Women and Newborn Health Service
Health Professionals
King Edward Memorial Hospital
O&G Clinical Guidelines Section B
Obstetrics and Midwifery Care
3. Medical Disorders Associated with Pregnancy
9. Complications of the Postnatal Period
Preface
1. Antepartum Care
1.1 Antepartum Clinic Visits
1.1.1 Guidelines for the Care of Women Planning a Non-Hospital Birth
1.1.2 Midwifery Care
1.1.2.1 Low Risk Midwifery Care
1.1.2.2 Low Risk Midwives Clinic with Medical Consultation
1.1.2.3 Exclusion Criteria to Low Risk Midwives Clinic
1.1.2.4 Midwifery Care Flow Chart
1.1.3 Antepartum Clinic Visits - Initial visit
1.1.4 Antepartum Clinic Visits – Subsequent Visits
1.1.5 Folic Acid Supplementation
1.1.6 Referral to genetic Services
1.1.7 Screening for Family Domestic Violence
1.1.8 Nicotine Dependence Assessment and Intervention
1.1.9 Screeening and treatment of vitamin D deficiency in pregnancy
1.1.10 Care Of A Woman With A Previous Caesarean Section - Antepatum Preparation
1.3 Complications of Early Pregnancy
1.3.1 Early Pregnancy Bleeding
1.3.2 Hyperemesis Gravidarum
1.4 Infections in Pregnancy
1.4.1 Group B Streptococcal Disease
1.4.2 Labour and Birth Suite Quick Reference Guide to Group B Streptococcal Disease
1.4.3 Hepatitis B Protocol
1.4.4 Herpes Simplex
1.4.5 Syphilis in Pregnancy and the Newborn
1.4.6 Varicella (Chicken Pox) in Pregnancy
1.4.7 Rubella in Pregnancy
1.4.8 Chlamydia
1.4.9 Hepatitis C in Pregnancy
1.5 Substance Use in Pregnancy
1.5.1 Referral to Women and Newborn Drug and Alcohol Service (WANDAS)
1.5.2 Booking Visit to the Women and Newborn Drug and Alcohol Service (WANDAS)
1.5.3 Subsequent Visits to the Women and Newborn Drug and Alcohol Service (WANDAS)
1.6 Antepartum Procedures - Maternal
1.6.1 Measuring Blood Pressure
1.6.2 Abdominal Examination / Palpation
1.7 Antepartum Procedures - Fetal
1.7.1 Ultrasound Examination
1.7.2 Antepartum Fetal Heart Rate Monitoring
1.7.3 Chorionic Villus Sampling
1.7.4 Amniocentesis
1.7.4.1 Diagnostic Amniocentesis
1.7.4.2 Therapeutic Amniocentesis
1.7.5 Intra Uterine Transfusions
1.7.6 Cordocentesis
1.8 Parent Education Guidelines for Midwives
1.9 Blood Investigations - see Section A 1.9
1.10 Minor Symptoms or Disorders in Pregnancy
1.11 Planning for a complex care needs patient at KEMH
2. Complications of Pregnancy
2.2 Hypertension in Pregnancy
2.2.1 Medical Management
2.2.2 Maternal Fetal Assessment Unit Quick Reference Guide to Gestational Hypertension and Pre Eclampsia
2.2.3.1 Midwifery Care of the Woman with Pre Eclampsia – Antepartum Ward
2.2.3.2 Antenatal Ward Quick Reference Guide to Midwifery Care of the Woman with Pre Eclampsia
2.2.3.3 Midwifery Care of the Woman with Severe Pre Eclampsia
2.2.3.4 Midwifery Care of the Woman with Severe Pre Eclampsia During Labour
2.2.3.5 Management of the Woman with Eclampsia
2.2.3.6 Magnesium Sulphate Anticonvulsant Therapy
2.2.3.7 Labour and Birth Suite Quick Reference Guide for Magnesium Sulphate Anticonvulsant Therapy
2.2.3.8 Hydralazine Antihypertensive Therapy
2.2.3.9 Labour and Birth Suite Quick Reference Guide for Hydralazine Antihypertensive Therapy
2.3 Antepartum Haemorrhage (APH)
2.3.1 Management of APH
2.3.1.1 MFAU Quick Reference Guide to APH
2.3.1.2 QRG Subsequent Antenatal Management of a women with an APH
2.5 Preterm Labour
2.5.1 Labour and Birth Suite Quick Reference Guide to Nifedipine Tocolytic Therapy
2.5.2 Maternal Fetal Assessment Unit Quick Reference Guide to Suspected Preterm Labour
2.6 Preterm Prelabour Rupture of Membranes (PPROM)
2.6.1 Medical and Midwifery Management
2.6.4 Antenatal ward QRG to the midwifery care of the woman with PPROM
2.8 Prelabour Rupture of the Membranes at Term
2.9.1 Maternal Fetal Assessment Unit Quick Reference Guide to Management of Prolonged Pregnancy
2.10 Abnormalities of Lie/Presentation
2.10.1 Breech Presentation
2.10.2 ECV
2.10.2.1 MFAU QRG ECV
2.10.3 Breech Labour QRG
2.10.4 Unstable Lie at or Near Term
2.10.5 Rare Presentations
2.11 Multiple Pregnancy
2.11.1 Antepartum Management Multiple Pregnancy
2.11.2 Intrapartum Planned Vaginal Birth
2.12 Venous Thrombosis and Embolism in Pregnancy and the Puerperium
2.12.1 Venous Thrombosis Occurring in the Present Pregnancy
2.12.3 Prophylaxis for Women with a Prior Thrombotic Event in whom no Thrombophilia has been Identified
2.12.4 Woman with Cardiac Problems Requiring Anticoagulation whether Pregnant or Not
2.12.5 Thromboprophylaxis after Caesarean Section
2.12.6 References for Venous Thrombosis and Embolism in Pregnancy and the Puerperium
2.13 Management of the HIV Positive Pregnant Woman and her Neonate
2.13.1 Quick reference guide - Management of the HIV positive woman
2.13.2 Quick reference guide - Management of the baby of the HIV positive woman
2.14 Women who refuse blood transfusion and blood products
2.15 Maternal Fetal Assessment Unit Quick Reference Guide to Decreased Fetal Movements
2.16 Maternal Fetal Assessment Unit Quick Reference Guide to Non Specific Abdominal Pain
2.17 Management of Abdominal Trauma
2.17.1 Quick Reference Guide for Management following Abdominal Trauma
2.18.1 MFAU Quick reference guide management of a woman with suspected cholestasis
2.18.2 MFAU Quick reference guide management of a woman with confirmed cholestasis
2.19 Small for Gestational Age
2.19.1 Quick Reference Guide Assessment For The (Suspected) Small For Gestational Age Fetus
2.20 Intrauterine growth restriction
2.21 Management of Pregnancy and Childbirth in Women with a BMI > 40
3. Medical Disorders Associated with Pregnancy
3.1 Diabetes (Including Intrapartum Care)
3.1.1 Screening for Diabetes in Pregnancy
3.1.2 Referrals
3.1.3 Diabetes Education
3.1.4 Admission Procedure
3.1.4.1 Quick Reference Guide – Midwifery Care Of The Woman With Diabetes During Pregnancy After Admission
3.1.5 Blood Glucose Monitoring / Goals / Records
3.1.6 Hypoglycaemia Management
3.1.7 Diabetic Ketoacidosis (DKA) Management
3.1.9 Pregnant Women with Diabetes Requiring Insulin or Oral Hypoglycaemic Agents (OHA's) Management
3.1.10 Pregnancy Care / Tests Quick Reference Guide
3.1.11 Medication in Pregnancy
3.1.12 Intrapartum - Including Planning for Induction of Labour / Caesarean Section
3.1.14 Postnatal Care / Followup
3.1.15 Blood Glucose Meter - Medisense Optimum
3.1.16 Blood Glucose Meter - Access of Supplies
3.1.17 Glucagon Education (Partners) - Diabetes Type 1
3.1.18 Insulin Pen Devices
3.1.18.1 Novopen 3 for 3ml Cartridges
3.1.18.2 Flexpen 3ml Disposable
3.1.18.3 Innolet 3ml Disposable
3.2 Cardiac Disease in Pregnancy
4. Pain Management in Labour
4.1 Relaxation/Comfort Measures
4.1.1 Water Therapy
4.1.2 Hot/Cold Therapy
4.1.3 Hypnotherapy
4.1.4 Aromatherapy
4.1.5 Music and Audio Therapy
4.2 Therapeutic Touch
4.2.1 Reflexology
4.2.2 Acupressure/Shiatsu
4.2.3 Massage
4.3 Transcutaneous Electrical Nerve Stimulation (TENS)
4.4 Acupuncture
4.6 Administration of Nitrous Oxide (N2O + O2)
4.7 Administration of Intramuscular/Intravenous Narcotic Analgesia
4.7.1 Intramuscular Pethidine Administration in Labour
4.7.2 Intramuscular Morphine Administration in Labour
4.7.3 Intravenous Patient-Controlled Analgesia in Labour - Medical
4.8 Neuraxial Blockade
4.8.1 Delegation of Care / Responsibilities of Registered Midwives / Nurses
4.8.2 Epidural Analgesia in Labour - Medical
4.8.3 Insertion of Epidural Catheter
4.8.4 Administration Of Epidural Therapy in Labour
4.8.4.1 Via Intermittent Top Ups
4.8.4.2 Via PCEA
4.8.5 Management of Common Problems Associated with Epidurals
4.8.6 Testing Dermatomes
4.8.7 Assessment of Motor Function
4.8.8 Epidural Catheter Removal
4.8.9 Epidural Therapy Side Effects
4.8.10 Epidural Therapy Complications
4.8.11 Guidelines For Ambulation
4.8.12 Acute Pain Service
5. Intrapartum Care
5.1.1 Labour and Birth Suite Quick Reference Guide to Oxytocin Regimen for Induction of Labour
5.1.2 Artificial Rupture of the Membranes (ARM)
5.1.3 Oxytocin Infusion
5.2 Assessment of the woman on admission to MFAU or Labour and Birth Suite
5.2.1 Assessment of the Woman in Labour
5.2.2 Booked Admissions
5.2.3 Protocol for Initial Assessment of Antenatal Women at KEMH
5.3 Discharge of low risk women from Maternal Fetal Assessment Unit by midwives
5.4 Maternal Fetal Assessment Unit Quick Reference Guide to Possible Early Labour at Term
5.5 Cervical Suture: Removal of
5.6 Intrapartum Fetal Heart Rate Monitoring
5.6.1 Corometric Fetal Scalp Electrode
5.6.2 Labour and Birth Suite QRG Intrapartum fetal Surveillance
5.7 Management Of Suspected Acute Fetal Compromise
5.7.1 Amnioinfusion
5.8 First Stage of Labour
5.8.1 Care of a Woman During the First Stage of Labour
5.8.2 Use of a Partogram
5.8.3 Management of Delay in the First Stage of Labour
5.9 Second Stage of Labour
5.9.1 Management of the Second Stage of Labour
5.9.3.1 Infiltration of the Perineum and Cutting an Episiotomy
5.9.4 Birth
5.9.4.1 Birth Management
5.9.4.2 Unexpected waterbirth
5.9.4.3 LBS QRG Attendance of paediatrician for at risk births
5.9.5 Shoulder Dystocia
5.10 Care of the Woman in the Third Stage of Labour
5.10.1 Active Management of the Third Stage
5.10.2 Guidelines for the use of Syntometrine
5.11 Techniques of Assisted Vaginal Cephalic Birth
5.11.1 Forceps Delivery
5.11.2 Vacuum Extraction Delivery
5.11.3 Pudendal Nerve Block
5.12 Vaginal Birth after Caesarean Section (VBAC) Intrapartum Management
5.13 Mid Trimester Termination of Pregnancy
5.14 Post Birth Specimen Collection / Examination
5.14.1 Umbilical Cord Blood Collection / Analysis
5.14.2 Indications for Pathological Examination of the Placenta
5.15 Perineal Repair
5.16 Management of Third and Fourth Degree Perineal Trauma
5.18 Photographs / Video during Birth
5.19 Substance use management intrapartum
5.20 Protocol for medication administration for labour and birth
5.21.1 Oxytocin injection for the Management of the third Stage of Labour (FBC)
5.21.2 Ergometrine Administration for Primary Postpartum Haemorrhage (FBC)
5.21.3 Misoprostol Administration for Primary Postpartum Haemorrhage (FBC)
5.21.4 Syntometrine Administration for the Third Stage of Labour (FBC)
5.21.5 Lignocaine Administration prior to performing an episiotomy (FBC)
6. Routine Postpartum Care
6.1 Immediate Care of Mother in Labour and Birth Suite Following Birth
6.2 Care of Mother on the Postnatal Ward
6.2.1 Care on Admission to the Ward
6.2.2 Subsequent Care
6.2.2.1 Bladder Care
6.2.2.2 Perineal Care
6.2.2.3 Anti-D Immunoglobulin - refer to section A 9
6.2.2.4 Administration of Measles, Mumps and Rubella Vaccine
6.2.2.5 Quick Reference Guide - Subsequent Care of the Woman in the Postnatal Ward
6.2.2.6 The Kleihhauer Test - Refer to section A 9
6.2.3 Postpartum Discharge of the Woman
6.2.3.1 Transfer of a Postnatal Woman by a Midwife to Home / Visiting Midwifery Service / GP Care
6.3 Substance Use Management Post Partum
6.4 Not Used
7. Caesarean Section
7.1 Pre-Admission Clinics for Births by Elective Caesarean Section
7.2 Pre-operative Management
7.3 Prevention of Gastric Aspiration in Obstetrics
7.4 Transfer of the Woman to the Operating Theatre
7.5 Theatre Guidelines for Midwives Attending Caesarean Sections
7.6 Transfer of the Woman from the Operating Theatre
7.8 Wound Care (See Section A)
7.9 Maternal Assisted Caesarean Section
8. Newborn Feeding
8.1 Breastfeeding Guidelines
8.1.1 General Overview
8.1.2 Professional Development requirements for staff
8.1.3 Antenatal Education and Counselling
8.1.4 Skin to Skin Contact
8.1.5 The First Feed
8.1.6 Showing the woman how to breast feed
8.1.7 Expressing
8.1.8 Storage and Thawing of Breast Milk
8.1.9 Medical Indications for the Use of Formula Feeds
8.1.10 Rooming In
8.1.11 Feeding According to Need
8.1.12 Use of Artificial Teats / Dummies
8.1.13 Finger Feeding Using a Fine Tube or Syringe
8.1.14 Cup Feeding
8.1.15 Discharge
8.2 Breastfeeding Challenges
8.2.1 Flat or Inverted Nipples
8.2.2 Nipple Trauma
8.2.3 Engorgement / Full, Lumpy Breasts
8.2.4 Blocked Ducts
8.2.5 Oversupply
8.2.6 Mastitis
8.2.6.1 Mastitis Management in the Home
8.2.7 Breast Abscess
8.2.8 Weight Loss Beyond 10% of Birth Weight
8.2.9 Increasing Breast Milk Supply
8.2.10 Thrush In Lactation
8.2.11 Preterm, low birth weight or small for gestational age baby
8.3 Breastfeeding Aids
8.3.1 Supply Line to Supplement Breastfeeding
8.3.2 Use of Nipple Shields
8.5 Guidelines for a Formula fed Baby
8.5.1 Preparation Of Infant Formula
8.5.2 Safe Handling Methods
8.5.3 Feeding Technique
8.5.4 Fluid requirements
8.5.5 Fluid requirements of the Low birth weight, preterm or small for gestational age baby
8.5.6 Cleaning of Equipment
9. Complications of the Postnatal Period
9.1 Postpartum Haemorrhage (PPH)
9.1.1 Primary Post Partum Haemorrhage
9.1.2 Uterine Inversion
9.1.3 Therapeutic and Prophylactic Oxytocin Infusion Regimens
9.1.4 Secondary Post Partum Haemorrhage
9.1.5 Selective Pelvic Arterial Embolisation in the Management of Obstetric Haemorrhage
9.2 Infections
9.2.1 Puerperal Pyrexia
9.3 Management of Urinary Catheters Postpartum (See Section A)
10. Care of the Neonate
10.1 Care of the Neonate in Labour and Birth Suite
10.2 Routine Care of the Neonate in the Ward
10.2.1 Admission and Discharge of the Neonate
10.2.2 Neonatal Observations
10.2.3 Rooming in
10.2.4 Neonatal Care
10.2.5 Strategies to Reduce Sudden Infant Death Syndrome (SIDS)
10.2.5.1 Bed-sharing / Co-sleeping
10.2.6 Circumcision
10.2.7 Use of Overhead Warmer
10.2.8 Baby Identification
10.3 Neonatal Screening
10.3.1 Examination of the Neonate
10.3.2 Quick Reference Guide to Examination of the Neonate
10.3.3 Blood – Collection from a Neonate
10.3.3.1 Capillary Blood Collection (Heel Stab)
10.3.3.2 Newborn Screening Test (Guthrie)
10.4 Medication Administration to the Neonate
10.4.1 Intramuscular Administration to the Neonate
10.4.2 Vitamin K1 Administration
10.4.3 Neonatal Hepatitis B Vaccine
10.5 Complications of the Neonate
10.5.1 Neonatal Sepsis
10.5.1.1 Eye Infections in the Neonate
10.5.2 Neonatal Jaundice
10.5.2.1 Phototherapy
10.6.1 PDHM for Babies of Diabetic women
11. Emergency Procedures
11.1 Resuscitation in Late Pregnancy
11.3 Cord Prolapse
11.6 Neonatal Resuscitation
. Neonatal Resuscitation Procedure Algorithm
. Administration of Drugs and Fluids
. When to Cease Resuscitation Attempts / Special Circumstances
11.7 Anaphylaxis - Refer to section A 11
