Pre-term Labour Care Guidelines

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Questions and Answers

What is the recommended course of action if the first twin is born at the scene?

Delay on scene for further assessment.

Transport both twins to the nearest hospital without any intervention.

Administer oxygen to the second twin before any other action.

Clamp the cord of the first twin immediately. (correct)

In what situation is the knees-chest position indicated?

When a mother requires immediate transport to a hospital.

To assist with breech deliveries.

During the birth of multiple infants.

If there is any delay in transferring the mother to the ambulance. (correct)

What is the main concern during a breech birth?

The baby will likely be larger than average at birth.

It is always a sign of multiple births.

The delivery must occur without any medical interventions.

The longer the time between the birth of the buttocks and complete delivery, the greater the risk of hypoxic injury. (correct)

Why is thermoregulation particularly important in multiple births?

Babies are likely to be pre-term or smaller. Signup and view all the answers

What is the appropriate response when there is a slow birth process?

Interventions are required to assist with delivery. Signup and view all the answers

What gestational age defines pre-term labour?

20 – 37 weeks Signup and view all the answers

In the assessment of unknown gestation, what indicates that the gestation is likely to be over 20 weeks?

Palpable fundus at the umbilicus Signup and view all the answers

Which of the following is NOT a sign of pre-term labour?

Heavy fatigue Signup and view all the answers

What is the appropriate action if a woman appears visibly pregnant but has received no antenatal care?

Consider safeguarding referral Signup and view all the answers

Which statement best describes the management of pre-term labour?

Transfer to an obstetric unit if birth is imminent Signup and view all the answers

What is the most critical intervention required when encountering a cord prolapse?

Pre-alert to the nearest obstetric unit Signup and view all the answers

Which factor increases the likelihood of cord prolapse occurring?

Breech presentation Signup and view all the answers

What is a necessary step for the diagnosis of cord prolapse?

Inspection with consent Signup and view all the answers

What should be done if the cord is visible during a prolapse?

Gently replace the cord to the vulva using a clean dry pad Signup and view all the answers

Which of the following complications can arise due to cord prolapse?

Fetal hypoxia Signup and view all the answers

In which situation should the cord not be reinserted into the vagina?

If there is a risk of further cord damage Signup and view all the answers

When should a pre-alert be made to the nearest obstetric unit when dealing with cord prolapse?

Unless the birth is imminent Signup and view all the answers

What position should the mother be assisted into when managing a cord prolapse?

Exaggerated SIMs position Signup and view all the answers

What is the immediate action required if the feet of a breech baby come out first without the buttocks following?

Rapidly transport to the hospital. Signup and view all the answers

What does axial traction involve during delivery?

Exerting steady pressure in a straight line. Signup and view all the answers

How is shoulder dystocia diagnosed?

If the body does not emerge within the next two contractions after the head is delivered. Signup and view all the answers

What is the primary guidance tool recommended for managing breech births?

Maternity Action Tool checklist. Signup and view all the answers

Which of the following should be avoided during the management of shoulder dystocia?

Encouraging the woman to push excessively. Signup and view all the answers

What should be documented during a shoulder dystocia incident?

The time of delivery of the baby's head and any maneuvers performed. Signup and view all the answers

What is the best course of action when dealing with obstetric emergencies?

Early pre-alert is essential. Signup and view all the answers

When encountering any birth complications, what should be done?

Datix all birth complications. Signup and view all the answers

Study Notes

Pre-term Labour

Pre-term labour is defined as birth occurring between 20 and 37 weeks gestation.
If birth is not imminent, the mother should be transferred to the nearest obstetric unit or ED with obstetrics onsite.
If the gestation is unknown, but the woman appears visibly pregnant and/or the fundus is palpable at the umbilicus, the gestation is likely to be over 20 weeks.
Any pregnancy over 20 weeks without antenatal care requires safeguarding referral through EBS.
Signs of pre-term labour include:
- Regular contractions or tightenings
- Period-type pain or pressure in the vagina
- Membrane rupture (waters breaking)
- Backache
- Bleeding (greater than 20 weeks is a RED FLAG)
If birth is imminent, prepare for birth on-scene:
- Update EOC, request additional resources
- Prepare for NLS, warm environment
If birth is not imminent, pre-alert the receiving hospital and continuously reassess the mother en route.
Survival-focused care is recommended for pregnancies at or below 21+6 weeks gestation.
Comfort care is recommended for pregnancies at or above 22 weeks gestation, or for any pregnancy with unknown gestation and fused eyes.
Comfort care is also recommended for pregnancies with unknown gestation and non-fused eyes.

Cord Prolapse

Cord prolapse occurs when the umbilical cord protrudes out of the vagina before the baby.
It most often occurs with membrane rupture and is more likely in pre-term labour, breech presentation, or with multiple births.
It is a TIME-CRITICAL EMERGENCY.
Inspect the vaginal opening for the cord with consent.
Cord prolapse causes fetal hypoxia by compression of the cord by the presenting part, or by vasospasm as the cord is exposed.
Pre-alert the nearest obstetric unit (unless birth is imminent, the mother will require an emergency cesarean section).
Minimise handling of the cord. Gently replace the cord to the vulva using a clean dry pad and do not re-insert the cord into the vagina.
Assist the mother into an exaggerated SIMS position for transporting to the ambulance.
If there is any delay in transferring the mother to the ambulance, a knees-chest position can be used.

Multiple Births

Have a lower threshold for conveyance in cases of multiple births.
If birth is not imminent, transport the mother to the nearest obstetric unit as quickly as possible.
Clamp the cord of the first twin immediately after birth on-scene.
Thermoregulation is even more important in multiple births as babies are likely to be premature and smaller.
There may be a delay of minutes to hours between the birth of the first baby and the subsequent babies, so do not delay on-scene.

Breech Birth

Breech birth is when the buttocks or feet are presenting first.
It is more common in pre-term births and with multiple births.
The longer the delay from the birth of the buttocks until complete delivery, the greater the risk of hypoxic injury.
If the baby is not delivered within 30 minutes, the obstetrician will need to intervene.
Be prepared for NLS and/or PPH.
If the feet come out first and are not immediately followed by the buttocks, this is an emergency and requires rapid transport (Footling breech).
Use the Maternity Action Tool checklist to guide management.
Call for help (second crew/APP-CC/CTM/IRO).
Have hands poised to intervene/receive the baby.
Set a timer for delivery of the baby. A delay means intervention is required.

Shoulder Dystocia

Shoulder dystocia occurs when the baby's head is born and the shoulders become stuck on the mother's pelvic bone, preventing delivery of the baby's body.
Diagnosis occurs when the head of the baby is born and the body is not born within the next two contractions.
It is an emergency.
Use the Maternity Action Tool checklist to guide management.
Prepare for NLS and PPH.
Early pre-alert is essential.
Document the time of delivery of the head and any maneuvers performed.
Avoid encouraging the woman to push or applying excessive traction.

General Notes

Birth complications can be difficult to predict, so call for help early.
Use the JRCALC+ maternal assessment and obstetric emergencies cards to guide management.
Do not call a midwife during an obstetric emergency, this will delay care (unless the patient declines transfer).
Datix all birth complications.

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Description

This quiz covers the essential guidelines and actions required for managing pre-term labour, defined as childbirth between 20 and 37 weeks of gestation. Key signs and necessary actions are highlighted to aid healthcare professionals in providing optimal care for mothers and newborns during this critical period.