Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
Best Practice in Labour and Delivery
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Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
Best Practice in Labour and Delivery Edited by Richard Warren Richard Warren is Consultant Obstetrician and Gynaecologist, Norfolk and Norwich University Hospital NHS Trust, UK.
Sir Sabaratnam Arulkumaran Sir Sabaratnam Arulkumaran is Professor and Head, Department of Obstetrics and Gynaecology, St Georges, University of London, UK.
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Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521720687 # Cambridge University Press 2009 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2009 Printed in the United Kingdom at the University Press, Cambridge A catalogue record for this publication is available from the British Library Library of Congress Cataloging-in-Publication Data Best practice in labour and delivery / edited by Richard Warren, S. Arulkumaran. p. ; cm. Includes bibliographical references and index. ISBN 978-0-521-72068-7 (pbk.) 1. Childbirth. I. Warren, Richard. II. Arulkumaran, Sabaratnam. [DNLM: 1. Labor, Obstetric. 2. Birth Injuries–prevention & control. 3. Delivery, Obstetric–methods. WQ 300 B561 2009] RG651.B47 2009 618.4–dc22 2009024542 ISBN 978-0-521-72068-7 paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.
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Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
Contents List of contributors vii Preface xi Acknowledgements xii
13. Antepartum haemorrhage 141 Neelam Potdar, Osric Navti and Justin C. Konje
1. Pelvic and fetal cranial anatomy and mechanism of labour 1 Louay S. Louis and Richard Warren
14. Management of the third stage of labour 153 Pina Amin and Audrey Long
2. The first stage of labour 14 Sambit Mukhopadhyay and David Fraser 3. Analgesia and anaesthesia in labour Jason Scott and Geraldine O’Sullivan
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15. Postpartum haemorrhage (PPH) 160 Nutan Mishra and Edwin Chandraharan
4. Intrapartum fetal surveillance 38 Rohan D’Souza and Sabaratnam Arulkumaran
16. Acute illness and maternal collapse in the postpartum period 171 Guy Jackson and Steve Yentis
5. Uterine contractions 54 Vivek Nama and Sabaratnam Arulkumaran
17. Episiotomy and obstetric perineal trauma 182 Ranee Thakar and Abdul H. Sultan
6. The management of intrapartum ‘fetal distress’ 66 Bryony Strachan
18. Induction of labour 195 Devi Subramanian and Leonie Penna 19. Preterm prelabour rupture of membranes (pPROM) 207 Austin Ugwumadu
7. Nutrition and hydration in labour 76 David Fraser and Sambit Mukhopadhyay 8. Prolonged second stage of labour including difficult decision-making on operative vaginal delivery and caesarean section 84 Hajeera Butt and Deirdre J. Murphy 9. Operative vaginal deliveries: indications, techniques and complications 93 Stergios K. Doumouchtsis and Sabaratnam Arulkumaran 10. Caesarean deliveries: indications, techniques and complications 104 Lisa Story and Sara Paterson-Brown 11. Breech and twin delivery Steve Walkinshaw
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21. Labour in women with medical disorders 227 Mandish Dhanjal and Catherine Nelson-Piercy 22. Management of women with previous caesarean section 241 Rajesh Varma and Gordon C. S. Smith 23. Rupture of the uterus 252 Nutan Mishra and Edwin Chandraharan 24. Management of severe pre-eclampsia/ eclampsia 262 James J. Walker
116
12. Cord prolapse and shoulder dystocia Joanna Crofts, Timothy Draycott and Mark Denbow
20. Preterm labour and delivery 216 Sarah L. Bell and Jane E. Norman
131
25. Neonatal resuscitation and the management of immediate neonatal problems 273 Paul Mannix
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Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
Contents
26. The immediate puerperium 285 Mahishee Mehta and Leonie Penna 27. Triage and prioritization in a busy labour ward 300 Tracey Johnston and Nina Johns 28. Risk management related to intrapartum care 311 Melissa K. Whitworth and Helen Scholefield 29. Teamworking, skills and drills 323 Dimitrios M. Siassakos and Timothy J. Draycott
30. Cerebral palsy arising from events in labour 332 Julian Woolfson 31. Objective Structured Assessment of Technical Skills (OSATS) in obstetrics S. M. Whitten and M. J. Blott Appendix
341
349
Index 350 Colour plates are to be found between pp. 194 and 195.
vi
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Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
Contributors
Pina Amin Consultant Obstetrician and Gynaecologist University Hospital of Wales Cardiff, UK
Mark Denbow Specialist Registrar in Obstetrics and Gynaecology St Michael’s Hospital Bristol, UK
Sir Sabaratnam Arulkumaran Professor, Department of Obstetrics and Gynaecology St George’s Hospital/St George’s University of London London, UK
Mandish K. Dhanjal Consultant Obstetrician and Gynaecologist Queen Charlotte’s and Chelsea Hospital, London Honorary Senior Lecturer Imperial College, London
Sarah L. Bell Consultant Paediatric Anaesthetist Glasgow Royal Infirmary Glasgow, UK M. J. Blott Elizabeth Garrett Anderson and Obstetric Hospital University College Hospital NHS Trust London, UK Hajeera Butt Clinical Lecturer in Obstetrics & Gynaecology Trinity College, University of Dublin Trinity College Department of Obstetrics and Gynaecology Coombe Women and Infants University Hospital Dublin, Ireland Edwin Chandraharan Consultant Obstetrician and Gynaecologist/Lead Clinician Labour Ward St. George’s Healthcare NHS Trust London, UK Joanna Crofts Specialist Registrar in Obstetrics and Gynaecology St Michael’s Hospital Bristol, UK
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Stergios K. Doumouchtsis Senior Specialist Registrar Department of Obstetrics and Gynaecology St George’s Hospital/St George’s University of London London, UK Timothy J. Draycott Consultant Obstetrician and Gynaecologist Southmead Hospital Bristol, UK Rohan D’Souza Clinical Research Fellow in Obstetrics and Gynaecology Division of Clinical Developmental Sciences St George’s University of London London, UK David Fraser Consultant Obstetrician and Gynaecologist Department of Obstetrics and Gynaecology Norfolk and Norwich University Hospital Norwich, UK Guy Jackson Obstetric Anaesthetic Fellow Chelsea & Westminster Hospital London, UK Nina Johns Birmingham Women’s Hospital
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Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
List of contributors
Edgbaston Birmingham, UK Tracey Johnston Consultant in Fetal Maternal Medicine Birmingham Woman’s Hospital Birmingham, UK Justin C. Konje Consultant Obstetrician and Gynaecologist Reproductive Sciences Section Department of Obstetrics and Gynaecology University of Leicester University Hospitals of Leicester Leicester, UK
Vivek Nama Clinical Research Fellow Department of Obstetrics and Gynaecology Division of Clinical Developmental Sciences St George’s University of London London, UK
Audrey Long Consultant Obstetrician and Subspecialist in Fetomaternal Medicine Department of Obstetrics and Gynaecology University Hospital of Wales Cardiff, UK
Osric Navti Subspecialty Trainee Reproductive Sciences Section Department of Obstetrics and Gynaecology University of Leicester University Hospitals of Leicester Leicester, UK
Louay S. Louis Department of Reproductive Biology Imperial College London Faculty of Medicine London, UK
Catherine Nelson-Piercy Consultant Obstetric Physician Guy’s and St Thomas’ Foundation Trust and Queen Charlotte’s and Chelsea Hospital London, UK
Paul A. Mannix Consultant Neonatal Paediatrician Northwick Park Hospital Harrow, UK
Jane E. Norman Professor of Maternal and Fetal Health University of Edinburgh Edinburgh, UK
Mahishee Mehta Specialist Registrar in Obstetrics and Gynaecology King’s College Hospital Denmark Hill London, UK Nutan Mishra Senior Registrar, St. George’s Healthcare NHS Trust Blackshaw Road, London, UK
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Deirdre J. Murphy Professor of Obstetrics and Gynaecology Trinity College, University of Dublin Trinity College Department of Obstetrics and Gynaecology Coombe Women and Infants University Hospital Dublin, Ireland
Sambit Mukhopadhyay Consultant Obstetrician and Gynaecologist Department of Obstetrics and Gynaecology Norfolk and Norwich University Hospital Norwich, UK
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Geraldine O'Sullivan Dept of Anaesthetics St Thomas’ Hospital London, UK Sara Paterson-Brown Consultant Obstetrician and Gynaecologist and Labour Ward Lead Queen Charlotte’s and Chelsea Hospital London, UK Leonie Penna Consultant Obstetrician King’s College Hospital Denmark Hill London, UK Neelam Potdar Clinical Lecturer & Specialist Registrar
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Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
List of contributors
Reproductive Sciences Section Department of Obstetrics and Gynaecology University of Leicester University Hospitals of Leicester Leicester, UK
Ranee Thakar Consultant Obstetrician & Gynaecologist and Urogynaecology Subspecialist Mayday University Hospital Croydon, Surrey, UK
Helen Scholefield Health Service Management (Claims Handling and Risk Management) Department of Obstetrics Liverpool Women’s NHS Foundation Trust Liverpool, UK
Austin Ugwumadu Consultant Obstetrician and Gynaecologist St. George’s Hospital, London, UK
Jason Scott Department of Anaesthetics St Thomas’ Hospital London, UK Dimitrios M. Siassakos Specialist Registrar in Obstetrics and Gynaecology Southmead Hospital, and Clinical Fellow in Medical Education North Academy, University of Bristol Bristol, UK Gordon C. S. Smith Professor and Head of Department Department of Obstetrics and Gynaecology Cambridge University The Rosie Hospital Cambridge, UK
Rajesh Varma Consultant Obstetrician and Gynaecologist Guy’s and St. Thomas’ NHS Foundation Trust Directorate of Women’s Services St Thomas’ Hospital, London, UK James J. Walker Professor, Department of Obstetrics and Gynaecology St James University Hospital Leeds, UK Steve Walkinshaw Consultant in Maternal and Fetal Medicine Liverpool Women’s Hospital Liverpool, UK Richard Warren Consultant Obstetrician and Gynaecologist Norfolk and Norwich University Hospital Norwich, UK
Lisa Story Clinical Research Fellow Imperial College London, UK
Melissa Whitten Consultant in Feto-maternal Medicine University Hospital NHS Trust London, UK.
Bryony Strachan Consultant Obstetrician St Michael’s Hospital Bristol, UK
Melissa K. Whitworth University of Liverpool Department of Reproductive and Developmental Medicine Liverpool Women’s NHS Foundation Trust Liverpool, UK
Devi Subramanian Specialist Registrar in Obstetrics and Gynaecology King’s College Hospital London, UK Abdul H. Sultan Consultant Obstetrician and Gynaecologist Department of Obstetrics and Gynaecology Mayday University Hospital Croydon Surrey, UK
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Julian Woolfson Consultant Obstetrician and Gynaecologist Independent Sector London, UK Steve Yentis Consultant Anaesthetist Chelsea & Westminster Hospital London, UK
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Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
Preface
Those privileged to look after women during their labours and deliveries have a duty to practise to the highest standards. A clear understanding of what constitutes best practice will help to ensure the safety and health of mothers and babies through parturition. Whilst the encouragement of normality is implicit, abnormality in labour must be recognized promptly and, when necessary, must be appropriately managed to ensure best outcome. An understanding of normality and when and how to intervene are the keys to good clinical care. This textbook is an encompassing reference covering all the essential information relating to childbirth; it offers clear practical guidance across the width of labour and delivery. We are very grateful to those well-known leading experts who, despite their busy lives, have made such excellent contributions to this definitive text. Each chapter offers a modern authoritative review of best practice with the evidence base for good clinical care necessary to optimize outcome through appropriate clinical management and justifiable intervention. Whilst this is an ideal textbook for those training or taking examinations in labour ward practice, it offers all those professionals caring for the labouring woman a modern, evidence-based approach, which will help them understand and deliver the best possible clinical care. The importance of team working,
prioritizing and the organization of maternity care receive appropriate emphasis with clear guidance and practical advice. Guided by appropriate, clearly defined management pathways, based on national guidance, attending professionals will be best placed to improve safety and the quality of the labour process for both mother and baby. The auditing and monitoring of standards and outcomes are vital to the organization and improvement of maternity services. The recent introduction of Clinical Dashboards (Appendix A) promises to be a major advance by facilitating the monitoring through traffic light recording of performance and governance (including clinical activity, workforce, outcomes risk incidents, complaints/ women’s feedback about care) against locally or nationally agreed benchmarked standards. This book contains the most up-to-date references and evidence base, including from the Guidelines and Standards of the Royal College of Obstetricians and Gynaecolgists (www.rcog.org.uk) and the National Institute for Health and Clinical Excellence (www. nice.org.uk). We believe that this textbook will be of great value for all midwives and doctors overseeing and managing childbirth. Richard Warren Sir Sabaratnam Arulkumaran
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Cambridge University Press 978-0-521-72068-7 - Best Practice in Labour and Delivery Edited by Richard Warren and Sabaratnam Arulkumaran Frontmatter More information
Acknowledgements
The editors would like to acknowledge the help of each and every author who has given their time generously to contribute the chapters and Mrs Sue Cunningham of St George’s University of London who helped with the invitation and organization of the chapters. We are indebted to Nick Danton, Katie James and Dawn Preston of Cambridge University
Press for their invaluable help in publishing this book and helping us all keep to time. We are greatly indebted to our families Jane, Pippa and Joffy Warren and Gayatri, Shankari, Nishkantha and Kailash Arulkumaran for their tolerance and understanding of the time away from them during our own careers and in editing this book.
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