Obstetric Management Policy

Obstetric Management Policy Document status Approved Version 3.0 DOCUMENT CHANGE HISTORY Initiated by Date Author Trust Expert Strategic September 2007 Assistant Medical Director Clinical Group Version Date Comments (i.e. viewed, or reviewed, amended approved by person or committee) 1.0 June 2008 Approved by Expert Strategic Clinical Group 1.1 September 2008 Updated and reformatted by Assistant Medical Director 1.1 17th September 2008 Reviewed by the Trust Expert Strategic Clinical Group 1.2 3rd October 2008 Updated with feedback from ESCG 2.0 14th October 2008 Approved by Expert Strategic Clinical Group 2.1 March 2011 Updated and reformatted by Tracy Nicholls Clinical General Manager 2.1 9 Approved by Clinical Quality and Safety Group 2.1 15 Approved by Executive Management Team EEAST_Obstetric Management Policy_V3.0 Page 1 of 20

The Trust will not tolerate unlawful discrimination on the grounds of the protected characteristics of: age, disability, gender reassignment, race, religion/belief, gender, sexual orientation, marriage/civil partnership, pregnancy/maternity. The Trust will not tolerate unfair discrimination on the basis of spent criminal convictions, Trade Union membership or non-membership. In addition, the Trust will have due regard to advancing equality of opportunity between people from different groups and foster good relations between people from different groups. Author: Dr. Nick Morton, Assistant Medical Director Document reference Recommended at Date Approved at Date Health and Social Care Act 2008 (Regulations) 2009 Regulated Activities: Regulation 14 NHSLA relevant to standard(s): 1.4.10 Directorate: Clinical Clinical Quality and Safety Group 9 Executive Management Team 15 Review date of approved document June 2013 Equality Impact Assessment Completed May 2011 Linked procedural documents Dissemination requirements JRCALC Clinical Practice Guidelines 2006 NSF Children, Young People and Maternity Services All managers and clinicians via email and intranet EEAST_Obstetric Management Policy_V3.0 Page 2 of 20

Contents Section Page 1 Introduction 4 2 Purpose 4 3 Duties 4 4 Clinical Quality & Safety Group 5 5 Approval of the Obstetric Policy 5 6 Process for Managing Obstetric Care 5 7 The Emergency Obstetric Response 6 8 Non Emergency Obstetric Response 6 9 Training Strategy 6 10 Obstetric Equipment, Replenishment and Cleaning 7 11 Process for monitoring compliance 9 12 Process for reviewing, approving and archiving 11 13 Dissemination, Implementation and Access to this Document 11 14 Equality and Human Rights Impact Statement 11 15 Bibliography 11 Appendix Appendix 1 Expectations of clinical care for obstetric care. 12 Appendix 2 - Equality Impact Assessment Summary 20 EEAST_Obstetric Management Policy_V3.0 Page 3 of 20

1.0 Introduction 1.1 The East of England Ambulance Service NHS Trust (EEAST) is committed to playing its part in providing a safe environment for transfer and management of all obstetric cases. This requires the necessary attitude, skills, knowledge and equipment. EEAST supports the guidance for obstetric care as detailed in the JRCALC, the National Service Framework for Children, Young People and Maternity Services (2004) and Maternity Matters (2007). 1.2 This policy is designed to be read in conjunction with other Trust policies which may be relevant, including: Protection of Vulnerable Adults and Children Policy Resuscitation Policy Recognition of Life Extinct Policy Clinical Supervision Policy Paediatric Care Policy Medicines Management Policy Learning and Development Policy JRCALC Guidelines 2006 2.0 Purpose 2.1 The purpose of the policy is to provide direction and guidance for the planning and implementation of a high-quality and robust obstetric care to the organisation. The strategy for obstetric care incorporates the current published guidelines for resuscitation (Resuscitation Council (UK), 2005) and will include the published guidelines for resuscitation (Resuscitation Council (UK), 2010) once all staff receive an update throughout 2011. 2.2 The Trust recognises the special responsibilities and guidance outlined in JRCALC with regard to the treatment for expectant mothers and the importance of ensuring that all operational staff are following these guidelines. 3.0 Duties 3.1 The Director of Clinical Quality and the Medical Director have overall responsibility for the implementation of this policy in accordance with JRCALC guidance and for ensuring that all clinical and non-clinical staff deliver care in accordance with this policy. The Director of Clinical Quality and the Medical Director sit on the Clinical Quality and Safety Group and the Director of Clinical Quality sits on the Quality and Risk Assurance Committee. Reports on clinical issues are submitted to the Clinical Quality and Safety Group which meets quarterly. 3.2 The Senior Training & Education Manager, who liaises with the Consultant Paramedic and the Head of Workforce and Organisational Development, have the responsibility for the Training & Education Department and the delivery of core training determined by the Training Needs Analysis, to meet the requirement of the national guidelines and the National Service Framework. 3.3 The Senior Training & Education Manager also has the responsibility for implementing all policies relevant to training and education. The Senior Training & EEAST_Obstetric Management Policy_V3.0 Page 4 of 20

Education Manager reports to the Head of Workforce and Organisational Development who attends the Clinical Quality and Safety Group. 3.4 All clinical staff: Have a responsibility to attend all calls of a perceived, possible or actual life threatening emergency relating to a pregnant patient as well as ante-partum and post-partum transportation. Should ensure that their assessment, diagnosis and treatment of obstetric and maternity patients is in line with their training and scope of practice. Should ensure that they maintain their obstetric assessment, diagnosis and treatment skills (as appropriate) in line with their training. Should actively manage obstetric pain appropriate to their training and scope of practice. If the management of pain is beyond their level of competency they should identify this by seeking immediate advice or the attendance of a clinical with the appropriate skills. Should ensure that they are conversant with this policy and ensure that they have the necessary equipment available to manage an obstetric emergency and be able to transport the patient to an appropriate care facility which will be able to comfortably meet the needs of the patient. Have a duty to act only within the boundaries of their scope of practice, expertise and training and should immediately call for assistance in accordance with this policy when appropriate. 4.0 Clinical Quality & Safety Group The Clinical Quality & Safety Group will monitor the implementation of relevant policies and guidelines, within the Trust s clinical governance framework. The Clinical Quality & Safety Group will monitor the effectiveness of clinical policies and guidelines ensuring that the Trust Board is aware of any significant non-compliance as a result of audit activity or reports from the Patient Services Department. 5.0 Approval of the Obstetric Policy The draft policy is to be submitted to the Clinical Quality & Safety Group for comment and recommendation and then to the Executive Management Team for approval, and then published in line with the Trust s Policy on Procedural Documents 6.0 Process for Managing Obstetric Care 6.1 Management of Pain in Obstetric and Gynaecological Emergencies The Trust adheres to the guidance as detailed in the JRCALC management of pain in adults and recognises that patients in pain need analgesia, regardless of age or situation. Analgesia should normally be introduced in an incremental way, considering timeliness, effectiveness and potential adverse effects. Analgesia should include the non-pharmacological methods of treatment if appropriate as a starting point and these may be administered by attending staff. However, if further analgesia is necessary this must be administered in accordance with the Trust Medicines Management Policy. EEAST_Obstetric Management Policy_V3.0 Page 5 of 20

If appropriate Entonox should be supplied until other drugs become effective. Analgesia administered by Trust staff must be done so only by appropriately trained staff and in accordance with JRCALC guidance, giving due consideration to analgesia previously administered to the patient by the patient themselves, the midwife, etc. 7.0 The Emergency Obstetric Response: EEAST advises its staff to follow the guidelines as laid down Joint Royal Colleges Ambulance Liaison Committee. These guidelines were updated in 2006 and are available on the EEAST intranet as well as in manual form. A full outline of the expectations of clinical care can be found in APPENDIX 1. JRCALC Guidelines describes the management of obstetric and gynaecological emergencies under the following headings: a. Birth imminent (normal delivery and delivery complications) b. Effects of pregnancy on maternal resuscitation c. Haemorrhage during pregnancy (including miscarriage and ectopic pregnancy) d. Pregnancy induced hypertension (including eclampsia) e. Vaginal bleeding gynaecological causes (including abortion) There is also a guideline for trauma management in pregnancy. Cardiac resuscitation of a pregnant patient is to be performed according to the guidelines set out by the Resuscitation Council (UK). Non compliance by patients a. There will be patients who decline health advice given by ambulance personnel despite best efforts. This does not totally absolve the clinician from being responsible for their care but their rights to refuse treatment must be respected. b. The non conveyance procedure should be applied with appropriate safety netting and assessment of capacity. c. The clinician must consider the following options: Contact patient s community midwife Contact patient s GP Contact hospital obstetrician 8.0 Non Emergency Obstetric Response The ambulance service has a responsibility, in line with current commissioning contracts, to arrange a. the transfer of a woman having a homebirth into hospital b. in-utero transfer c. transfer of babies to other units d. transfer of women in the postnatal period to other units 9.0 Training Strategy: 9.1 The management of obstetric emergencies is covered in the following syllabuses of training courses attended by EEAST clinical staff: 9.1.1 Student paramedic course 9.1.2 Paramedic course 9.1.3 University based courses leading to a degree, diploma or certificate in paramedic science or emergency care. EEAST_Obstetric Management Policy_V3.0 Page 6 of 20

9.1.4 Emergency Care Practitioner (ECP) or Critical Care Practitioner (CCP) courses. These must be benchmarked by a minimum standard of ensuring compliance with the current national guidelines, for example as described in JRCALC Guidelines 2006, Part 2 and Section 5. Current minimum standards can be found in Appendix A. 9.2 All staff responding to general emergency and urgent call involving Obstetric and Gynaecological Emergencies receive the relevant level of obstetric and gynaecological training on their core training course e.g. Ambulance Support Worker (ASW), Emergency Care Assistant s (ECA s), Emergency Medical Technicians (EMT), Student Ambulance Paramedics (SAP), Paramedics, Nurses working for the Ambulance Service and Specialist or Advanced Paramedic Practitioners (ECP, CCP). 9.3 Staff receive ongoing training in obstetric care in line with the Trust s Training Needs Analysis. If changes are published to current clinical guidelines staff will be required to attend or receive update training, also indicated in the Trust s Training Needs Analysis.. 9.4 Staff should indicate during the PDR process if they consider that they require update of additional training in Obstetric and Gynaecological Emergencies 9.5 Non-attendance by staff for Obstetric and Gynaecological Emergencies training, as identified by the Training Needs Analysis or personal appraisal, will be monitored and reported via the Oracle Learning Management System to the Training and Education Group and the Clinical Quality & Safety Group. Relevant operational General Managers for these staff will be informed and action plans implemented to rectify this. This will also be added to the risk register and be noted at the Clinical Risks Group which may be escalated to the Trust Risk Management Group. 9.6 EEAST work with a number of partner Higher Education Institutions (HEIs) across the region. Any university based course must meet the curriculum requirements of the Health Professions Council, the College of Paramedics and the Quality Assurance Agency for Higher Education. 9.7 EEAST will ensure that resuscitation training in the context of obstetric calls will comply with the latest guidance by the Resuscitation Council (UK). 10.0 Obstetric Equipment, Replenishment and Cleaning 10.1 All obstetric and resuscitation equipment must be maintained in a state of readiness at all times. Ambulances should be checked by a qualified member of staff at the start of a shift and immediately following conclusion of a resuscitation event/obstetric intervention. 10.2 The obstetric kit should be stocked in accordance with the standardised list according to EEAST policy and issued by the Medical Devices Group. Disposable items should be replenished at the earliest opportunity from the central storage areas in accordance with EEAST policy. Non-disposable items should be de-contaminated / cleaned in accordance with both the manufacturers policy and EEAST infection control policy and re-instated to the ambulance as soon as is practical. EEAST_Obstetric Management Policy_V3.0 Page 7 of 20

10.3 Pharmacy items must be replenished from within the hospital/pharmacy stock and in accordance with EEAST policy recommendations. EEAST_Obstetric Management Policy_V3.0 Page 8 of 20

11.0 Process for monitoring compliance with, and the effectiveness of this Policy The monitoring of compliance with this document is undertaken through a number of ways which is demonstrated in the table below: What How Frequency By whom Evidence Monitored through PDRs Annually Line Managers including Trust Board PDR forms level Identified Training needs submitted to LDU Duties As a result of concerns raised following an investigation of a complaint or incident Training Needs Analysis As required Annually Line Managers including Trust Board level LDU Documentation included on Datix Risk Management System Board reports Organisations expectations in relation to training Training programmes Trust Board review Training Attendance Monthly LDU Minutes of meetings, training plans Corporate Dashboard Minimum standards of obstetric care training which reflect national guidelines Training programmes reviewed to ensure they reflect latest evidence based guideline Annually Trust Board LDU Training and Education Clinical Development and Effectiveness Safeguarding Team Minutes of meetings, clinical bulletins, training programme modules, PU Programme Process for managing obstetric care Individual PCRs - Monthly Clinical Audit Department As a result of concerns raised by staff, incident reporting, patient feedback As required COMs Supervisors DOMs Sector Teams Datix reports Report submitted to: CAPE Group Minutes of Local Clinical Focus Group to address poor compliance Minutes of Local Clinical Focus Group to address poor compliance RMG Learning / CAPE Groups EEAST_Obstetric Management Policy_V3.0 Page 9 of 20

What How Frequency By whom Evidence Individual PCRs - Monthly Clinical Audit Department Pain management arrangements As a result of concerns raised by staff, incident reporting, patient feedback As required COMs Supervisors DOMs Sector Teams Datix reports Report submitted to: CAPE Group Minutes of Local Clinical Focus Group to address poor compliance Minutes of Local Clinical Focus Group to address poor compliance RMG Learning / CAPE Groups EEAST_Obstetric Management Policy_V3.0 Page 10 of 20

12.0 Process for reviewing, approving and archiving this document 12.1 This document will be reviewed annually or whenever national policy or guideline changes are required to be considered (whichever occurs first), primarily by the Clinical Quality & Safety Group following which it will be subject to re-ratification. 12.2 Archiving of this document should be conducted in accordance with the EEAST electronic archiving procedure. 13.0 Dissemination, Implementation and Access to this Document 13.1 This policy should be implemented and disseminated throughout the organisation immediately following ratification and will be published on the organisations intranet site. 13.2 Access to this document is open to all. 14.0 Equality and Human Rights Impact Statement This policy embraces Diversity, Dignity and Inclusion in line with emerging Human Rights guidance. EEAST recognises, acknowledges and values the difference between all peoples and their respective backgrounds. EEAST will treat everyone with courtesy and consideration and ensure that no-one is belittled, excluded or disadvantaged in anyway, shape or form. 15.0 Bibliography JRCALC Guidelines 2006 Resuscitation Council (UK) (2005) Resuscitation Guidelines 2005. NHSLA Risk Management Standard for the provision of Pre Hospital Care in the Ambulance Service College of Paramedics, Institute of Health and Care Development, Ambulance Technician Syllabus Health Professions Council, Institute of Health and Care Development Paramedic Syllabus Units, Elements and Course Objectives Relevant website addresses: Health Professions Council IHCD UEA paramedic course Resuscitation Council (UK) Department of Health www.hpc-uk.org www.edexcel.org.uk www1.uea.ac.uk www.resus.org.uk www.dh.gov.uk EEAST_Obstetric Management Policy_V3.0 Page 11 of 20

APPENDIX 1 Ambulance Technician Training Syllabus SECTION F: 7 MATERNITY F7:1 MATERNITY References: Clinical Guidelines OB/GY 1-5; EAAT Local Handout. The student should be able to; Briefly describe the three stages of labour. Describe the management techniques for normal and abnormal cases. Describe the complications and management of relevant dangers of pregnancy and labour. Key learning points Supporting evidence is required of the students understanding of: What happens during each stage of labour The considerations when deciding whether to transport a patient in labour The actions necessary when assisting a normal birth The guidelines for the specific situations covered by this unit The altered blood volume of a pregnant patient and the significant asymptomatic blood loss which can occur How to manage haemorrhage during pregnancy How to manage umbilical cord emergencies How to manage haemorrhage after birth What is meant by 'eclampsia', its clinical presentation and management The management principles for a breech delivery The importance of ensuring and maintaining a clear airway in a newborn child All aspects of the maternity checklist The importance of liaison with community maternity resources The difficulties and drawbacks of delivery in an ambulance The need to keep a neonate warm The procedure for severing an umbilical cord. F7:2 PREMATURE BABIES AND INCUBATORS References: EAAT Local Handout. The student should be able to; Define the term 'premature' when applied to a baby. Describe relevant aspects of Ambulance management of a premature baby during transport. State the functions of an incubator. Describe, or demonstrate, the checks to be made of an incubator prior to transportation. Key learning points Supporting evidence is required of the students understanding of: The particular problems and needs of premature babies The fact that trained medical and/or nursing personnel will normally accompany the crew The special physical and health characteristics of premature babies The importance of bringing the incubator up to the correct temperature before use The special importance of strict hygiene procedures. Paramedic Training Syllabus H1.4.6 TRAUMA IN PREGNANCY (References: PHTLS, Chapter 7; Module 4 booklet, Unit 9, Part 5; JRCALC, TR7) Underpinning knowledge and key learning points anatomical and physiological changes during pregnancy EEAST_Obstetric Management Policy_V3.0 Page 12 of 20

mechanisms of injury and causative effects pathophysiology of injury importance of patient positioning importance of oxygen therapy Related skills and use of equipment primary / secondary survey airway management oxygen therapy IV cannulation fluid replacement as per JRCALC National Clinical Guidelines (TR7; DRUGS 22 & 23) pain relief as per JRCALC National Clinical Guidelines (TR7; DRUGS 7) patient monitoring and recognition of additional support appropriate equipment: - semi rigid collars - spinal boards - splinting I1.6 RESUSCITATION OF THE BABY AT BIRTH (common element with I2.7) (References: Current UK Resuscitation Council Guidelines; Module 4, Unit 9, Part 6; JRCALC, PAED 5). The student should be able to: describe the pathophysiology of cardiac arrest in the baby at birth perform effective resuscitation procedures for baby at birth in line with current advisory guidelines of the Resuscitation Council (UK) Underpinning knowledge and key learning points normal physiological parameters of the baby at birth role of the midwife and ambulance crew in resuscitation the pathophysiology of cardiac arrest in the baby at birth relationship between gestational age and viability procedure for assessing the newborn baby, to include APGAR scoring the effect of manual stimulation by drying and wrapping the baby ratio of chest compression to ventilation (3:1 at a rate of 120 chest compressions per minute importance of adequate ventilation and oxygenation life support algorithm prevention of body heat loss during resuscitation treatment of hypoglycaemia hazards and removal of meconium involving and caring for the parents criteria and procedure for transferring Related skills and use of equipment assessment technique for the baby at birth stimulation technique AIRWAY MANAGEMENT - manual methods - suction - oropharyngeal airway BREATHING EEAST_Obstetric Management Policy_V3.0 Page 13 of 20

- bag/valve/mask ventilation - mouth to mouth and mouth to mouth & nose ventilation - oxygen equipment CIRCULATION - chest compression techniques (two fingers and encircling thumbs methods) - intravenous - drug administration via indwelling tracheal tube and umbilical vein methods of conserving the baby s body heat I2.1 GENERAL AND LOCAL ORGANISATION OF OBSTETRIC AND GYNAECOLOGY SERVICES (References: Local Handout; Cumberledge Report: Changing Childbirth ). The student should be able to: describe the local arrangements for hospital and domicilliary obstetric and gynaecology services, including lines of communication, phone numbers of Obstetric units and direct lines describe relevant aspects of their Service s protocols and policies for out-of-hospital obstetric and gynaecological cases Underpinning knowledge and key learning points organisation of obstetric and gynaecology services within the student s operational area roles of the midwife, doctor and ambulance crew at an obstetric or gynaecological incident the role of the paramedic as a primary responder to a obstetric or gynaecological incident where midwifery assistance is not immediately available Service protocols and procedures relating to obstetrics and gynaecology procedure for summoning midwifery assistance to an incident common causes of mortality and morbidity associated with childbirth evolution of the paramedic syllabus in obstetrics and gynaecology admission procedures for women with obstetric or gynaecological disorders concept of patient choice in childbirth and how this may impact on decisions at an incident potential for litigation associated with incidents involving childbirth I2.2 ANATOMICAL, PHYSIOLOGICAL AND PATHOLOGICAL CHANGES DURING PREGNANCY (References: Greaves and Porter; Module 4, Unit 9, Part 5). The student should be able to: describe anatomical, physiological and pathological changes during pregnancy Underpinning knowledge and key learning points normal changes during pregnancy and limits beyond which they become pathological normal and pathological changes in anatomy and physiology relating to: definitions and consequences of postural and supine hypotension changes in and resulting from pre-existing diseases, including asthma, diabetes, heart disease and hypertension potential consequences of trauma during pregnancy, including: EEAST_Obstetric Management Policy_V3.0 Page 14 of 20

I2.3 ASSESSMENT AND EXAMINATION OF THE PREGNANT WOMAN (References: Greaves and Porter; Module 4, Unit 9, Part 5; JRCALC, OBS/GY 1) The student should be able to: appropriately assess and examine a pregnant woman and relate the findings to the gestational period Underpinning knowledge and key learning points terminology associated with pregnancy and childbirth information available in the patient held record and standard terms and abbreviations used importance of ensuring patient held record accompanies the patient to hospital primary and secondary surveys anatomy and physiology of pregnancy according to gestational age vaginal examination by ambulance staff is inappropriate in any circumstances inspection of the vulva is appropriate only in specific and limited circumstances (usually only in the 2nd and 3rd stage of labour), requires patient s consent and needs to take account of cultural Issues systolic blood pressure is measured using the simplest and most reproducible way possible (note: automated blood pressure monitors should not normally be used) systolic blood pressure of <90mmHg (not 100) is indicative of shock if other signs are present value of pulse oximetry and its limitations in carbon monoxide poisoning and other circumstances relationship between position of the fundus and gestational age Related skills and use of equipment history taking primary and secondary surveys patient monitoring measurement and recording of systolic blood pressure pulse oximetry examination of the abdomen (under supervision) explanation of procedures to the patient I2.4 NORMAL LABOUR (References: Greaves and Porter; Module 4, Unit 9, Part 5; JRCALC, OBS/GY 2). The student should be able to: describe the normal stages of labour facilitate a normal delivery Underpinning knowledge and key learning points the stages of labour physiology of labour care of the perineum need for all dressings, swabs, etc to be retained for inspection by midwife or at hospital (in clinical waste bag) physiology of the umbilical cord and maternal/baby circulation after birth use of Entonox and oxygen in labour importance of saving the placenta for examination by midwife or doctor normal and pathological levels of blood loss during childbirth all cases where the baby is born out of hospital must be seen by a midwife or admitted to hospital EEAST_Obstetric Management Policy_V3.0 Page 15 of 20

Related skills and use of equipment primary and secondary surveys patient monitoring pulse oximetry patient positioning administration of analgesia (Entonox) administration of oxygen clamping and cutting the umbilical cord examination of the abdomen care of the perineum maintenance of baby s body heat removal of fluid from the baby s mouth and nose I2.5 ABNORMALITIES IN PREGNANCY AND LABOUR (References: Greaves and Porter; Module 4, Unit 9, Part 5; JRCALC, OBS/GY 3, 4 & 5). The student should be able to: define, recognise and provide appropriate care for abnormalities of early and late pregnancy, during labour and postpartum, including: Early pregnancy Late pregnancy -eclampsia/eclampsia -term labour Intra-partum pregnancies Postpartum EEAST_Obstetric Management Policy_V3.0 Page 16 of 20

At any time during pregnancy - and hypoglycaemia and epilepsy Underpinning knowledge and key learning points anatomy and physiology of pregnancy according to gestational age information which should be reported to other healthcare professionals and the procedure for contacting them primary and secondary surveys indications and causes of obstructed labour cord rupture, short cord and prolapsed cord McRobert s position indications for rapid admission for specialist assistance older obstetric patients who haemorrhage have a higher mortality causes of haemorrhage during pregnancy and postpartum uterine atony is a principle cause of primary postpartum haemorrhage drug management of postpartum haemorrhage (DRUGS 24) on-scene times should be limited where possible to a maximum of 10 minutes with bleeding in late pregnancy risk of abruption in trauma pulmonary embolism is the most common cause of maternal death hypertensive disorders, ectopic pregnancy and complications of miscarriage are the main causes of maternal death after pulmonary embolism miscarriage is preferred to the term abortion features of pre-eclampsia and eclampsia sedative therapy for eclampsia (OBS/GY 4; DRUGS 6) causes of inversion of the uterus and how to avoid it management of perineal tears Related skills and use of equipment primary and secondary surveys patient monitoring administration of analgesia (Entonox) administration of oxygen administration of syntometrine administration of diazepam clamping and cutting the umbilical cord examination of the abdomen intravenous cannulation intravenous fluid infusion pulse oximetry patient positioning including McRobert s position reporting information to other healthcare professionals care of the perineum maintenance of baby s body heat removal of fluid from the baby s mouth and nose EEAST_Obstetric Management Policy_V3.0 Page 17 of 20

I2.6 RESUSCITATION IN PREGNANCY (References: Current UK Resuscitation Council Guidelines; JRCALC CAA2; Module 4 booklet, Unit 9, Part 5). The student should be able to: describe the aetiology of cardio-respiratory arrest in pregnancy discuss the special considerations in the management of cardiac arrest in pregnancy Underpinning knowledge and key learning points normal and pathological changes in anatomy and physiology relating to: basic principles of airway management and cardiopulmonary resuscitation are similar but some modifications may be necessary priority is in treating the mother where the mother suffers irreversible cardiac arrest or injuries incompatible with life, resuscitation should continue until medical opinion is sought aspects of resuscitation which may be affected by pregnancy (eg endotracheal intubation) increased likelihood of passive regurgitation or vomiting and increased morbidity make early intubation advisable importance of patient positioning and uterine displacement in avoiding aortocaval occlusion where indicated, defibrillation should be performed in the normal way importance of high concentrations of oxygen therapy management of severe haemorrhage rapid transfer to hospital may be necessary Related skills and use of equipment basic airway management with and without adjuncts insertion of laryngeal mask endotracheal intubation bag/valve/mask and mechanical ventilation techniques chest compression uterine displacement technique use of longboard at left lateral tilt to relieve caval compression intravenous cannulation intravenous fluid administration administration of cardioactive drugs I 2.7 RESUSCITATION OF THE BABY AT BIRTH (common element with I1.6) (References: Current UK Resuscitation Council Guidelines; JRCALC, PAED 5). The student should be able to: describe the pathophysiology of cardiac arrest in the baby at birth perform effective resuscitation procedures for baby at birth in line with current advisory guidelines of the Resuscitation Council (UK). Underpinning knowledge and key learning points normal physiological parameters of the baby at birth role of the midwife and ambulance crew in resuscitation EEAST_Obstetric Management Policy_V3.0 Page 18 of 20

the pathophysiology of cardiac arrest in the baby at birth relationship between gestational age and viability procedure for assessing the newborn baby the effect of manual stimulation by drying and wrapping the baby ratio of chest compression to ventilation (3:1 at a rate of 120 chest compressions per minute) importance of adequate ventilation and oxygenation life support algorithm prevention of body heat loss during resuscitation treatment of hypoglycaemia hazards and removal of meconium involving and caring for the parents criteria and procedure for transferring baby to hospital when to stop resuscitation Related skills and use of equipment assessment technique for the baby at birth stimulation technique AIRWAY MANAGEMENT - manual methods - suction - oropharyngeal airway BREATHING - bag/valve/mask ventilation - mouth to mouth and mouth to mouth & nose ventilation - oxygen equipment CIRCULATION - chest compression techniques (two fingers and encircling thumbs methods) - drug administration methods of conserving the baby s body heat EEAST_Obstetric Management Policy_V3.0 Page 19 of 20

Executive Summary Page for Equality Impact Assessment: Document Reference: Document Title: Obstetric Care Policy Assessment Date: 11 May 2011 Responsible Director: Dr. Pam Chrispin, Medical Director Document Type: Policy Lead Manager: John Martin Conclusion of Equality Impact Assessment: No negative impact has been identified within this policy however it can be made available in other formats should individuals require. Recommendations for Action Plan: None Risks Identified: None Approved by a member of the executive team: YES NO Name: Dr Pamela Chrispin Position: Medical Director Signature: Date: 11 May 2011 EEAST_Obstetric Management Policy_V3.0 Page 20 of 20