Maternal and Newborn assessment 18.05.2023 v4.pdf

Maternal and Newborn Assessment Maternal physiology History taking Life support considerations Newborn parameters Maternity and newborn patients Women who are pregnant, at any gestation (either reported or confirmed on scan) Women who have recently given birth (including pregn...

Maternal and Newborn Assessment Maternal physiology History taking Life support considerations Newborn parameters Maternity and newborn patients Women who are pregnant, at any gestation (either reported or confirmed on scan) Women who have recently given birth (including pregnancy loss and termination of pregnancy), up to 4 weeks post- partum Babies from birth until 4 weeks of age London Ambulance Service NHS Trust 2 History taking Should include: PC, HxPC, PMHx, DHx, FHx, SHx, ROS, IMP, Hx Also include: Current pregnancy (admissions, risk factors) Past obstetric history London Ambulance Service NHS Trust 3 History taking For non-English speakers, use language line wherever possible. Communication difficulties is a common theme in maternity cases with adverse outcomes. Review any hand-held notes if available (may not yet have notes if early pregnancy).* *Many maternity units have moved to paperless documentation. Some women may have electronic notes which can be challenging to access. London Ambulance Service NHS Trust 4 Maternal physiology Blood volume and cardiac output increases by 50% Blood pressure decreases by 10mmHg Growing uterus compresses the aorta and the inferior vena cava Vessels retain fluid, oedema of the larynx can result in a difficult airway London Ambulance Service NHS Trust 6 What does this mean? NEWS2 is not validated for use in pregnancy Maternity patients compensate well- abnormal observations are a late sign of deterioration We have a lower threshold for conveyance in maternity than with the general population London Ambulance Service NHS Trust 7  1 red flag or 2 amber flags = TIME Where to go: Convey to maternity (obstetric CRITICAL unit): If 20 or more weeks Go to the nearest hospital with gestation AND woman stable obstetrics on site Convey to ED with obstetrics Early blue call pre alert via PD09 on site: If less than 20 weeks gestation OR woman unstable (for example, ongoing life DO NOT CALL A MIDWIFE threatening haemorrhage, recent seizure, reduced GCS) London Ambulance Service NHS Trust Acute presentations in maternity Abdo pain / shoulder tip pain / haemorrhage  Think ectopic pregnancy, miscarriage, placental abruption or praevia Hypertension / seizures / new onset confusion  Think pre-eclampsia/eclampsia, stroke, pregnancy-induced hypertension Hypotension / tachypnoeia / tachycardia  Think sepsis, haemorrhage (concealed?) Chest pain / shortness of breath  Think cardiac, PE London Ambulance Service NHS Trust 10 Maternal Cardiac Arrest Causes Heart failure Hypovolaemia Anaphylaxis Embolism Sepsis London Ambulance Service NHS Trust 11 Management Over 20 weeks (in absence of known gestation, visibly pregnant or fundus palpable at umbilicus)→ Manual displacement ALS Early call to critical care and HEMS Aim is to increase probability of ROSC by reducing aortocaval compression. To save mother. London Ambulance Service NHS Trust 12 Newborn physiology Babies’ lungs are filled with fluid at birth Transition from fetal circulation to newborn circulation No mechanism for producing and conserving heat Low levels of Vitamin K (clotting factors) High levels of haemoglobin (Hb) London Ambulance Service NHS Trust 13 In the first minute of life: Start timer/note time of birth Dry, stimulate, apply hat, optimise thermoregulation Assess COLOUR, TONE, BREATHING, HEART RATE Leave cord intact as long as thermoregulation is not compromised – don’t handle the cord until you’re ready to cut it Call for help If the baby is not crying spontaneously or has a suboptimal assessment, clamp/cut cord and take baby to resuscitation area London Ambulance Service NHS Trust 14  Clamp + cut No regular Move to Heart rate Pale? Floppy? resp resus area