No useful history could be obtained, and Ms. S did not cooperate with attempts to evaluate the status of her pregnancy. Contractions increase in intensity with walking. The total dose of oxytocin required was also proportional to BMI. B. Dilatation: process by which external os enlarges from a few millimeters to approximately 10 cm. Following admission procedures, observe for degree of cervical dilatation. A control group was not used and hence outcomes are presented as simple percentages. 190). Involuntary: cannot be controlled by will of client. 4. Box 1 Clinical governance in all settings … Variability (baseline): irregular fluctuations in the baseline FHR; usually at least two cycles/min (humps) and ranges between 6 and 25 beats/min (jagged line). D. Fontanels: points where sutures intersect. National Institute for Health and Clinical Excellence (NICE) recommends the use of membrane sweeping and vaginal prostaglandin E2 followed by artificial rupture of membranes and syntocinon augmentation where necessary. 2. 4. A hospital-based trial from South Africa found no impact, however, of maternal vaginal and newborn skin cleansing with chlorhexidine on rates of neonatal sepsis or the vertical acquisition of potentially pathogenic bacteria among neonates [124]. Maternal–Newborn Nursing: Duration of Labor. J. F. Encourage deep ventilation prior to and after each contraction to avoid hyperventilation. F. Determine client’s psychological state and readiness for coping with labor: some clients may complain of intense pain in very early labor. Chiswick and Denison (Chapter 24) observe that obese women are more likely to require induction of labour for a variety of reasons. Averages 6.4 hours. Therefore, it was hypothesised that increased requirement of oxytocin may be explained by impaired myometrial contractility in obese women and the relative increase in volume of distribution in obese women which may have a dilutional effect on both the prostaglandin ripening agent and the oxytocin. The ACNM advocates that provision of care by CNMs is less likely to result in the use of labor and birth interventions, including cesareans, resulting in less invasive and costly practices (ACNM, 2012b). 2. E. Inspect placental membranes to be sure they are intact after delivery. 5. 2. 2. Get an awesome nursing career ahead! Fixed: no longer movable in inlet but not engaged. Retrospective cohort studies provided large amounts of population-based data supported by findings from 50 RCTs. 2. Issues around intrapartum care and place of birth have been fully explored by Edwards and Lim (Chapter 25), suggesting that in line with the established guidelines, a detailed risk assessment of each women with BMI>30 kg/m2 should be carried out and a multidisciplinary team should be involved in the care of these women. 2. a. The Centre for Maternal and Child Enquiries (CMACE) and the Royal College of Obstetricians and Gynaecologists (RCOG) Guideline on the Management of Women with Obesity in Pregnancy (2010) recommends that ‘Women with a BMI greater than 35 kg/m2 should give birth in a consultant-led obstetric unit with appropriate neonatal services’ [14]. B. Initiate external fetal monitoring using tocodynamometer (place over the fundus) and ultrasound transducer (usually placed in area of fetal back). A study from Mexico identified several faults in the reprocessing chain, such as inadequate monitoring of sterilization standards and use of inappropriate sterilization agents [129]. Women continuing therapy need to be carefully followed for adherence because the loss of incentive to prevent transmission may affect compliance. A. C. Transverse lie: Long axis of infant lies at rightangles to longitudinal axis of mother (necessitates delivery by cesarean section). 3. A. Transfer is not recommended once labour has established due to the increased need for, and the difficulties with, monitoring both the maternal and foetal status, as well as the technical difficulties in arranging appropriate transport for the woman with extreme obesity. Confirm rupture by nitrazine paper (turns blue) or ferning. Normal fetal heart rate (baseline): 110–160 beats/min baseline rate between contractions for a duration of at least 2 minutes (during a 10-minute segment). PLAY. At birth, baby skin barrier is adequately developed to tolerate extrauterine environment; however, it continues to develop throughout the initial years of life (Fluhr et al., 2011; Stamatas et al., 2011; Nikolovski et al., 2008). 1. Lower portion: passive, becomes thinner and more expanded. B. 2. C. Provision of comfort and safety measures during labor and delivery. Difficulties in manual handling of obese women is a particular risk to staff in terms of … Contractions do not bring about appreciable changes in cervix. 5. b. Lowered blood pressure and rising pulse may reflect increased blood loss. On birthing bed or delivery table, pad stirrups to avoid pressure to popliteal veins and pressure areas. Gently raise both legs simultaneously into stirrups to avoid ligament strain. E. Auscultate fetal heart tone every 5 minutes or after each push; transient fetal bradycardia not unusual due to head compression. B. Client’s pelvis is divided into four imaginary quadrants: right anterior, right posterior, left anterior, and left posterior. Position baby so that mother and baby may have eye-to-eye contact. There should be clearly agreed guidelines between obstetric and anaesthetic teams to ensure that all high-risk women are identified antenatally and they had been appropriately assessed by the anaesthetic team as early as possible during pregnancy and a clear plan laid out for intrapartum care. Providing nursing care to a postpartum woman during the first 24 hours entails the following: Assess the woman’s family profile to determine the impact that the newborn would give to the family … Ultrasonic transducer: picks up fetal heart tones. B. Degeneration of the placenta, which no longer provides necessary elements to fetus. Guidelines for Perinatal Care… Amanda Jefferys, ... Tahir Mahmood, in Obesity, 2013. Lindsay Edwards, Boon H. Lim, in Obesity, 2013. 1. H. Start IV if ordered. Aseptic technique during intrapartum care for the mother and sterile cord cutting are other important areas of intervention. This up-to-date, comprehensive and consolidated guideline on essential intrapartum care brings together new and existing WHO recommendations that, when delivered as a package, will ensure good-quality …