpartum Haemorrhage

Genital Tract/Abdominal Sepsis

Amniotic Fluid Embolus

Peripartum Cardiomyopathy

Thromboembolic Disease

Pulmonary Embolism

Cerebral Vein Thrombosis

General Anaesthesia

Aspiration Pneumonitis

Atelectasis, Respiratory Depression and Airway Obstruction

Regional Anaesthesia

Cardiac Disease

Myocardial Infarction

Aortic Dissection

Arrhythmias

Respiratory Disease

Asthma

Pneumonia

Adverse Drug Reactions

Anaphylaxis

Toxicity/Side-Effects

Drug Withdrawal

Metabolic

Primary Neurological

Epilepsy

Stroke/Cerebrovascular Accident (CVA)

Posterior Reversible Encephalopathy Syndrome (PRES)

Other Non-Obstetric

Air Embolus

Vasovagal Syncope

Other Vascular

Other Considerations

Summary

References

Chapter 18 Episiotomy and Obstetric Perineal Trauma

Applied Anatomy

Anatomy of the Perineum

Urogenital Triangle

Anal Triangle

Perineal Body

Levator Ani

Classification

Episiotomy

Indications for Episiotomy

Diagnosis of Perineal Trauma

Management and Repair of Perineal Trauma

First-Degree Tears and Labial Lacerations

Episiotomy and Second-Degree Tears

Third- and Fourth-Degree Tears

Postoperative Care

Follow-up

Management of Subsequent Pregnancy

Medico-legal Considerations

Training

Prevention

Conclusions

References

Chapter 19 Induction of Labour

Introduction

Definition

Factors Determining Success of Induction of Labour

Parity and Cervical Status

Changes in the Cervix

Uterine Contractions

Position of Vertex

Body Mass Index

Role of Cervical Length Measurement by Ultrasound and Fetal Fibronectin

Methods of Induction of Labour

Pharmacological Methods

Dinoprostone (PGE2)

Evidence

Gel versus Tablets

Misoprostol (PGE1)

Evidence

Oral versus Vaginal Misoprostol

Oxytocin

Evidence

Non-Pharmacological Methods

Mechanical Methods

Evidence

Other Methods of Mechanical Induction

Amniotomy (ARM – Artificial Rupture of Membranes)

Sweeping Membranes

Mifepristone

Indications for Induction of Labour

Risks Associated with Induction of Labour

Place of Induction of Labour

Evidence for IOL in Various Obstetric Situations

Prolonged Pregnancy

Prelabour Rupture of Membranes (PROM) at Term

Fetal Macrosomia

Overt Diabetes and Gestational Diabetes Mellitus (GDM)

Pre-eclampsia

Intrauterine Growth Restriction (IUGR)

Vaginal Birth After Caesarean (VBAC)

Intrauterine Fetal Death (IUFD)

Other Indications

Failed Induction of Labour

Definition

Reasons for Failed Induction of Labour

Failed Induction of Labour: Suggestions to Improve the Vaginal Delivery Rates

Antenatal Counselling

Management Options after Failed Primary Induction

Summary

References

Chapter 20 Preterm Prelabour Rupture of Membranes (pPROM)

Introduction

Aetiology and Pathophysiology

Diagnosis and Initial Assessment

Current State of the Management of pPROM

Appropriate Setting for Management

Timing of Delivery

Antibiotic Therapy to Prolong Latency and Prevent Neonatal Morbidity After pPROM

Tocolysis

Antenatal Corticosteroids Administration

Group B Streptococcal Colonization and pPROM

The Role of Amniocentesis

Conclusions

References

Chapter 21 The Management of Preterm Labour

Background

Mortality and Morbidity Associated with PTB

Financial Cost of PTB

Diagnosis of Genuine Preterm Labour

The Use of Transvaginal Ultrasound Scanning of Cervical Length or Measurement of Fetal Fibronectin for the Diagnosis of SPTL

Contraindications to Intervention in SPTL

Tocolytics for the Inhibition of SPTL and PTB

Historical Perspective

Tocolytic Myths and Legends

Maintenance Therapy

Efficacy of Tocolytics for the Inhibition of Preterm Labour

Prostaglandin Synthetase Inhibitors

β2-agonists

Pathophysiology of Pulmonary Oedema with the Use of β2-agonists

Calcium Channel Blockers

Oxytocin Receptor Antagonists

The Worldwide Comparative Trial of Atosiban Versus β2-agonists

The 2005 Cochrane Systematic Review of Oxytocin Receptor Antagonists

Safety of Tocolytics

Cardiovascular Actions of Nifedipine

Safety Concerns for Nifedipine

Cost of Tocolytic Therapy

International Differences in the Choice of First Line Tocolytic

In Utero Transfer

Antepartum Glucocorticoids

Intrapartum Monitoring of Preterm Infants

Mode of Delivery of the Preterm Infant

Mode of Delivery of the Preterm Infant Presenting Cephalically

Mode of Delivery of the Preterm Infant Presenting by the Breech

Vaginal Operative Deliveries of the Preterm Infant

Preterm Prelabour Rupture of the Membranes

Management of SPTL at the Limits of Viability

Magnesium Sulphate as a Neuroprotective in the Management of PTB

Conclusions

References

Chapter 22 Labour in Women with Medical Disorders

Introduction

Heart Disease

Managing Anticoagulation

Timing of Delivery

Mode of Delivery

Effective Regional Analgesia

Monitoring

Infective Endocarditis

Postpartum Haemorrhage

Postpartum Care

Thrombosis

Intrapartum Management of Anticoagulation

Intrapartum Anticoagulation Management in Specific Situations

Women Receiving Prophylactic Low-Dose LMWH for Recurrent Miscarriage or Previous Adverse Pregnancy Outcome

Women Receiving Prophylactic Low-Dose LMWH for VTE Prophylaxis Because of Previous VTE or Other Identified Risk Factors for VTE

Women Fully Anticoagulated with LMWH

VTE in the Current Pregnancy [4]

Metal Heart Valves

Women Presenting in Labour or Needing Urgent Delivery Fully Anticoagulated on Warfarin or Heparin

Thrombocytopenia

Imminent Delivery with a Platelet Count

Inherited Coagulation Deficiencies

Haemophilia and von Willebrand Disease (VWD)

Treatment

Delivery

Postnatally

Sickle Cell Disease

Diabetes

Pre-Existing Diabetes

Delivery

Diabetic Control in Labour and Delivery

Diabetic Control Postpartum

Neonate

Gestational Diabetes

Delivery

Diabetic Control

Addison's Disease

Asthma

Cystic Fibrosis

Epilepsy

Myasthenia Gravis

Drug Use and Drug Interactions in MG

Neonatal Myasthenia Gravis

Puerperal Infection

Berry Aneurysms and Cerebral Arteriovenous Malformations

Infectious Diseases

HIV

Mode of Delivery

Antiretroviral Treatment

Untreated Women with HIV in Labour

Hepatitis B

Hepatitis C

Genital Herpes

Renal Disease

Obstetric Cholestasis

References

Chapter 23 Management of Women with Previous Caesarean Section

Introduction

Antenatal Management

Contraindication to TOLAC

Benefits and Risks of TOLAC vs ERCD

Maternal Benefits and Risks of TOLAC vs ERCD

Short-Term Maternal Outcomes

Long-Term Maternal Outcomes

Fetal and Neonatal Benefits and Risks of TOLAC vs ERCD

Overall

Factors Affecting VBAC in TOLAC

Counselling on Mode of Delivery

Labour Management for TOLAC

Setting

Analgesia and Anaesthesia

Induction and Augmentation

Membrane Stripping

Oxytocin

Prostaglandins E2

Trans-cervical Balloon Catheter

Misoprostol

Uterine Rupture

Predicting Uterine Rupture

Consequence of Uterine Rupture

Maternal Risks

Perinatal Risks

Diagnosis of Uterine Rupture

Labour Monitoring

Third Stage Management

Special Clinical Situations

Breech

Twin

Fetal Macrosomia

Preterm Pregnancy

Prolonged Pregnancy

Previous Low Vertical Incision

Unknown Type of Previous Uterine Incision

Two Previous Caesareans

TOP or IUD

TOLAC in Midwifery Practice

Hospital-based Midwifery Practice

Out-of-hospital TOLAC

Unconventional TOLAC

ERCD

Timing of ERCD

Adhesion Prevention in ERCD

Conclusion

References

Chapter 24 Rupture of the Uterus

Introduction

Epidemiology

Classification and Risk Factors

Previous Caesarean Section

Previous Uterine Surgery

Obstructed Labour

Congenital Uterine Malformations and Connective Tissue Disorders

Induction of Labour and Termination of Pregnancy

Trauma

Mechanisms

Clinical Features

Antepartum Rupture

Intrapartum Rupture

Postpartum Rupture

Findings on Laparotomy

Diagnosis

Management

Differential Diagnosis

Complications

Maternal

Perinatal

Reproductive Outcome

Conclusion

References

Chapter 25 Management of Severe Pre-Eclampsia/Eclampsia

Introduction

Presentation and Diagnosis

Definitions

The Problem

How Should Women be Assessed at Initial Presentation?

How Should the Blood Pressure be Taken?

How Should the Woman be Monitored?

What Further Tests are Required?

Uric Acid

Urea and Creatinine

Platelets

Liver Function Tests

Fluid Management

How Should the Fetus be Assessed?

Pre-delivery Care

General Measures

Antihypertensive Therapy

Labetalol

Nifedipine

Hydralazine

Methyldopa

Management of Seizures

How Should Seizures be Prevented?

How Should Fluid Balance be Managed?

Thrombo-prophylaxis

Delivery Guidelines

Gestation Before 34 Weeks

Gestation Between 34 and 37 Weeks

Gestation After 37 Weeks

The Delivery

Anaesthesia and Fluids

How Should the Woman be Managed Following Delivery?

Postpartum Fluid Management

HELLP Syndrome

Ongoing Care and Discharge

References

Chapter 26 Neonatal Resuscitation and the Management of Immediate Neonatal Problems

Introduction

Opening the Airway

Resuscitation of the Premature Baby

Continuous Positive Airway Pressure (CPAP)

Cord Clamping

Meconium-stained Liquor

Babies Born Outside Hospital

Babies with Congenital Abnormalities

Persistent Pulmonary Hypertension of the Newborn (PPHN)

Shock

Summary

References

Chapter 27 The Immediate Puerperium

The Postnatal Check

Maternal Observations

Infant Care

Infant Feeding

Mental State

General Health

Puerperal Complications

Postpartum Haemorrhage

Postpartum Haematomas

Sepsis

Ogilvie's Syndrome

Venous Thromboembolism and Pulmonary Embolus

Postnatal Hypertension

Anaesthetic Complications

Pelvic Girdle Pain

Urine Infection

Lower Urinary Tract Dysfunction

Pelvic Organ Prolapse

Wound Breakdown

Breast Pain

Anaemia

Mental Health

Stillbirth

Conclusion

References

Chapter 28 Triage and Prioritization in a Busy Labour Ward

Introduction and Definition

Triage and Prioritization in Obstetrics

Staffing

Space

Workload

General Principles of Triage and Prioritization in Obstetrics

Clinical Scenarios

Clinical Scenario A

Clinical Scenario B

References

Chapter 29 Risk Management in Intrapartum Care

Introduction

Implementing Risk Management in the Delivery Suite

Raising Awareness

What Patient Safety Incidents Occur in Intrapartum Care?

What are the Underlying Causes of Patient Safety Incidents in Intrapartum Care?

Design for Safety

Standardization of Care

Good Handover Practice

Maintaining Situational Awareness

Appropriately Interpreting and Responding to CTGs

Judicious Use of Oxytocin

Early Detection of Deterioration in Maternal Condition and Responding Appropriately

Involve Users

Collect and Analyse Data

Learn from Patient Safety Incidents

Conclusion

References

Chapter 30 Team Working, Skills and Drills on the Labour Ward

Background

Team Working

Knowledge, Skills and Attitude (KSA)

Communication

Leadership

Situational Awareness

Shared Mental Methods

Teamwork Training: Why Bother?

Acquisition of Knowledge and Skills

Satisfaction of Learners

Change in Attitude

Clinical Behaviours

Patient and Organizational Outcomes

Patient Safety

Patient Satisfaction

Cost-Effectiveness

Teamwork Training: How Should We Organize It?

Lessons for Training

Organizing Effective Skills and Drills Training

Course Planning and Administration

Access

Location

Scenarios

Facilitation

Patient-Actors

Equipment

Record Keeping

Objectives, Feedback and Assessment

Frequency of Training

Additional In-House Training

Summary

Conclusion

References

Chapter 31 Cerebral Palsy Arising from Events in Labour

Introduction

Definition of Cerebral Palsy

Classification of Cerebral Palsy

Diagnosis of Cerebral Palsy

Pathogenesis and Risk Factors

Cerebral Palsy Arising from Events in Labour

Hypoxic-ischaemic Encephalopathy

Neuroimaging

Antenatal Approaches to the Prevention of Cerebral Palsy

Acknowledgements

References

Chapter 32 Objective Structured Assessment of Technical Skills (OSATS) in Obstetrics

Background

How do OSATS Fit into the RCOG Training Curriculum?

OSATS Requirements

Undertaking an OSATS

Formative vs. Summative Assessment

The Formative Assessment

The Summative Assessment

OSATS in Practice

The Future

Appendices

Appendix 32.1: Example of Formative Assessment

Appendix 32.2: Example of Summative Assessment

References

Chapter 33 Non-Technical Skills to Improve Obstetric Practice

Introduction and Background

Patient Safety and Error

Human and Systems Error

Errors and Violations

Errors

Execution Errors

Mistakes

Violations

Managing Error in Health Systems

Non-Technical Skills: Cognitive Components

Situation Awareness (or Situational Awareness)

Decision Making

Improving Decision Making

Non-Technical Skills: Social Components

Teamwork

Leadership, Followership and Assertiveness

Leadership

Followership and Assertiveness

Communication

Handover Tools

Closed-Loop Communication

Non-Technical Skills: Coping with Tiredness and Fatigue

Conclusion

References

Index

 

An aparitie	24 Nov. 2016
Autor	Sir Sabaratnam Arulkumaran
Dimensiuni	19.05 x 2.54 x 25.15 cm
Editura	Cambridge University Press
Format	Paperback
ISBN	9781107472341
Limba	Engleza
Nr pag	431