Maternal Monitoring

1. OBSERVATIONS

Blood pressure and respiration are to be monitored every five (5) minutes for the first twenty (20) minutes after the initiation of the epidural block and subsequent epidural top-ups. Note that in the event of hypotension, measurement must be more frequent. Thereafter, these observations are to be made half-hourly until the cessation of the block.

The anaesthetist is to be informed if:

	The systolic blood pressure is less than 90mmHg
	The respiratory rate is greater than 25
	The patient complains of difficulty in breathing.

Whilst awaiting arrival of the anaesthetist the following should be instituted :

Intravenous infusion of Hartmann's' solution, give as rapidly as possible.

If hypotension is profound i.e. less than 70mmHg systolic, as well as point above, the following should be carried out:

	Patient, whilst lying on a right wedge, should have her legs elevated.
	An ampoule of ephedrine +5ml syringe made ready.

If the respiratory rate is greater than 25 then the following should be carried out:

	The patient should be nursed in the left lateral position.
	The patient should be given oxygen via a mask giving the highest concentration of oxygen possible.

If the patient stops breathing, the Laerdal resuscitator is to be used to maintain respiration. Mouth-to-mask expired air resuscitation is to be used if nursing staff is unfamiliar with resuscitator.