Fuafuaga Fa'alavelave Fa'afuase'i o Ma'itaga Tolu-Tolu: Ave'ese A'o le'i Fa'atupu Fa'ama'i Fa'ata'ita'i ma Fa'auma se Pusa Fanau mama.¶

Pe a oo mai se afā, matagi malosi, lologa emo, po o se afi afi a o e i ai i lou tolu tolu masina o le maitaga (28 to 40+ weeks gestation), e lē mafai ona e mulimuli i le taimi tutusa "faatalitali ma vaai" e pei o se aiga e leʻi maʻitaga. O afā tetele, pa'u fa'afuase'i i le mamafa o le ea, fa'amama le tino, ma le fa'alavelave fa'afuase'i o le alu ese e masani ona fa'atupuina tamaita'i ma'i, gau vave o ga'o (PROM), po'o le fa'ato'a fanautama i le itula tonu e loka ai alalaupapa, o lalo o auala 1 meter (3.3 feet) lolovaia, ma e le mafai ona tali mai ta'avale a le falema'i. Afai o lo'o e feagai ma le to'aga o le manava, tafetotoi le toto, oso fa'afuase'i po'o le tafe mai o le sua amniotic, tiga tiga le ulu ma suiga vaaia, po'o le fa'aitiitia o gaioiga o fetal i le taimi nei, vala'au lau numera fa'afuase'i fa'apitonu'u e ala i la matou numera fa'afuase'i fa'atonuga vave. Toe iloilo a matou ta'iala fesoasoani muamua ile falema'i ile fa'anatinati fa'afuase'i ma galuega fa'afuase'i i fafo o le falema'i, dystocia tau'au, uaea nuchal, ma le manava mai fafo o le falema'i, ma eclampsia seizures, HELLP syndrome, ma le fa'ama'i fa'atamatama, fa'atasi ai ma a tatou ta'iala o taga fa'alavelave fa'afuase'i pepe ma tamaiti.

E tusa ai ma le American College of Obstetricians and Gynecologists (ACOG), le Centers for Disease Control and Prevention (CDC), le Faalapotopotoga o le Soifua Maloloina a le Lalolagi (WHO), ma le March of Dimes, ua mavae atu gasegase maitaga 34 to 36 weeks gestation (po'o so'o se tausaga fa'atama e iai se ma'i maualuga e ono tula'i mai e pei o le placenta previa, muamua C-section, preeclampsia, masaga/tele ma'itaga, po'o vasa previa) fa'afeagai ma tulaga lamatia o tina ma pepe pepe pe a pu'eina i totonu o se sone fa'alavelave e aunoa ma se taotoga fa'atama fa'atama. Tusa lava pe tumau pea le tatalaina o lau falema'i fa'anatinatiina i le taimi o se matagi po'o le pa'u eletise, Electronic Health Record (EHR) faitotoa ma'i ma feso'ota'iga komepiuta a le falema'i e masani ona alu tuusao i le taimi o le initaneti po'o le fa'aogaina o feso'ota'iga, ma tu'u ai se foma'i e le masani ai ile potu fa'alavelave fa'afuase'i e leai se malamalama i lou ituaiga toto ma le Rh(D) factor, Vaega B Streptococcus (GBS) tulaga, nofoaga o le fale, poo vailaau ma'i suka/toto maualuga. Fa'atinoina o le Early Third-Trimester Evacuation Protocol, o lo'o tauaveina se pepa lolomi Pepa Prenatal Chart, fa'afanua lua fa'asao Leipa & Tiliva (L&D) falema'i i le fa'afeagai o itu tapasa, ma le fa'apipi'iina o se Pusa Fanau Fa'ama'i Fa'afuase'i Fa'afuase'i Fa'afuase'i a WHO e puipuia uma ai le tinā ma le pepe pe a fa'aletonu mea tetele.

Fai nei loa¶

1. Talosaga i lau OB/GYN po'o le tausima'i-fa'atosaga fa'amaonia mo se kopi lolomi, pepa o lau Pepa Fa'amama Fa'ato'a & Ultrasound/Lab Summary i Week 28 ma faafou i Week 36, fa'amauina i totonu o se taga sipi pito e le susu i totonu o lau ato ma lau ato. Aua ne'i fa'alagolago i se telefoni feavea'i ma'i ma'i app (MyChart) e le manuia pe a alu i lalo olo sela. E mana'omia e se foma'i fa'atama i fafo ni fa'amatalaga se ono i luga o pepa i le 30 sekone: (1) Ituaiga Toto, Tulaga Rh, ma le Antibody Screen (whether you need RhoGAM), (2) Nofoaga Fa'anofo mai lou 20-vaiaso o le anatomy ultrasound (ruling out Placenta Previa before any vaginal exam), (3) Vaega B Strep (GBS) i'uga o le swab, (4) Aso Fa'atatau (EDD) e ala ile trimester muamua o le crown-rump ultrasound, (5) Vaega o faama'i pipisi (HIV, Hepatitis B, Syphilis, Rubella), ma le (6) Ituaiga Ma'ila Fa'aa'a Mua (low-transverse vs. classical vertical C-section).
2. Fai le "T-Minus 48-Hour Early Evacuation Rule" afai o oe 36+ weeks pregnant (po o 28+ weeks fa'atasi ai ma so'o se tulaga lamatia tele) pe a tu'uina atu se afā, afā tetele o le taumalulu, lologa, po'o le afi afi. Aua le **fa'atali mo se fa'atonuga fa'atulafonoina e aveese ai: alu 36 to 48 hours a'o le'i agi matagi malolosi (63 km/h / 39 mph) po'o fa'ato'a taunu'u mai aisa, ma tusi se faletalimalo pe nofo ma le aiga i totonu 15 minutes o se Level III po'o le Level IV Perinatal / NICU Falemai i fafo atu o le sone o a'afiaga.
3. Muai faafanua TOLU Leipa & Tiliva (L&D) falema'i - e le'o falema'i fa'anatinati po'o ER tuto'atasi e aunoa ma se fa'atamatama - o lo'o i totonu a itiiti mai LUA fa'afeagai itu tapasa mai lou fale. E ova atu i le 40 pasene o potu fa'alavelave fa'afuase'i i nu'u ma pitonu'u e le o toe iai se potu fa'amama ma le Labour & Delivery ward. Fa'ailoa muamua po'o fea falema'i i Matu, Saute, Sasa'e, ma Sisifo o lou fale o lo'o i ai 24/7 OB/GYN ta'otoga fa'ainisinia ma se Vaega o Tausiga Fa'atamatama (Neonatal Intensive Care Unit) (NICU) ina ne'i poloka e se vaitafe lolovaia po'o se alatele tele i lalo le auala i lou falema'i muamua.
4. Aua ne'i siaki i totonu ose faleaoga lautele/ta'aloga ta'aloga i 36+ weeks ma'itaga e aunoa ma le fesili muamua i lou itumalo fa'alavelave fa'afuase'i lala sooupu e uiga i a "Medical / Special-Needs Shelter" pe "Hospital Pre-Admit Staging Program". Ole tele o falema'i i gataifale e fa'atagaina fafine e 38 to 39+ weeks pregnant (po'o le maualuga o le lamatiaga) e siaki sa'o i totonu o le potu malolo o le falema'i po'o se fale fa'afoma'i lata ane * a'o le'i pa'ū i uta e alu ese mai le afa mai le potu tipitipi.
5. ** Fa'amau se fa'amaufa'ailoga, e le susu "WHO Six-Cleans" Emergency Clean Birth Kit i totonu uma o lau pusa fa'alavelave i le fale ma le ogalaau o lau ta'avale.** Afai e maileia oe i totonu o le fale po'o totonu o se ta'avale i se afā fa'afuase'i, mafui'e, po'o totonu o se ta'avale i le taimi o le ga'o o le Laasaga Lua, e iai sau palasitika i lalo, totigilima nitrile sterile, chlorhexidine/fasimoli, lua pipii fa'amau (or boiled cotton tape), o se seulu fa'amanu fou/seulu (though in out-of-hospital births within 1 to 2 hours of EMS, you clamp/tie the cord and DO NOT cut it), o se tui o le pulufana, thermal Mylar + fulufulu mamoe palanikeke pepe, ma se otometi i luga o le lima pito i luga o le toto maualuga e laveai ai ola.
6. ** Inu 3 to 4 liters (100 to 135 fluid ounces) o vai mama i aso uma i le taimi o so'o se fa'asa'oga po'o le motusia o le eletise.** O le fa'amama o le tina ma le mamafa o le vevela e mafua ai ona tu'u mai e le pituitary gland i tua le antidiuretic hormone (ADH / vasopressin), lea e felavasa'i fa'atasi ma le manava oxytocin receptors ma fa'atupu ai le malepelepe vave o le manava.

La'au fa'ai'uga: Fa'alavelave fa'afuase'i lona tolu masina ma le fa'afeagai i totonu o le nofoaga ma su'ega faigaluega.¶

Mulimuli i le auala lea e fai ai filifiliga fa'atama'i pe a fa'amata'u lau eria i se lapataiga o le tau, fa'amalo le laina, po'o se fa'atonuga e aveese mai ai.

flowchart TD
    Alert["Mata'i Mata'utia o le Tau (Afa, Afā, Lolo, Afi) po'o Fa'alavelave Fa'afuase'i."] --> GestCheck{"O le a lou matua'i ma'itaga ma le tulaga lamatia o le fa'atama?"}

    GestCheck -->|"TULAFONO MAITAI I SO'O SE VAIASO (Placenta Previa, Prior Classical C-Section, Preeclampsia, Masaga/Triplets, History of Precipitous <2-Hour Work) POO LE 36+ Vaiaso Ma'itaga"| EvacEarly["VAIVAI AVEAGA (36 i le 48 Itula Aʻo leʻi Aʻafia): 1. Aveese i fafo o le afa / lologa i se faletalimalo / aiga i totonu o le 15 min o le Level III / IV L&D + NICU Hospital 2. Afai ua tapunia auala o le aveeseina -> Valaʻau lau OB / GYN & Primary L&D Refmission vave e fesili i le Falemaʻi Faʻataʻitaʻi i le Falemaʻi i le taimi lava lea. Fa'apitoa-Manaoga Fa'afoma'i Tofiga"]

    GestCheck -->|"Ma'itaga Nofofua Ma'ilalo i lalo ole 35 Vaiaso (Ma Tumau ile Fauga Saogalemu)"| PrepStay["SAUNIUNI MO LE MALO FA'AVAE I LE LUAGA: 1. Fa'apipi'i Pepa Prenatal Siata + 14-Aso Tu'uina o Vailaau (Prenatals, Insulin, Labetalol/Nifedipine, Low-Dose Aspirin, RhoGAM card) 2. Teu 4 Liters/Aso vai inu e puipuia ai le fa'amamāina o pepe pepe + 3. Stage Pepe Fa'amama 3. Stage BP Automated WHO. Alu-Tago i le moega"]

    EvacEarly --> SymptomCheck{"Pe e iai ni Fa'ailoga Lapata'iga Fa'amama'o e Atiina I le taimi o Fa'alavelave Fa'afuase'i?"}
    PrepStay --> SymptomCheck

    SymptomCheck -->|"To'oto'o masani (Ta'i 5 Minu'i pe Latalata), Fufulu/Tili ole Sua (ROM), Fa'atoto toto, Fa'aitiitia le Faitauina o Kiki o Fetal (<10 Kicks i le 2 Itula), PO'O le Tiga Tele / Va'ai Va'ai / BP >= 140/90"| GoHospital["FUAFUAGA FAAMATALAGA FAAMATALAGA: 1. Valaau le 911 / 112 / 999 ma le L&D Triage Desk 2. Siaki le tulaga o le auala -> Ave i le Primary L&D Hospital PO'O le Faafeagai-Compass Backup L&D Falema'i 3. Aumai Pepa Prenatal Chart + Mama Fanau Pusa + Nofo Ta'avale Pepe."]

    SymptomCheck -->|"Fa'anatinati lata mai e una'i, Omiga Fa'asa'o, Po'o Va'aia le Ulu o Pepe (Fa'apaleina) A'o poloka Auala."| ImminentBirth["TU'UINA I LE FALEMA'I VAA'I: 1. AUA LE taumafai e ave le taavale a'o faapaleina -> Valaau le 911 / 112 / 999 i luga o le sipika 2. Tatala Pusa Fanau Mama i luga o le moega mama / fola ('A'E LE'I luga o se faleta'ele) 3. Lagolago lemu le ulu o le pepe -> Fa'amago pepe i lalo -> Tuu le pa'u i le pa'u o le palanikeke i luga o palanikeke se lua. NA'O le mae'a ona taofi le ta'alo ('AUA LE tipiina uaea pe a taunu'u mai le EMS)"]

Vaega 1: Aisea e Fa'atupuina ai le Vavega o Afā ma Aveesega (Barometric Pressure & Dehydration Physiology)¶

O le malamalama i le aisea E faatumu ai uarota a Leipa & Tiliva i le 24 itula a o lei oo ma le taimi o se afa tetele, e fesoasoani ia te oe i le taimi e te alu ese ai a o lei le mafai ona uia auala:

1. O le A'afiaga o le Pa'u o le To'a o le Barometric (Atmospheric Low-Pressure Systems):
2. O afā malolosi, afa pomu, pomu sasa'e, ma asiosio mata'utia o lo'o fa'aalia ai le pa'u tifato o le mamafa o le ea (often dropping from 1,013 millibars down to 940 to 980 millibars).
3. Su'esu'ega fa'atamatama (including analyses of Hurricane Katrina, Hurricane Sandy, and typhoon landfalls in Japan and Taiwan) fa'aalia le fa'atupuina fa'afuainumera fa'atupulia i le Tape vave o Membranes (PROM - "vai gau") ma amata galue malosi i totonu 12 to 24 hours o le pa'u malosi o le mamafa o le barometric, ona o le eseesega o le mamafa lelei i totonu o le taga amniotic e galue faasaga i le chorioamniotic ua vaivai.
4. O le Fa'agata-Vasopressin-Oxytocin Loop:
5. Pe a saisai se fafine maʻitaga i le 8-itula o le alatele o le alatele (po o le sulufaʻi i se fale vevela e aunoa ma se ea malulu pe a pe a uma le eletise), e masani ona faʻatapulaʻa lana inu vai e aloese ai mai le suʻeina o faletaele o le alatele, aʻo maʻimau le sua i le afu.
6. A'o si'itia le osmolality o le plasma, o le hypothalamus o le fai'ai ma le pito i tua o le pituitary release e pa mai ** Antidiuretic Hormone (ADH / Arginine Vasopressin)**. Ona o le ADH ma le Oxytocin e eseese i le na o le 2 amino acids i totonu o latou mama 9-amino-acid peptide mama, maualuga maualuga o le ADH e fusifusia i oxytocin receptors (OXTR) i luga o le uterine myometrium, fa'aosoina le tiga Braxton Hicks po'o le fa'ato'itama moni a'o le'i fanau.
7. O le Catecholamine Si'i (And the "Safety Reflex" Crash):
8. O le fefe tele e tupu mai ai le si'itia o le epinephrine ma le cortisol a tina, lea e mafai ona taofiofia ai le tafe toto o le uteroplacental (triggering placental abruption in hypertensive mothers) po'o le fa'agata le fanau vave - se'ia o'o le tina i se malutaga pogisa, o le taimi lea e pa'u ai le adrenaline, osooso oxytocin, ma fa'ato'a tu'u lona lua fa'ata'ita'i e tupu i lalo ole 45 minute.

Vaega 2: O le Pepa Suavai Prenatal Siata: O le 10 Faʻamatalaga e manaʻomia e le fomaʻi ER e le masani ai.¶

Afai ua e alu ese atu i se isi aai pe savali i totonu o se falemai faaleoleo ua faaletonu le komepiuta, tuu atu i le tausima'i fa'ata'ita'i se 2-itulau Pepa Prenatal Summary ua fa'amaufa'ailogaina i totonu o se taga pusaaisa kalone e le susu. Fa'amaonia o lau pepa lolomi o lo'o aofia ai nei 10 fa'amatalaga fa'amatalaga tau falema'i:

Vaega 3: Fa'afefea ona Fa'apipi'i se Pusa Fanau Mama Mama Fa'afuase'i (WHO "Six Cleans" + Maternal Triage)¶

O le Faalapotopotoga o le Soifua Maloloina a le Lalolagi (WHO) ma le United Nations Population Fund (UNFPA) fa'amatala le lautele "Ono Fa'amama" e mana'omia e puipuia ai le ma'i pepe o le tina ma le fa'ama'i oti neonatal tetanus/omphalitis i le taimi o le fanau mai i fafo o le falema'i e le'i fuafuaina: (1) Lima Mama, (2) Fa'amama Mama, (3) Lau'ele'ele Tiliva Mama, (4) Fa'amama Mama-5) Mea Fa'amama Uaea-6** Tausiga Mama mama / afifi vevela**.

Aua le faatali se'i mailei oe ile fale ile matagi po'o lologa e su'e ai ile faleta'ele. Fa'apipi'i mea nei i totonu o se pepa mago 8-lita (2-kalone) fa'amaufa'ailogaina, po'o se atigipusa fa'amago fa'amago i ** Vaiaso 28*:

+-------------------------------------------------------------------------+
|  THE COMPLETE EMERGENCY CLEAN BIRTH & MATERNAL TRIAGE KIT CHECKLIST     |
|                                                                         |
|  A. CLEAN HANDS, SURFACE, AND PERINEUM ("CLEANS 1, 2, & 3")             |
|     [ ] 2 bars of unopened antibacterial or castile soap + 1 bottle of  |
|         70% alcohol hand sanitizer + 1 nail-scrub brush                 |
|     [ ] 4 pairs of sterile, individually wrapped Nitrile Exam Gloves    |
|     [ ] 1 large waterproof disposable plastic sheet (1x2 meters / 3x6   |
|         ft) + 6 sterile disposable absorbent Chux underpads             |
|     [ ] 12 large sterile 4x4-inch (10x10 cm) gauze pads + 1 peri-bottle |
|         filled with sterile or boiled-and-cooled water                  |
|                                                                         |
|  B. CLEAN UMBILICAL CORD MANAGEMENT ("CLEANS 4, 5, & 6")                |
|     [ ] 4 sterile disposable plastic Umbilical Cord Clamps (OR 3 pieces |
|         of clean white cotton shoelace/umbilical tape boiled in water   |
|         for 20 minutes and sealed in a sterile pouch)                   |
|     [ ] 1 single-use sterile disposable surgical scalpel blade (#10) OR |
|         1 pair of new stainless-steel trauma/blunt-tip scissors sealed  |
|         in an alcohol-sterilized pouch (NOTE: If ambulance/hospital     |
|         care is reachable within 1-2 hours, CLAMP/TIE the cord in two   |
|         places after pulsing stops, but DO NOT CUT THE CORD - let EMS or  |
|         the ER cut it with hospital-autoclaved instruments)             |
|     [ ] 2 sterile alcohol prep pads (to wipe scissors if completely     |
|         cut off from medical rescue for >6 hours)                       |
|                                                                         |
|  C. NEWBORN AIRWAY, WARMTH, AND APGAR RESUSCITATION                     |
|     [ ] 1 sterile soft rubber Bulb Syringe (for gentle mouth-then-nose  |
|         suction ONLY if thick secretions block breathing)               |
|     [ ] 4 warm, pre-washed flannel/fleece receiving blankets + 2 warm   |
|         knit newborn hats (babies lose 70% of heat through their wet    |
|         scalp and skin in the first 3 minutes; hypothermia kills        |
|         newborns even in warm rooms)                                    |
|     [ ] 1 infant-sized Mylar thermal space blanket (wrap OVER the dry   |
|         cloth blanket, never directly against wet newborn skin)         |
|                                                                         |
|  D. MATERNAL POSTPARTUM HEMORRHAGE & PREECLAMPSIA TRIAGE                |
|     [ ] 1 gallon-sized heavy-duty zip-top plastic bag (to hold the      |
|         delivered Placenta intact for hospital inspection - never throw   |
|         the placenta away, as doctors must check if a lobe tore off)    |
|     [ ] 1 pack of heavy maternity postpartum pads (NEVER use tampons)   |
|     [ ] 1 automated upper-arm Blood Pressure Cuff + 1 digital           |
|         thermometer + LED headlamp (so the birth helper has both hands  |
|         free in a power blackout)                                       |
+-------------------------------------------------------------------------+

Vaega 4: Fa'ata'ita'iga o Leipa i fafo o le Falema'i: O afea e Avea ai Ta'avale Vs. O afea e Taofi ai ma Fa'aolaina i le nofoaga.¶

I le taimi o se fa'alavelave fa'afuase'i po'o se poloka auala, o le mea sese sili ona mata'utia e mafai ona faia e se aiga o le taumafai e fa'avavevave i lalo o se alatele lolovaia pe tumu i le kiona a'o fa'ato'a faapaleina le tina (Second Stage of Labor), i'u ai i le fanau mai e le taofiofia i luga o le laupapa o le fola o le taavale. Fa'aaoga le tulafono fa'ata'ita'i fa'apitoa lea:

1. Fa'afefea ona ta'u le Laasaga 1 Leipa (Safe to Transport Carefully) Mai le Fa'atupuina o le La'asaga 2 o lo'o lata mai (STOP and Prepare to Deliver)¶

• Laasaga 1 Leipa (Fa'atosina e aunoa ma le Uunaiga e Uunaia):
• Fa'ato'a tumau 45 to 60 seconds ma tupu uma 3 to 10 minutes, ae E LE lagonaina e le tina le mamafa o le sa'o, e LE lagona le mana'omia o le manava, ma E LEAI se vaega o le ulu o le pepe e vaaia i le avanoa o le manava i le taimi o le to'oto'o.
• Gaioiga: Valaau 911 / 112 / 999 ma lau L&D Triage Desk e fa'amaonia po o fea le auala o lo'o matala, fa'amau lelei le tina i le nofoa pito i tua (sliding the seat back and reclining slightly onto her left side to prevent Supine Hypotensive Syndrome, where the heavy uterus crushes the inferior vena cava), ma ave le taavale i le falemaʻi lata ane o le Labor & Delivery falemaʻi.
• Laasaga 2 Fa'ata'ita'i Fa'ata'ita'i (TUMAU Aveta'avale Vave):
• Afai e tupu so'o se tasi o nei fa'ailoga e tolu, fanau mai e tupu ile 2 i le 20 minute:
  1. Ua tagi le tina "Ua sau le pepe i le taimi nei / e tatau ona ou tuleia / e tatau ona ou fe'ai (Fergusson reflex from the fetal head pressing on the sacral nerves and rectum)".
  2. O le perineum o le tina (the skin between the vagina and anus) e amata fa'aoso i fafo a'o fa'ama'i.
  3. E te va'ava'ai i le matala fa'ama'i a'o e to'oto'o ma e mafai ona e va'ai se li'o e pei o le tupe siliva o le pa'u susu o le pepe (crowning).
• Gaioiga: Toso i totonu o se pakaga taavale saogalemu, malamalama lelei poʻo se nofoaga malu (pe nofo i totonu o lou fale), valaʻau **911 / 112 / 999 i luga o le telefoni ** ina ia mafai e se avefeʻau EMS ona aʻoaʻoina oe e ala i la matou fa'anatinati fa'afuase'i ma fa'atonuga fa'apitoa tau galuega, ma aua ne'i taumafai e kolosi vae o le tina pe toe tulei le ulu o le pepe i totonu (which causes fatal fetal brain hypoxia and uterine rupture).

2. O Tulafono Fa'auro e Lima o le Fanau mai o Fa'alavelave Fa'afuase'i (If EMS Is Delayed by Storm)¶

Afai e tatau ona e fa'aolaina le pepe a'o le'i o'o atu foma'i i lou fale po'o le ta'avale (silasila i la matou ta'iala ta'i ta'iala atoa ile fanau faafuasei): 1. Aua Ne'i Fa'ata'ita'i I luga o se Fale Ta'u'ele: O tama'ita'i o lo'o fa'ato'a fanau e lagona le mamafa tele o le fa'amama ma nofonofo i luga o le faleuila, fa'aulu muamua le ulu o le pepe fou i le vai malulu. Fa'ae'e o ia i luga o se moega, sofa, po'o se nofoa ta'avale fa'ata'oto e ufiufi i solo mama ma lau pepa palasitika Pusa Fanau Mama. 2. ** Lagolago Lemu le Ulu & Siaki le Ua mo se Uaea Nuchal:** A o sau le ulu, tuu le alofilima mafolafola o lou lima totinilima i luga o le perineum e taofia ai le masae o mea pāpā (never pull on the baby's head or neck). Fa'ata'amilo le tamatama'ilima e tasi i le ua o le pepe: pe afai o lo'o fa'avili le uaea i le ua (Nuchal Cord, o lo'o iai i le 25% o pepe fananau mai), fa'apipi'i le tasi tamatamai lima i lalo o le matasele ma fa'ase'e malie i luga o le ulu o le pepe e pei o le to'ese o se ofutino laumei (silasila i le matou dystocia tauau ma taiala uaea nuchal). 3. ** Faamago, Faaosofia, ma Tuu le Pa'u i le Pa'u i totonu ole 30 Sekona (The #1 Resuscitation Step): olo malosi le tua, fatafata, ma alofivae o le pepe i se solo mama mama (drying stimulates the baby to cry and expand their lungs while stopping evaporative heat loss), tia'i le solo susu, tu'u le pepe e le lavalava pa'u-pa'u sa'o i luga o le fatafata o le tina, tu'u se pulou lalaga mago i luga o le ulu o le pepe, ma ufiufi uma le tina ma le pepe i palanikeke mafanafana matutu. 4. ** Faatuai le Oomiina o Uaea (Ma Le Mea e Te Le Manaomia Ona Otiotiina ai le Uaea):** Ia aua nei pa'i le maea o le umbilical mo a itiiti ifo i le 1 i le 3 minute seia oo ina taofi le tata ma liu pa'epa'e/pa'epa'e (this transfuses 80 to 100 mL of iron-rich placental blood into the newborn). Ona nonoa lea pe pipii mau le maea i ni nofoaga se lua (15 cm / 6 inches mai le manava o le pepe ma 20 cm / 8 inches mai le manava). Afai e mafai ona e o'o i le falema'i po'o le ta'avale a le falema'i i totonu ole 1 i le 2 itula, AUA LE TOTOSI LE MAUA: na'o le tu'u le maea o lo'o pipi'i fa'apipi'i i le placenta (a'i i se solo mama i tafatafa o le pepe) ina ia mafai e le falema'i ona tipiina i mea faigaluega tipitipi mama. 5. ** Taofi le toto pe a uma le fanau (Immediate Breastfeeding + Fundal Massage):** O le taimi lava e fanau ai le placenta na o ia (within 5 to 30 minutes - NEVER pull on the umbilical cord), tuu loa le pepe i le fatafata o le tina (suckling triggers a natural surge of endogenous **Oxytocin** that contracts the uterus) ma fa'amaumau le manava pito i lalo i le maualuga o le pute se'ia o'o ina lagona le manava malosi ma lapotopoto e pei o se vine.

Numera fa'aitulagi o fa'alavelave fa'afuase'i ma fa'atonuga a le lala sooupu¶

I taimi o fa'alavelave tetele, e fa'amaopoopo e fa'alapotopotoga fa'alesoifua maloloina lautele ma feso'ota'iga fa'anatinati felauaiga mana'oga fa'apitoa ma fa'ata'ita'iga o tina ma fetal:

• Amerika:
• Fa'asalalau Fa'alavelave Fa'afuase'i & Resitala Manaoga Fa'apitoa: Valaau 911 mo le galue malosi po'o fa'alavelave fa'anatinati. I setete e afaina i afa (Florida, Texas, Louisiana, Karolaina i Matu, Karolaina i Saute, Georgia), resitaraina ma lou itumalo Special-Needs Evacuation & Shelter Registry i le amataga o lou tolu masina (e.g., Florida Department of Health Special Needs Registry at snr.flhealthresponse.com).
• Taiala a Tina-Fetal: ACOG (acog.org), CDC Vaega o le Soifua Maloloina (Hear Her Campaign), ma le National Maternal Mental Mental Hotline (1-833-TLC-MAMA / 1-833-852-6262, 24/7 leai se totogi OB/lagona soifua maloloina o le mafaufau).
• Kanata:
• Vala'au 911 mo fa'alavelave fa'afuase'i felauaiga EMS. Sosaiete o Foma'i ma Foma'i o Kanata (SOGC) ma fa'alapotopotoga fa'apitonu'u (Perinatal Services BC, PCMCH Ontario) fa'amaopoopo fe'avea'i ea/ele'ele a tina.
• Malo tupu:
• Valaau vave le 999 mo le vave fanau mai, tafetotoi lona tolu masina, po'o fa'ailoga eclampsia; vala'au lau falema'i 24-itula NHS Maternity Triage / Delivery Suite Helpline (lomi i luma o lau NHS Maternity Notes / BadgerNet app - fesili i taimi uma i lau faatosaga mo se pepa lolomi o lau faamaumauga BadgerNet i le 34 vaiaso).
• Iuni Europa:
• vili le 112 i isi setete uma o le EU. Ave lau pepa Mutterpass (Siamani/Austria) po'o le Carnet de Sante Maternite (Farani) i totonu o se lima e le susu i taimi uma i le tolu masina.
• Ausetalia ma Niu Sila:
• Ausetalia: Valaau 000 mo taavale a le falemai; ave lau pepa ** Faamaumauga o le Ma'itaga (Green/Yellow Book)** i taimi o afi o le vao po o lologa (RANZCOG taʻiala). Ma'itaga, Fanau mai ma Pepe Fesoasoani (1800 882 436).
• Niu Sila: Valaau 111 i se fa'alavelave fa'afuase'i ma fa'afeso'ota'i lau Ta'ita'i Tausi Tina (LMC faatosaga) tuusao; ave au pepa fa'amauina i totonu o lau ato tago.
• Initia, Iapani, ma Asia-Pasefika:
• Iapani: Ave lau malo aloa'ia ** Tusitaulima Soifua Maloloina o Tina ma Tamaiti (Boshi Kenko Techo)** i lau ato fa'alavelave fa'afuase'i i taimi uma; itumalo Fesootaiga Fa'amatalaga Fa'afoma'i Fanau (MFICU) fa'amaopoopo fa'alavelave fa'anatinati (119).
• Initia: vili 112 poʻo 108 / 102 (Janani Shishu Suraksha Karyakram / JSSK ta'avale a le tina e leai se totogi) ma ave lau tusi MCP (Mother and Child Protection) Kata. Vaai numera fa'afuase'i.

Fesili e fai soo¶

Aisea e to'atele ai fafine e fa'ato'a fa'ataga sa'o a'o taia e se afā po o se afa?¶

E lua fa'aoso fa'aoso fa'aletino e fa'afeso'ota'i i taimi o afā tetele: muamua, o le **pa'u i lalo o le mamafa o le ea o le ea** i totonu o le totonugalemu o se afā po'o le afā o le taumalulu e fa'ateleina ai le fa'alili o le mamafa i fafo i luga o le taga amniotic, fa'ateleina le fua o le ** ma'i le taimi o Membranes (`water breaking`)**. Lona lua, **faamamafa o le alu ese ma le vaivai tele** e mafua ai ona faamatuu mai e le fai'ai le pituitary gland **antidiuretic hormone (`ADH`)**, lea e fa'atatau i kemikolo ma le **oxytocin** ma fa'aosofia ai le fa'ama'iina o le manava. O le mafuaaga lena e fautuaina ai e le au faifataga tamaitai o loo i ai `36+ weeks pregnant` (po'o le tulaga lamatia i so'o se vaiaso) e alu ese **36 i le 48 itula a'o le'i o'o mai le afā.

Aisea e taua tele ai le i ai o se pepa lolomi o la'u ultrasound 20-vaiaso e iloa ai le mea o lo'o i ai lo'u placenta?¶

Afai e te taunu'u i se falema'i fa'asao e le masani ai ma le tolu-tiga masina o le toto toto po'o le ma'itaga a'o fa'aletonu feso'ota'iga komepiuta, e tatau ona vave iloa e le foma'i ER po'o le faatosaga pe o iai sau **Placenta Previa** (`where the placenta covers the cervix`). Afai e le'i iloa e le tagata ma'i le placenta previa ma fai e le tausima'i se su'ega masani e lua tamatamailima e siaki ai le fa'alolotoina o le manava, e mafai e o latou tamatamailima ona tu i le placenta ma fa'aoso ai le toto e lamatia ai le ola i sekone. O le lolomiina o lau lipoti ole ultrasound e 20-vaiaso e fa'amaonia ai se **pito i luma, pito i tua, po'o le fa'aputuga o le tino** (po'o le fu'a o se **mua'i**) e sefe ai le taimi taua ma puipuia ai fa'alavelave oti.

Afai e fanau la'u pepe i le fale i le taimi o le matagi po'o le lolo a'o matou fa'atali mo se ta'avale a le falema'i, pe tatau ea ona ou tipiina le pute?¶

**Leai.** Afai e o'o atu le au foma'i po'o le tausiga ile falema'i i totonu o ni nai itula, **e te LE mana'omia le tipiina o le maea o le umbilical** (ma aloese mai le tipiina i seleulu e le'i fa'amama le fale e puipuia ai le tetanus o pepe pepe ma siama siama). Na'o le fa'atali **1 i le 3 minute** pe a uma ona fanau mai se'ia taofi le tā o le uaea ma liu pa'epa'e, nonoa pe pipii mau le uaea i nofoaga e lua (`15 cm / 6 inches` ma `20 cm / 8 inches` mai le manava o le pepe), ma o le taimi lava e fanau ai le placenta na o ia, afifi le placenta i totonu o se solo mama poʻo se taga palasitika ma faʻaeʻe i luga tonu lava i tafatafa o le pepe seia oʻo ina tipi e fomaʻi le uaea i meafaigāluega mama.

Aisea e tatau ai ona ou fa'apipi'iina le susu o pepe Sauni e Fafaga pe a ou fuafua e susu ile 100% ole taimi?¶

O le susu o le susu o le mea'ai sili lea ona saogalemu mo pepe i se fa'alavelave fa'afuase'i ona e le mana'omia e le susu o susu se vai mama, leai se eletise, ma o lo'o tumu i fa'amasani mai tina. Ae peitai, i le taimi muamua `48 to 72 hours` pe a uma ona fanau mai (a'o le'i o'o i totonu le susu atoa), po'o pe a maua le tina i se fa'alavelave failele, fa'amama le vai, po'o le tete'a mai le pepe, o lo'o i ai ** fa'aoga tasi le tui `59-mL (2-ounce)` O fagu vai fa'asusu ma fa'amama fa'amama tu'umamafa** e puipuia ai le pepe fou mai le ma'isuka po'o le fa'amama le vai e aunoa ma le pa'i atu i vai lologa.

O a ni fa'ailoga lapatai "Postpartum Preeclampsia" pe a uma ona fanau e mafai ona o'o i le 6 vaiaso talu ona fanau?¶

O le fanauina o le pepe e **leai** e faamuta ai le tulaga lamatia o le ma'itama'i po'o le ma'i fa'ato'a: **Postpartum Preeclampsia** e masani ona tupu i le va o le **48 itula ma le 14 aso talu ona fanau mai** (ma e oo atu i le 6 vaiaso talu ona fanau). Fa'aaoga lou pa'u toto maualuga pe a e lagona le le lelei pe a uma ona fanau, ma vala'au loa le **911/112/999** pe a o'o lou toto toto **`140/90 mmHg` po'o le maualuga atu** ma le ** tiga o le ulu, faanenefu le va'ai po'o ma'ila emo, fula o foliga ma lima, pua'a le manava, po'o le tiga o le manava taumatau pito i luga** (silasila i le matou [fa'ata'ita'iga o le fa'ama'i ma le fa'ama'itama](../first-aid/eclampsia-seizures-hellp-syndrome-postpartum-preeclampsia-and-magnesium-triage.md)).

Taiala fa'atatau¶

• Fa'anatinati fa'afuase'i ma galuega fa'afuase'i i fafo o le falema'i
• Tau'au dystocia, maea umbilical i le ua (nuchal cord), ma le fa'ataga
• Eclampsia seizures, ma'i HELLP, ma le ma'itama o le pepe
• Pepe ma tamaiti la'ititi fa'alavelave fa'afuase'i ato fa'afuase'i ma fuafuaga fa'ate'a
• Numera fa'alavelave

Punavai ma ta'iala aloa'ia¶

• American College of Obstetricians and Gynecologists (ACOG): Manatu a le Komiti Nu. 726: Sauniuniga mo Faalavelave Faafuase'i a le Falema'i mo Foma'i Fanau ma Fale o lo'o Tuuina atu Tausiga Fa'atama ma le Taiala mo Tagata Ma'i i le Sauniuniga mo Fa'alavelave i le Ma'itaga.
• ** Nofoaga Autu mo Fa'ama'i ma Puipuiga (CDC, Iunaite Setete):** Soifua Maloloina i Faalavelave Tutupu Faafuasei Sauniuniga ma Tali: Saogalemu Savali mo Tina ma’itaga, Fa’atama, ma Fa’asusu i Fa’alavelave Fa’alenatura (cdc.gov/reproductive-health/emergency-preparedness).
• Faalapotopotoga o le Soifua Maloloina a le Lalolagi (WHO) & Faaputugatupe a Malo Aufaatasi (UNFPA): Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings: Clean Delivery Kit ("The Six Cleans") and Emergency Obstetric and Newborn Care (EmONC).
• ** American Academy of Pediatrics (AAP):** Fafagaina o Pepe i Faalavelave Matuia ma Faalavelave Faafuasei: Lagolago mo le Fasusuina ma le Saogalemu o le Faaaogaina o le Suavai Fuafua o Pepe Sauni e Fafaga.
• March of Dimes: Sauniuniga mo Fa'alavelave Fa'afuase'i mo Tina ma'itaga: Va'aiga Va'ai Vave, Fa'amaumauga Fa'afoma'i Fa'ata'ita'i Fa'ata'ita'i, ma Fa'ailoga Lapata'iga Fa'ata'ita'i Leipa.