1.6.8 Offer active management rather than physiological management of the third stage of labour for women with bleeding disorders, in line with the NICE guideline on intrapartum care for healthy women and babies. /l. People have the right to be involved in discussions and make informed decisions about their care, as described in your care. consider giving steroids or intravenous immunoglobulin to raise the maternal platelet count. 1.3.13 For women with mechanical heart valves, consider delaying restarting warfarin until at least 7 days after birth and arrange specialist follow‑up as outlined in the multidisciplinary care plan (see recommendation 1.3.6). To find out why the committee made the recommendations on fluid management for women with kidney disease and how they might affect practice, see rationale and impact. Last updated: 1.14.3 If a woman in labour has any vaginal blood loss other than a 'show', transfer her to obstetric-led care, in line with the NICE guideline on intrapartum care for healthy women and babies. 1.13.17 Advise continuous cardiotocography during labour for: women with confirmed sepsisin line with recommendation 1.10.4 in the NICE guideline on intrapartum care for healthy women and babies. 1.13.11 For women in labour with sepsis and any signs of organ dysfunction (see recommendation 1.13.6), regional anaesthesia should only be used with caution and advice from a consultant obstetric anaesthetist, and with a senior anaesthetist present. increases the chance of an instrumental birth. the comparative risks of general anaesthesia. 1.9.4 For women with a BMI over 30 kg/m2 at the booking appointment and reduced mobility in the third trimester, consider advising the lateral position in the second stage of labour. 1.10.5 Clarify with women with obstetric complications or no antenatal care whether and how they would like their birth companion(s) involved in discussions about care during labour and birth. Respect the woman's decision if she declines continuous cardiotocography. NICE has published a guideline on diabetes in pregnancy. 1.14.4 If a woman in labour has any vaginal blood loss other than a 'show', explain to her and her birth companion(s) what is happening. do not administer therapeutic dose low-molecular-weight heparin while an epidural catheter is in place. /l. palpitation (awareness of persistent fast heart rate at rest). 25 April 2019. Explore sensitively any possible vulnerability or safeguarding concerns, including: the woman or family members being known to children's services or social services. is presented as recommended in the NICE guideline on patient experience in adult NHS services. 1.3.18 For women with heart disease who have a planned caesarean section, develop an individualised emergency care plan with the woman in case she presents in early labour, with new symptoms or with obstetric complications. 1.14.2 The maternity service and ambulance service should have strategies in place to respond quickly and appropriately if a woman has an intrapartum haemorrhage in any setting. Aim to restart therapeutic low-molecular-weight heparin or unfractionated heparin 4 to 6 hours after birth. Do not offer supplemental hydrocortisone in the intrapartum period to women taking inhaled or topical steroids. Non-members can purchase access to tutorials but also need to sign in first. Consider including a cardiologist with expertise in managing heart disease in pregnant women in the multidisciplinary team discussions. 1.14.1 If there are signs of shock in a woman with intrapartum haemorrhage, proceed with immediate resuscitation. To find out why the committee made the recommendations on mode of birth for babies suspected to be large for gestational age and how they might affect practice, see rationale and impact. UK prices shown, other nationalities may qualify for reduced prices. 1.9.5 For women with a BMI over 30 kg/m2 at the booking appointment and adequate mobility, provide care in the second stage of labour in line with the NICE guideline on intrapartum care for healthy women and babies. For pregnant women with a medical condition, the multidisciplinary team may include, as appropriate: an obstetric physician or clinician with expertise in caring for pregnant women with the medical condition, a clinician with expertise in the medical condition. [2] See American Heart Association's information about classes of heart failure. 9 Ergometrine (because of risk of coronary ischaemia). shared with the woman's GP and teams providing her antenatal and intrapartum care. Be aware that maternal corticosteroids given antenatally for fetal lung maturation should not affect the advice given in recommendations 1.5.2 to 1.5.4. To find out why the committee made the recommendation on pain relief during labour for women with asthma and how it might affect practice, see rationale and impact. 330(7491):576-80. 1.13.25 Explain to the woman in labour with sepsis or suspected sepsis and her birth companion(s): there is no evidence to support the use of one broad-spectrum antimicrobial over another. 1.3.1 Risk assessment for women with heart disease should follow the principles of multidisciplinary team working (outlined in recommendation 1.2.1).

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