Read Oxford Handbook of Midwifery Online
Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker
Consider other options;
Document the head to body delivery interval, order of manoeuvres, and cord pH.
Debrief—full and clear explanations should be given to the parents. The professionals involved should be offered the chance to discuss the case in a supportive environment.
Fig. 19.7
Wood’s screw manoeuvre. Rotate anterior shoulder.
Reprinted by permission of Henry Lerner M.D. from M
www.shoulderdystociainfo.com.
Fig. 19.8
Rubin’s manoeuvre. Rotate posterior shoulder.
Reprinted by permission of Henry Lerner M.D. from M
www.shoulderdystociainfo.com.
SHOULDER DYSTOCIA
449
1
The Confidential Enquiry into Stillbirths and Neonatal Deaths. 5th Annual Report. London: CESDI, pp. 73–9. Available at: M
www.cesdi.org.uk (accessed 25.2.11).
CHAPTER 19
Emergencies
450
Guidelines for admission to neonatal ICU
‘Provision for sick neonates has developed rapidly over the last two decades from a small area on a maternity ward to a giant, technical, scientifically based system of care. Advances in technology and an increased understanding of the problems and needs of premature and low birth weight babies have increased the survival rates of babies who would have died a few years ago
.’
1
In 1992 the WHO
2
clarified the definitions for premature and small for
date babies:
These definitions indicate that a baby can be both premature and small for dates, or term and small for dates.
In 1990 the Human Fertilization and Embryology Act stated that a baby is capable of surviving from 24 weeks of pregnancy. Viable gestational age is considered by law to be 24 weeks, whatever the baby’s weight.
1,3
The current structure of neonatal care in the UK
Regional units
Full intensive expert care is provided for the smallest, sickest babies. There is also provision for neonatal surgery. Mothers are referred to these centres for delivery if problems are indicated, or retrieval teams will collect the baby following delivery and stabilization. It is preferable to transfer the baby
in utero
as, once born, its survival depends on provision of a stable thermal environment and effective management of oxygena- tion. Transferring a small, sick baby in the back of an ambulance can prove to be very hazardous. The baby returns to the referring unit once he or she is well enough.
Subregional units
These are subsidiary to the regional units. They provide full expert inten- sive care. The only difference being that they do not provide surgery, and will transfer any baby requiring surgery to the nearest surgical unit.
Special care baby units
These are based in all maternity hospitals, for the care of small babies from 32 weeks’ gestation. They can also provide emergency treatment and stabilization for the smaller, sicker babies, until transfer to the regional
GUIDELINES FOR ADMISSION TO NEONATAL ICU
451
unit can be arranged. They usually have two or three intensive cots and may keep the baby if it can be managed within that context.
Transitional care units
These are usually based on a maternity ward away from the intensive and high-dependency care contexts, thus keeping the baby with or near to its mother, and cared for by midwives or neonatal nurses. Babies needing this level of care usually require treatment for jaundice or infections, or they may be small but are otherwise well.
Criteria for admission to the NICU
4