Exclusion complications for outset low risk | Exclusion complications for remaining low risk throughout the antenatal period | Exclusion complications for remaining low risk throughout intrapartum |
Previous obstetric problems Perinatal death ≥3 miscarriages CS or difficult delivery Post-partum haemorrhage >1000 ml Hysterectomy, myomectomy or cone biopsy Shoulder dystocia Retained placenta Group B strep | Infections, bloods and hypertension Blood group antibodies Abnormal infection screen confirmed (HIV, hepatitis B, syphilis) Hyperemisis with ketonuria Glycosuria++ Haematuria persistent Proteinuria (+) no hypertension, UTI excluded Proteinuria (++) no hypertension and >22 weeks' gestation Sustained diastolic >100 mm Hg Or diastolic increment >25 mm Hg PIH=diastolic >90 mm Hg and proteinuria (++) Symptomatic vaginal discharge Group B strep | Fetal problems Non-cephalic presentation at onset of labour Suspected fetal distress in labour Fetal tachycardia Fetal bradycardia Decelerations in FH rate Meconium staining—unless delivery imminent Prolonged ruptured membranes >37 weeks (>24 h) Preterm labour Neonatal complications at birth Describe neonatal complications: |
Medical problems Diabetes mellitus/endocrine disorders Essential hypertension Cardiac disease Renal disease Epilepsy Non-pregnant BMI <20 or >35 Haematology problems Major psychiatric illness Any other serious problems If yes: describe here | Maternal problems Low placenta/placenta praevia Positive hCG, abdominal pain, no bleeding Intrauterine pregnancy not confirmed Vaginal bleeding/antepartum Haemorrhage Deep vein thrombosis Polyhydramnios/oligohydramnious Child protection concerns Prelabour rupture of membranes <37 Any other serious problems If yes: describe here | Maternal problems Unsatisfactory progress in labour Prolonged first stage Prolonged active second stage Hypertension in labour (diastolic >90 mm Hg on two consecutive occasions) Retained placenta Fits Shoulder dystocia Perineal tears (third and fourth degree) Postpartum Haemorrhage blood loss >1000 ml Prolonged pyrexia in labour (temperature >37.5°C, not reduced by paracetamol) |
Current pregnancy problems Multiple pregnancy Blood group antibodies Hepatitis carrier HIV-positive Substance misuse Grand multiparous (para 5 or more) | Fetal/other problems Fetal anomaly confirmed Women >37 years requesting CVS/amniocentesis Fundal height 3 cm less than gestational age SGA confirmed by ultrasound scan Abnormal presentation >36 weeks Reduced fetal movements Suspected intrauterine death Prolonged pregnancy T+10, induction of labour Maternal request for access to specialist Obstetrician care Maternal request for access to specialist Anaesthetist care (for epidural) Maternal request for access to specialist Paediatric care | Process of intrapartum Consult with referral unit for advice or interpretation of observations Assisted delivery (lift-out ventouse) to hasten second stage head low in cavity Maternal request for access to specialist Obstetrician care Maternal request for access to specialist Anaesthetist care (for epidural) Maternal request for access to specialist paediatric care Any other serious problems: Describe: |
BMI, body mass index; CVS, chorionic villus sampling; hCG, human chorionic gonadotropin; FH, fetal heart; PIH, pregnancy induced hypertension; SGA, small for gestational age; UTI, urinary tract infection.