Maternal

•

On admission, as a baseline recording.

•

Any deviation from normal, signs of illness or accident or when the Modiied Early Obstetric Warning Score (MEOWS) triggers further investigation and repeat of the vital signs (p. 66).

•

Prior to undertaking blood pressure measurements especially when using an electronic

sphygmomanometer to ensure there are no irregularities of the pulse (NICE 2011a).

•

When auscultating the fetal heart including when applying a cardiotocograph (p. 16).

•

During labour – hourly (but not during a

contraction) and prior to transfer of care following labour (NICE 2014).

•

Following recovery from anaesthesia, NICE (2011b) recommends the pulse should be recorded every half hour for 2 hours, and hourly thereafter provided that the observations are stable. Meakins (2011), however, advises recording the pulse every 15 minutes for the Figure 4.2 Main sites for neonatal pulse assessment.

Apex

Brachial

REFERENCES

SUMMARY

•

Pulse assessment is a straightforward, non-invasive skill of considerable importance.

•

An accurate assessment includes the rate, rhythm and amplitude of the pulse.

•

Assessment of the general condition of the woman or baby is made simultaneously.

PROCEDURE: baby

The baby should be peaceful and not crying when undergo-ing pulse assessment. When usundergo-ing a stethoscope, the bell/

diaphragm should be disinfected before and after use and if it does not belong to the midwife, the earpieces should also be disinfected prior to and following use (Campos-Murguia et al 2014).

•

Obtain informed consent from the parents, expecting at least one parent to be present throughout.

•

Wash and dry hands.

•

Loosen the clothing and access the chosen site.

•

Place a warmed stethoscope over the apex of the heart (midline, left side of the chest); or place index and middle ingers over the apex; or place the index and middle ingers over the brachial artery. Count the pulse for 60 seconds, noting amplitude and rhythm.

•

Observe the colour, behaviour and general condition of the baby at the same time. Other vital sign observations may also be undertaken, e.g.

temperature, respiratory assessment.

•

Replace the clothing and ensure comfort.

•

Discuss the results with his parents.

•

Wash and dry hands and clean the stethoscope if used.

•

Document the indings and act accordingly.

Other means of pulse measurement

•

ECG (electrocardiogram) monitors give a continuous or single reading, or printout of the heart rate and pattern.

•

Automated blood pressure machines may provide a single heart rate reading.

•

Pulse oximeters (see Chapter 6) also give a

continuous heart rate reading, as do cardiotocograph machines for fetal heart assessment when the inger probe is attached (see Chapter 1).

ROLE AND RESPONSIBILITIES OF THE MIDWIFE These can be summarized as:

• recognizing what constitutes a normal pulse rate, rhythm and amplitude and identifying deviations

• recognizing when pulse assessment is indicated

• undertaking the assessment correctly

• referral if indicated

• contemporaneous record keeping.

SELF-ASSESSMENT EXERCISES

The answers to the following questions may be found in the text:

1. Discuss the signiicance of pulse assessment and when it should be undertaken for the childbearing woman.

2. What changes occur to the heart rate during pregnancy and labour and why do they occur?

3. Discuss the factors that increase the heart rate.

4. Summarize the role and responsibilities of the midwife when undertaking pulse assessment.

Alexis, O., 2010. Providing best practice in manual pulse measurement. Br. J.

Nurs. 19 (4), 228–234.

Blackburn, S., 2013. Maternal, Fetal and Neonatal Physiology: A Clinical Perspective, fourth ed. Saunders, St. Louis, pp. 252–296.

Campos-Murguia, A., Leon-Lara, X., Munoz, J., et al., 2014. Stethoscopes as potential intrahospital carriers of

pathogenic microorganisms. Am. J.

Infect. Control 42 (1), 82–83.

Churchill, D., Rodger, A., Clift, J., Tuffnell, D., on behalf of the MBRRACE-UK sepsis chapter writing group, 2014.

Think sepsis. In: Knight, M., Kenyon, S., Brocklehurst, P., et al. on behalf of MBRRACE-UK (Eds.), Saving Lives, Improving Mothers’ Care – Lessons Learned to Inform Future Maternity

Care from the UK and Ireland Conidential Enquiries into Maternal Deaths and Morbidity 2009–12.

National Perinatal Epidemiology Unit, Oxford, pp. 27–43.

Dearsley, A., 2013. Vital signs. In:

Koutoukidis, G., Stainton, K., Hughson, J. (Eds.), 2013. Tabbner’s Nursing Care, sixth ed. Churchill Livingstone, Chatswood, pp. 301–331.

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Assessment of maternal and neonatal vital signs: pulse measurement

deWit, S., O’Neill, P., 2014. Fundamental Concepts and Skills for Nursing, fourth ed. Elsevier, St. Louis, p. 348.

Docherty, B., Coote, S., 2006. Monitoring the pulse as part of track and trigger.

Nurs. Times 102 (43), 28–29.

Edmunds, S., Hollis, V., Lamb, J., Todd, J., 2011. Observations. In: Dougherty, L., Lister, S. (Eds.), The Royal Marsden Hospital Manual of Clinical Nursing Procedures, eighth ed. Wiley-Blackwell, Oxford, pp. 749–755.

England, C., 2014. Recognising the healthy baby at term through examination of the newborn screening. In: Marshall, J., Raynor, M.

(Eds.), 2014 Myles Textbook for Midwives, sixteenth ed. Elsevier, Edinburgh, pp. 591–610.

Higgins, D., 2008. Patient Assessment:

part 5 – Measuring Pulse. Nurs. Times 104 (11), 24–25.

Jevon, P., 2007. Cardiac Monitoring part 4: Monitoring the apex beat. Nurs.

Times 103 (4), 28–29.

Jevon, P., 2010. How to ensure patient observations lead to effective management of tachycardia. Nurs.

Times 106 (3), 16–17.

Knight, M., Nair, M., Shah, A., et al., 2014. Maternal mortality and morbidity in the UK 2009–2012:

surveillance and epidemiology. In:

Knight, M., Kenyon, S., Brocklehurst, P., et al. on behalf of MBRRACE-UK (Eds.), Saving Lives, Improving Mothers’ Care – Lessons Learned to Inform Future Maternity Care from the UK and Ireland Conidential Enquiries into Maternal Deaths and Morbidity 2009-12. National Perinatal Epidemiology Unit, Oxford, pp. 9–26.

Lippincott, Williams, Wilkins, 2013.

Lippincott’s Nursing Procedures, sixth ed. Wolters Kluwer, Philadelphia, pp. 614–616.

Meakins, S., 2011. Procedures in obstetrics. In: Macdonald, S., Magill-Cuerden, J. (Eds.), Mayes

Midwifery, fourteenth ed. Elsevier, Edinburgh, pp. 839–850.

NICE (National Institute for Health and Clinical Excellence), 2011a.

Hypertension: management of hypertension in adults in primary care. Available online: <www.nice .org.uk> (accessed 1 March 2015).

NICE (National Institute for Health and Clinical Excellence), 2011b. CG 132 Caesarean Section. Available online:

<www.nice.org.uk> (accessed 1 March 2015).

NICE (National Institute for Health and Care Excellence), 2014. CG55 Intrapartum Care: Care of healthy women and their babies during childbirth. Available online: <www .nice.org.uk> (accessed 22 February 2015).

Thibodeau, G., Patton, K., 2012.

Structure and Function of the Body, fourteenth ed. Elsevier-Mosby, St. Louis, p. 293.

Assessment of maternal and neonatal vital signs:

blood pressure measurement

Chapter

Central venous pressure 55

Equipment 56

PROCEDURE: measuring central venous pressure using a manual manometer 56

Summary 57

Role and responsibilities of the midwife 57

Self-assessment exercises 57

References 58

LEARNING OUTCOMES

Having read this chapter, the reader should be able to:

•

deine blood pressure, identifying the difference between systolic and diastolic pressure and the normal range for the childbearing woman and baby

•

discuss the midwife’s role and responsibilities in relation to the measurement of blood pressure, identifying when and how it is undertaken

•

discuss the factors that inluence blood pressure including the changes relating to childbearing

•

discuss factors that inluence the accuracy of blood pressure measurement and how the midwife can minimize these

•

describe how central venous pressure is measured using a manual manometer.

Death from hypertensive disease, particularly pre-eclampsia and eclampsia, is the fourth highest direct cause of mater-nal deaths in the UK and is at its lowest rate since the 1985–87 triennial report (Knight et al 2014). Across the

5

CHAPTER CONTENTS

Learning outcomes 46

Deinition 47

Arterial blood pressure 47

Venous blood pressure 48

Normal maternal arterial values 48 Blood pressure changes related

to childbirth 48

Pregnancy 48

Labour 49

Postnatal period: maternal 49

Postnatal period: baby 49

Factors inluencing arterial blood

pressure 49

Indications 50

Equipment 50

Sphygmomanometer 50

The cuff 52

Stethoscope 52

Korotkoff sounds 53

PROCEDURE: blood pressure estimation

using a manual manometer 53

Factors affecting accuracy 54

Technique 54

Equipment 54

Operator 55

Monitoring blood pressure in the baby 55

Normal range 55

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