Palani Fakatamaki 'o e Feitama 'i he Trimester Tolu: Faka'ehi'ehi mei he Barometric Labor Spikes mo e Fakapaaki ha Kit Fanau'i Ma'a¶

‘I he taimi ‘oku ofi mai ai ha afā, ‘ahiohio, tāfea fakavavevave, pe vela ‘i he vaotaá lolotonga ho‘o ‘i ho‘o tolu tolu ‘o e feitamá (28 to 40+ weeks gestation), he'ikai ke ke lava 'o muimui ki he taimi "tatali mo sio" tatau mo ha 'api 'oku 'ikai ke feitama. Ko e ngaahi matangi lahi, tō fakafokifā ʻi he ʻea barometric ʻo e ʻea, ʻikai ha vai ʻi he sinó, mo e mafasia ʻo e fetukutuku ʻoku faʻa fakatupu ʻe he ngaue taʻe taimi, movete vave ʻo e ngaahi membranes (PROM), pe fā‘ele fakavavevave ‘i he houa tonu ‘oku loka‘i ai ‘a e ngaahi halafakakavakavá, ‘oku ‘i lalo ‘a e ngaahi halá ‘i he . 1 meter (3.3 feet) ‘o e vai tāfeá, pea ‘oku ‘ikai lava ke tali ‘e he ngaahi me‘alele fakahaofi mo‘uí. Kapau 'oku ke a'usia 'a e ngaahi faka'au ke ngaue 'a e ngaue, toto 'i he vaginal, ha gush fakafokifā pe trickle 'o e vai amniotic, mamahi 'ulu lahi mo e ngaahi liliu 'i he sio, pe holo hifo 'a e ngaue 'a e fetal 'i he taimi ni, telefoni ki ho'o fika fakavavevave fakalotofonua 'o fakafou 'i he'emau . ngaahi fika fakavavevave directory ‘i he taimi pē ko iá. Vakaiʻi foki ʻetau ngaahi fakahinohino ki he tokoni ʻuluaki fakafaitoʻó ʻi he . fā‘ele fakavavevave mo e ngāue fakavavevave ‘i tu‘a mei he falemahakí, dystocia 'o e uma, maea nuchal, mo e tu'uaki 'o e breech mei he falemahaki, mo e . ngaahi puke ‘o e eclampsia, mahaki HELLP, mo e preeclampsia hili ‘a e fā‘elé ., pea tānaki atu ki heʻetau . fakahinohino fakavavevave 'a e ki'i tamasi'i mo e ki'i tamasi'i.

Fakatatau ki he Kolisi ʻAmelika ʻo e Kau Toketā Fakafanaú mo e Kau Toketā Fakafaʻeé (ACOG), ko e Senitā ki hono Puleʻi mo e Taʻofi ʻo e Ngaahi Mahakí (CDC), ko e Kautaha Mo'ui 'a Mamani (WHO), pea mo e Ma'asi 'o e Dimes, kau mahaki feitama kuo 'osi 2019. 34 to 36 weeks gestation (pe 'i ha fa'ahinga ta'u motu'a 'o e feitama 'oku 'i ai ha tu'unga fakatu'utamaki lahi hange ko e placenta previa, C-vahe fakakalasi kimu'a, preeclampsia, feitama mahanga/lahi, pe vasa previa) fehangahangai mo e ngaahi fakatu'utamaki fakatu'utamaki ki he mo'ui 'a e fa'ee mo e fanau kei valevale kapau 'oku ma'u 'i loto 'i ha sone fakatamaki 'o 'ikai ha tafa fakafanau. Neongo kapau ‘oku kei fakaava pē ho‘o falemahaki fā‘ele kuo palaní lolotonga ha afā pe ‘ikai ke ‘i ai ha ‘uhila, Lekooti Mo‘ui Faka‘ilekitulōnika (EHR) ngaahi portal 'o e kau mahaki mo e ngaahi netiueka komipiuta 'o e falemahaki 'oku nau 'alu ma'u pe ki he offline lolotonga 'a e ngaahi 'initaneti fakavahefonua pe grid outages, 'o tuku ai ha toketā 'o e loki fakavavevave 'oku 'ikai ke ne maheni mo e 'ilo 'o ho'o fa'ahinga toto mo e Rh(D) factor, Kulupu B Streptococcus (GBS) tu'unga, feitu'u 'o e pelesenta, pe ngaahi faito'o suka/toto ma'olunga. Fakahoko ha Polokalama Fakafetongi 'o e Tolu-Tolu 'o e Tolu, 'ave ha Saati Prenatal Pepa Paaki 'oku 'ikai ke 'i ai ha vai, mape'i ua backup 'o e Ngaue & Tu'uaki (L&D) ngaahi falemahaki ‘i he ngaahi tafa‘aki fehangahangai ‘o e kāpasá, pea ko hono fakafonu ‘o ha Emergency Clean Birth Kit ‘oku ‘ikai ke ‘i ai ha me‘a ‘i he tu‘unga ‘o e WHO ‘okú ne malu‘i fakatou‘osi ‘a e fa‘eé mo e pēpeé ‘i he taimi ‘oku ‘ikai ke ngāue ai ‘a e ngaahi langa fakalakalaká.

Fai ʻeni he taimí ni .¶

1. Kole ki ho'o OB/GYN pe neesi-fakafanau kuo fakamo'oni'i ki ha tatau kuo paaki, pepa 'o ho'o Flowsheet kakato 'o e Prenatal & Ultrasound/Lab Fakanounou 'i he Week 28 pea fakafo'ou ia 'i he 10.00. Week 36, sila'i ia 'i loto 'i ha kato zip-top 'oku 'ikai ke 'i ai ha vai 'i ho'o kato pa'anga mo e go-bag. 'Oua 'aupito na'a ke falala ki ha app portal 'o e kau mahaki smartphone (MyChart) ‘oku ‘ikai ke ola lelei ‘i he taimi ‘oku ‘alu hifo ai ‘a e ngaahi taua selá. ‘Oku fiema‘u ‘e ha toketā fakafanau ‘i tu‘a ‘i he feitu‘ú ha ngaahi mo‘oni‘i me‘a ‘e ono ‘i ha pepa ‘i ha sekoni ‘e 30: (1) Fa‘ahinga Toto, Tu‘unga ‘o e Rh, mo e Sivi ‘o e Ngaahi Me‘a Faka‘auhá (whether you need RhoGAM), (2) Feituʻu ʻo e Pelasenita mei hoʻo ultrasound ʻo e ʻanatomí ʻi he uike ʻe 20 (ruling out Placenta Previa before any vaginal exam), (3) Kulupu B Strep (GBS) ola 'o e swab, (4) 'Aho Fakafuofua (EDD) 'e he ultrasound 'o e pale-rump 'o e 'uluaki-mahina, (5) Panel 'o e mahaki pipihi (HIV, Hepatitis B, Syphilis, Rubella), mo e (6) Fa'ahinga 'o e Mafu 'o e 'Uto kimu'a (low-transverse vs. classical vertical C-section).
2. Ohi 'a e . "T-Minus 48-Hour Early Evacuation Rule" kapau ko koe 36+ weeks pregnant (pe 28+ weeks mo ha fa'ahinga tu'unga fakatu'utamaki lahi) 'i he taimi 'oku tuku atu ai ha afā, matangi lahi 'o e fa'ahita'u momoko, tafea, pe vela 'o e vao. 'Oua 'e 'oua ke tatali ki ha tu'utu'uni fakamālohi ke fetukutuku: mavahe 36 to 48 hours kimu‘a ‘i he matangi fakatalopiki-afā-mālohí (63 km/h / 39 mph) pe ngaahi whiteouts 'o e 'ahiohio 'oku a'u mai, pea puke ha hotele pe nofo mo e famili 'i loto 'i he . 15 minutes ‘o ha Falemahaki Levolo III pe Levolo IV Perinatal / NICU ‘i tu’a mei he feitu’u ‘oku uesia ai.
3. Pre-map TOLU Ngaue & Tu'uaki (L&D) ngaahi falemahaki - 'ikai ko ha ngaahi kiliniki tauhi fakavavevave pe ngaahi ER tu'u-taha 'o 'ikai ha ngaahi tafa'aki fakafanau - 'oku tu'u 'i he ngaahi tafa'aki fehangahangai 'o e kāpasa 'o 'ikai si'i hifo he UA mei ho 'api. Laka hake he peseti 'e 40 'o e ngaahi loki fakavavevave 'o e komiuniti 'i he tukui kolo mo e ngaahi kolomu'a 'oku 'ikai ke toe 'i ai ha uooti Labor & Delivery 'o e kau mahaki. Fakamo'oni'i kimu'a pe ko e fē 'a e ngaahi falemahaki 'i he Tokelau, Tonga, Hahake, mo e Hihifo 'o ho 'api 'oku 'i ai 'a e tafa 24/7 OB/GYN mo ha 'Iuniti Tauhi Fakalahi 'o e Fānau Kei Vahevahe (NICU) telia na'a poloka 'e ha vaitafe 'oku tafea pe ko ha overpass 'o e hala lahi 'oku holo hifo 'a e hala ki ho'o falemahaki tefito.
4. 'Oua 'aupito na'a ke vakai'i ha fale nofo'anga fakatamaki 'o e ako'anga fakapule'anga/fale fakamalohisino 'i he 36+ weeks feitama ‘o ‘ikai ke ke ‘uluaki ‘eke ki ho‘o kautaha pule‘i fakavavevave ‘o e vahefonuá fekau‘aki mo ha . "Medical / Special-Needs Shelter" pe . "Hospital Pre-Admit Staging Program". Ko e ngaahi falemahaki lahi ‘i he matātahí ‘oku nau faka‘atā ‘a e kakai fefine ‘oku nau . 38 to 39+ weeks pregnant (pe high-risk) ke vakai'i hangatonu ki he loki 'o e falemahaki pe ko ha fale fakafaito'o 'oku ofi mai kimu'a pea toki tu'uta ke heka atu 'i he ngaahi sitepu 'o e matangi 'o mama'o mei ha loki tafa.
5. Pack ha sila'i, 'ikai ke 'i ai ha vai "WHO Six-Cleans" Emergency Clean Birth Kit ‘i loto fakatou‘osi ‘i ho‘o kato fakatamaki ‘i ‘apí mo ho‘o puha ‘o e me‘alelé. Kapau ‘oku tauhele‘i koe ‘e ha ‘ahiohio fakafokifā, mofuike, pe tāfea fakafokifā ‘i loto pe ‘i ha me‘alele lolotonga ‘a e ngāue fakavavevave ‘a e Siteisi Ua, ‘o ‘i ai ha ‘uhiki pelesitiki ‘oku ‘ikai ke ‘i ai ha me‘a ‘i lalo, ngaahi kofunima nitrile ‘oku ‘ikai ha me‘a ‘i ai, chlorhexidine/socorderor boiled cotton tape)**, ko ha fo'ou 'o e scalpel 'oku 'ikai ke 'i ai ha 'uhinga/siisi (though in out-of-hospital births within 1 to 2 hours of EMS, you clamp/tie the cord and DO NOT cut it), ko ha huhu 'o e fo'i pulu, thermal Mylar + ngaahi palanikete pēpē fulufulu'isipi, mo ha cuff toto 'o e nima 'i 'olunga 'oku 'otometiki 'oku ne fakahaofi 'a e mo'ui.
6. Inu 3 to 4 liters (100 to 135 fluid ounces) ‘o e vai ma‘a faka‘aho lolotonga ha fa‘ahinga fetuku pe mate ‘a e ‘uhilá. Ko e ‘ikai ha vai ‘i he fa‘eé mo e mafasia ‘i he velá ‘oku fakatupunga ai ‘e he kēleni ‘o e pituitary ‘i muí ke ne tukuange mai ‘a e homoni antidiuretic (ADH / vasopressin), 'a ia 'oku kolosi-reacts mo e 'uto oxytocin receptors pea 'oku ne fakatupu 'a e ngaahi faka'au ke vave 'a e 'uto.

'Akau 'o e tu'utu'uni: Tolu-trimester fakatamaki 'o e fetukutuku vs.¶

Muimui ki he hala tuʻutuʻuni fakafanau ko ʻení ʻi he taimi ʻoku fakamanamanaʻi ai ʻe ha fakatokanga ʻea kovi, ʻuli ʻo e grid, pe tuʻutuʻuni ke fetukutuku ho feituʻú.

flowchart TD
    Alert["Vakai ki he 'Ea Malihi (Afa, 'Ahiva, Tafea, Vela 'o e Vao) pe Fakavavevave 'o e Grid Kuo Tuku atu"] --> GestCheck{"Ko e Ha Ho Ta'u Feitama & Tu'unga Fakatu'utamaki Fakafanau?"}

    GestCheck -->|"FAKATU'UTAMAKI LAHI 'I HA UIKE PE (Placenta Previa, C-Section Fakakalasi Kimu'a, Preeclampsia, Māhanga/Tolu, Hisitōlia 'o e Fakatu'utamaki <2-Houa 'o e Feitama) PE 36+ Uike Feitama"| EvacEarly["VAVE VAVE (36 ki he 48 Houa Kimu'a pea toki Uesia): 1. Fetuku ki tu'a mei he feitu'u 'o e matangi/tafea ki ha hotele/kainga 'i loto 'i he miniti 'e 15 mei ha Falemahaki Levolo III/IV L&D + NICU 2. Kapau 'oku 'OSI tapuni 'a e ngaahi hala fetukutuku ho'o Prill> L&D - L Tesi vave ke kole ki he Hū ki he Falemahaki Kimuʻa ʻi he Matangí pe ko ha ngāue ki he Falemahaki Fakafaitoʻo ʻo e Ngaahi Fiemaʻu Makehé"]

    GestCheck -->|"Feitama Singleton Fakatu'utamaki Ma'ulalo 'i Lalo he Uike 'e 35 (Pea Nofo 'i he Fa'unga Malu)"| PrepStay["TEUTEU KI HE FAKALOA 'O E NOFO'ANGA-'I-HE-FEITU'U: 1. Pack Pepa Saati kimu'a 'i he fanau'i + 'Aho 'e 14 'o e Faito'o (Prennatals, 'Inisulini, Labetalol/Nifedipine, 'Asilini-Tu'unga ma'ulalo, kaati RhoGAM) 2. Falekoloa prenduvent dehydration ki he d-3. Siteisi WHO Ma'a 'a e Fanau'i 'o e Kit + 'Otometiki BP Cuff + Pepe Go-Bag 'i he mohenga"]

    EvacEarly --> SymptomCheck{"‘Oku ‘I AI ha Ngaahi Faka‘ilonga Fakatokanga Fakafanau ‘oku Tupu Lolotonga ‘a e Fakatu‘utāmakí?"}
    PrepStay --> SymptomCheck

    SymptomCheck -->|"Ko e ngaahi fakasi'isi'i ma'u pe ('i he miniti 'e 5 kotoa pe pe ofi ange), Gush/Trickle 'o e vai (ROM), Toto 'i he Vaginal, Fakasi'isi'i 'a e Fetal Kick Count (<10 Kicks 'i he Houa 'e 2), PE Mamahi 'ulu lahi / Ngaahi feitu'u 'o e sio / BP >= 140/90"| GoHospital["FEKAU'AKI FAKAVAVEVAVE: 1. Ta ki he 911 / 112 / 999 mo e L&D Triage Desk 2. Sivi'i 'a e tu'unga 'o e hala -> Faka'uli ki he Falemahaki L&D Palaimeli PE Falemahaki L&D 'o e Fehangahangai-Kāpasa Fakafepaki Sefan Birth Chart 'I + Cle"]

    SymptomCheck -->|"Ko e Faka‘ai‘ai Vave ke Teke, Rectal Pressure, pe ‘Oku ‘Asi ‘a e ‘Ulu ‘o e Pēpeé (Fakakalauni) Lolotonga ‘Oku Ta‘ofi ‘a e Ngaahi Halá"| ImminentBirth["TU'UAKI VAVE KI TU'A MEI HE FALEMAHAKI: 1. 'OUA 'e feinga ke faka'uli lolotonga 'a e fakakalauni -> Ta ki he 911 / 112 / 999 'i he telefoni le'o 2. Fakaava 'a e Clean Birth Kit 'i he mohenga/folau ma'a ('OUA 'E TEITEI 'i 'olunga 'i ha fale kaukau) 3. Poupou'i 'a e ba' Tuku kili-ki-kili 'i he fatafata 'o e fa'ee 'i lalo 'i he ngaahi palanikete momoko -> Fusi/clamp 'a e maea 'i he feitu'u 'e ua hili PE 'a e ngaahi tu'u 'a e pulsing ('OUA 'e motuhi 'a e maea kapau 'oku a'u mai 'a e EMS)"]

Konga 1: Ko e hā ʻoku fakatupunga ai ʻe he ngaahi afā mo e ngaahi fetukutuku ʻa e fāʻele vave (Barometric Pressure & Dehydration Physiology)¶

Ko e mahino ki he ko e ha 'oku fonu ai 'a e ngaahi uooti Labor & Delivery 'i he houa 'e 24 kimu'a pea mo e lolotonga 'o ha matangi lahi 'oku tokoni ia kiate koe ke ke taimi'i ho'o fetukutuku kimu'a pea toki hoko 'a e ngaahi hala 'o 'ikai lava ke fou ai:

1. Ko e ola 'o e to 'o e 'omi 'o e Barometric (Atmospheric Low-Pressure Systems):
2. Ko e ngaahi afā lahi, saikolone pomu, nor'easters, mo e ngaahi supercells tornadic 'oku nau fakahaa'i ha holo lahi 'i he 'ea 'o e 'atakai (often dropping from 1,013 millibars down to 940 to 980 millibars).
3. Ngaahi ako fakafanau fakafaito'o (including analyses of Hurricane Katrina, Hurricane Sandy, and typhoon landfalls in Japan and Taiwan) fakahaa'i ha spike mahu'inga fakasitetisitika 'i he Rupture vave 'o e Membranes (PROM - "maumau'i 'o e vai") mo e kamata 'o e ngaue malohi 'i loto 'i he 2019. 12 to 24 hours 'o ha barometric 'o e 'omi 'o e 'omi 'o e 'ea, 'i he ngaue 'a e 'omi 'o e 'omi 'o e kehekehe 'i loto 'i he kato amniotic ki he ngaahi membranes chorioamniotic vaivai.
4. Ko e 'ikai ha vai-Vasopressin-'Okisitosini Loop:
5. Ko e taimi ʻoku tō ai ha fefine feitama ʻi ha houa ʻe 8 ʻo e fefonongaʻaki ʻi he hala lahí (pe malu ʻi ha fale vela ʻoku ʻikai ha ʻea fakamokomoko hili ha mate ʻa e ʻuhilá), ʻokú ne faʻa fakangatangata ʻene maʻu vaí ke fakaʻehiʻehi mei he kumi ki he ngaahi falemālōlō ʻi he hala lahí ʻoku tāpuni, lolotonga ia ʻoku mole ʻa e vaí ʻo fakafou ʻi he efuefu.
6. 'I he tupulaki 'a e osmolality 'o e plasma, 'oku pa 'a e hypothalamus 'o e 'uto mo e tukuange 'o e pituitary 'i mui 'o e Homoni fakafepaki'i 'o e 'uto (ADH / Arginine Vasopressin). Koe'uhi ADH mo e Oxytocin kehekehe 'e he 2 pe 'amino 'esiti 'i honau ngaahi mama peptide 9-'amino-'esiti, 'oku ma'olunga 'a e ngaahi tu'unga 'o e ADH kolosi-fakahokohoko ki he oxytocin receptors (OXTR) 'i he myometrium 'o e 'uto, 'o fakatupu 'a e mamahi Braxton Hicks pe mo'oni 'a e ngaahi faka'auha 'o e ngaue 'oku te'eki ke taimi.
7. Ko e 'Oho 'a e Katekolamine (And the "Safety Reflex" Crash):
8. Ko e manavasi‘i lahi ‘okú ne fakatupu ha tupulaki ‘i he epinephrine mo e cortisol ‘a e fa‘eé, ‘a ia ‘e lava ke ne fakangatangata ‘a e tafe ‘a e toto ‘i he ‘utó (triggering placental abruption in hypertensive mothers) pe fakataimi fakataimi 'a e fanau'i vave - kae 'oua kuo a'u 'a e fa'ee ki ha malu'anga fakapo'uli, 'i he taimi ko ia 'oku to 'a e adrenaline, endogenous oxytocin surges, pea precipitous 'a e tu'uaki 'o e siteisi hono ua 'oku hoko 'i lalo he miniti 'e 45.

Konga 2: Ko e Saati Prenatal Pepa Vai: Ko e Ngaahi Moʻoniʻi Meʻa ʻe 10 ʻoku Fiemaʻu ʻe ha Toketā ER ʻoku ʻikai ke maheni¶

Kapau ʻe hiki koe ki ha kolo ʻe taha pe lue atu ki ha falemahaki fakafetongi ʻoku ʻikai ke ngāue ʻene netiueka fakakomipiutá, ʻoange ki he neesi ʻo e triage ha Paper Prenatal Summary peesi ʻe 2 ʻoku silaʻi ʻi loto ʻi ha kato ʻaisi kāloni ʻoku ʻikai ke ʻi ai ha vai. Fakapapau'i 'oku kau 'i ho'o packet kuo paaki 'a e ngaahi poini fakamatala fakakiliniki 'e 10 ko 'eni:

Konga 3: Founga ke Fakatahatahaʻi ai ha Meʻalele Fakafānauʻi Maʻa Fakavavevave ʻoku ʻIkai Fakaʻauha (WHO "Six Cleans" + Maternal Triage)¶

Ko e Kautaha Mo'ui 'a Mamani (WHO) mo e Pa'anga Tokoni 'a e Pule'anga Fakatahataha (UNFPA) fakamatala'i 'a e "Ma'a 'e Ono" faka'univeesi 'oku fie ma'u ke ta'ofi 'a e sepsis puerperal 'a e fa'ee mo e tetanus/omphalitis fakatupu mate 'o e fanau'i kei valevale lolotonga ha fanau'i ta'e palani 'i tu'a mei he falemahaki: (1) Nima Ma'a, (2) Ma'a 'a e Perineum, (3) Ma'a 'a e Perineum, (3) Ma'a Me'angaue ki hono Nono'o 'o e Maea, (5) Me'angaue Motuhi Maea, mo e (6) Tokanga'i 'o e Maea Ma'a / Takai'i 'o e Mafana.

'Oua 'oua 'e tatali kae 'oua kuo tauhele'i koe 'e ha 'ahiohio pe tafea 'i 'api ke ke kumi 'i he ngaahi tu'asila 'o e falekaukau. Fakatahataha'i 'a e ngaahi me'a ko 'eni 'i loto 'i ha sila'i, mahino 'oku 'ikai ke 'i ai ha vai 'e 8-lita (2-kaloni) 'a e kato momoko pe puha latching fefeka 'oku lava ke faka'auha 'i he Uike 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)                                       |
+-------------------------------------------------------------------------+

Konga 4: Triage 'o e Ngaue 'i tu'a 'i he Falemahaki: Ko e taimi ke faka'uli ai vs.¶

Lolotonga ha fetukutuku fakatamaki pe poloka hala, ko e fehalaaki fakatu'utamaki taha 'e lava ke fai 'e ha famili ko e feinga ke fakavavevave hifo 'i ha hala lahi 'oku tafea pe sinou lolotonga 'oku fakakalauni malohi 'a e fa'ee (Second Stage of Labor), ‘o iku ai ki ha fā‘ele ta‘efakangatangata ‘i he laupapa ‘o e faliki ‘o ha kā ‘oku nga‘unu. Faka'aonga'i 'a e tu'utu'uni triage fakakiliniki ko 'eni:

1. Founga ke Tala ai 'a e Siteisi 1 'o e Ngaue (Safe to Transport Carefully) Mei he Fakakalauni 'o e Siteisi 2 'oku vave mai (STOP and Prepare to Deliver)¶

• Steisi 1 Ngaue (Ngaahi Faka'auha 'o 'Ikai ha Faka'ai'ai ke Teke):
• Ko e ngaahi fakanounou 'oku tolonga 45 to 60 seconds pea hoko kotoa pē . 3 to 10 minutes, ka 'oku 'IKAI ongo'i 'e he fa'ee 'a e involuntary rectal pressure, 'oku 'IKAI ongo'i 'oku fiema'u ke ne fai ha ngaue 'a e 'uto, pea 'oku 'IKAI 'asi ha konga 'o e 'ulu 'o e pepee 'i he ava 'o e vaginal lolotonga ha contraction.
• Ngaue: Ta ki he 911 / 112 / 999 mo ho'o L&D Triage Desk ke fakamo'oni'i pe ko e hala fe 'oku fakaava, ha'i malu 'a e fa'ee 'i he sea 'i mui (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), pea faka'uli ma'u pe ki he falemahaki Labour & Delivery 'oku fakaava ofi taha.
• Steisi 2 Tu'uaki vave (TA'OFI 'a e Faka'uli 'i he taimi pe ko ia):
• Kapau 'e hoko ha taha 'o e ngaahi faka'ilonga 'e tolu ko 'eni, 'e hoko 'a e fanau'i 'i loto 'i he miniti 'e 2 ki he 20:
  1. 'Oku tangi 'a e fa'ee "'Oku ha'u 'a e pepee he taimi ni / Kuo pau keu teke / 'Oku ou fie ma'u ke poop (Fergusson reflex from the fetal head pressing on the sacral nerves and rectum)".
  2. Ko e perineum ‘o e fa‘eé (the skin between the vagina and anus) kamata bulging ki tu'a lolotonga ha faka'au'auhifo.
  3. ‘Okú ke sio ki he ava ‘o e va‘é lolotonga ha faka‘au‘auhifo pea ‘oku lava ke ke sio ki he ha fo‘i siakale ‘oku lahi hangē ha koini ‘o e kili ‘ulu ‘o e pēpeé ‘oku sū (crowning).
• Ngaue: To'o atu ki ha tau'anga me'alele malu, maama lelei pe feitu'u malu (pe nofo 'i loto 'i ho 'api), ta ki he 911 / 112 / 999 'i he speakerphone koe'uhi ke lava 'e ha tokotaha fakahoko ngaue 'o e EMS 'o ako'i koe 'o fakafou 'i he'etau fāʻele fakavavevave mo e polokalama ngāue fakavavevave, pea ‘oua ‘aupito na‘á ke feinga ke kolosi ‘i he va‘e ‘o e fa‘eé pe teke‘i ‘a e ‘ulu ‘o e pēpeé ki mui ki loto (which causes fatal fetal brain hypoxia and uterine rupture).

2. Ko e Ngaahi Tu‘utu‘uni Koula ‘e Nima ‘o e Fā‘ele ‘i he Fakatamaki Ta‘e Palani (If EMS Is Delayed by Storm)¶

Kapau kuo pau ke ke fā‘ele‘i ‘a e pēpeé ki mu‘a ke a‘u atu ‘a e kau toketā fakafaito‘ó ki ho ‘apí pe me‘alelé (vakai ki he‘emau fakahinohino fakafaito‘o kakato ‘i he sitepu ki he sitepu ‘i he . fāʻele fakavavevave): 1. Never Deliver Over a Toilet: Ko e kakai fefine 'i he fanau'i fakavavevave 'oku nau ongo'i 'a e 'omi 'o e rectal lahi pea 'oku nau tangutu fakanatula 'i ha fale kaukau, 'o tuku hifo 'a e 'ulu-'uluaki 'o e pepee toki fanau'i ki he vai momoko 'o e fale kaukau. Hiki ia ki ha mohenga, sofa, pe sea kā ʻoku fakatokoto ʻo ʻufiʻufi ʻaki ha ngaahi taueli maʻa mo hoʻo laʻipepa pelesitiki ʻo e Clean Birth Kit. 2. Poupou'i 'a e 'Ulu 'i he Malimali & Sivi'i 'a e Neck ki ha Nuchal Cord: 'I he 'asi mai 'a e 'ulu, fokotu'u 'a e 'alofi 'o e 'aofinima 'o ho nima gloved 'i he malimali ki he perineum ke ta'ofi 'a e haea 'o e pahū (never pull on the baby's head or neck). Lele'i 'a e tuhu 'e taha 'i he kia 'o e pepee: kapau 'oku takai 'a e umbilical cord 'i he kia (Nuchal Cord, 'oku 'i ai 'i he 25% 'o e fanau'i), hook 'a e tuhu 'e taha 'i lalo 'i he loop pea faka'uli malie ia 'i he 'ulu 'o e pepee hange ko hono to'o ha sū turtleneck (vakai ki he'etau dystocia 'o e uma mo e fakahinohino 'o e maea nuchal .). 3. Momoko, Faka'ai'ai, pea Tuku 'a e Kili-ki-Kili 'i loto 'i he Sekoni 'e 30 (The #1 Resuscitation Step): Mimili mālohi ‘a e tu‘a, fatafata, mo e lalo va‘e ‘o e pēpeé ‘aki ha taueli mōmoa ma‘a (drying stimulates the baby to cry and expand their lungs while stopping evaporative heat loss), liʻaki ʻa e taueli sūú, ʻai ʻa e pēpē telefua kili-ki-kili ʻo fakahangatonu ʻi he fatafata ʻataʻatā ʻo e faʻeé, ʻai ha pulou lalanga mōmoa ʻi he ʻulu ʻo e pēpeé, pea ʻufiʻufi fakatouʻosi ʻa e faʻeé mo e pēpeé ʻaki ha ngaahi palanikete māfana mōmoa. 4. Toloi 'a e Cord Clamping (Pea ko e 'Uhinga 'oku 'IKAI Fiema'u ai ke ke Motuhi 'a e Cord): Tuku 'a e umbilical cord ke 'oua 'e lave ki ai 'i he miniti 'e 1 ki he 3 kae 'oua kuo tuku 'ene pulsating pea liliu 'o hinehina/flat (this transfuses 80 to 100 mL of iron-rich placental blood into the newborn). Hili iá pea nonoʻo pe fakamaʻu fefeka ʻa e afo ʻi ha feituʻu ʻe ua (15 cm / 6 inches mei he kete ‘o e pēpeé pea . 20 cm / 8 inches mei he keté). Kapau te ke lava ‘o a’u ki ha falemahaki pe me’alele fakahaofi mo’ui ‘i loto ‘i he houa ‘e 1 ki he 2, ‘OUA ‘E MOTUHI ‘A E MAEA: tuku pe ‘a e maea kuo fakama’u ‘o fakapipiki ki he placenta (takai ‘i ha taueli ma’a ‘i he tafa’aki ‘o e pepee) koe’uhi ke lava ‘e he falemahaki ‘o motuhi ia ‘aki ‘a e ngaahi me’angaue tafa ‘oku ‘ikai ke ‘i ai ha me’a ‘e hoko. 5. Ta'ofi 'a e Tafe Toto Hili 'a e Fanau (Immediate Breastfeeding + Fundal Massage): Ko e taimi pē ʻoku fāʻeleʻi ai ʻe he placenta ʻiate ia pē (within 5 to 30 minutes - NEVER pull on the umbilical cord), ‘ai ‘a e pēpeé ki he fatafata ‘o e fa‘eé ‘i he taimi pē ko iá (suckling triggers a natural surge of endogenous **Oxytocin** that contracts the uterus) pea milimili fefeka 'a e konga ki lalo 'o e kete 'i he levolo 'o e uho kae 'oua kuo ongo'i 'e he 'uto fefeka mo takai hange ha kalepi.

Ngaahi fika fakavavevave fakavahefonua mo e ngaahi tu'utu'uni 'a e ngaahi potungaue¶

Lolotonga e ngaahi fakatamaki lalahí, ʻoku fakafekauʻaki ʻe he ngaahi kautaha moʻui lelei ʻa e kakaí mo e ngaahi netiueka fakafanaú ʻa e fefonongaʻaki ʻo e ngaahi fie maʻu makehé mo e siviʻi ʻo e faʻeé mo e pēpeé:

• 'Amelika:
• Ngaahi Lesisita Fakavavevave & Ngaahi Fiema'u Makehe: Ta ki he 911 ki he ngaahi fakatu'utamaki fakavavevave 'o e ngaue pe fakafanau. ‘I he ngaahi siteiti ‘oku faingata‘a ke hoko ai ‘a e afā (Fololita, Tekisisi, Luisiana, Kalefōnia Tokelau, Kalefōnia Tonga, Siōsia), lesisita ki ho vahefonuá Lesisita ki he Feitu‘u mo e Nofo‘anga ‘o e Ngaahi Fiema‘u Makehé ‘i he kamata‘anga ‘o ho‘o māhina tolu (e.g., Florida Department of Health Special Needs Registry at snr.flhealthresponse.com).
• Fakahinohino ki he Fa'ee mo e Tamasi'i: ACOG (acog.org), Vahenga Mo'ui Fakafanau 'a e CDC (Hear Her Kemipeini), pea mo e Laine Fakafonua ki he Mo'ui Faka'atamai 'a e Ngaahi Fa'ee (1-833-TLC-MAMA / 1-833-852-6262, 24/7 ta'etotongi OB/poupou ki he mo'ui lelei faka'atamai).
• Kānata:
• Ta ki he 911 ki he fefononga'aki fakavavevave 'a e EMS fakafanau. Sosaieti 'o e kau toketā fakafanau mo e kau toketā fefine 'o Kānata (SOGC) mo e ngaahi netiueka fakavahefonua fakafanau (Perinatal Services BC, PCMCH Ontario) fakafekau'aki 'a e ngaahi fe'ave'aki 'ea/kelekele 'o e ngaahi fa'ee 'oku fakatu'utamaki lahi.
• Pule'anga Fakatahataha:
• Ta ki he 999 he taimi pe ko ia ki he fanau'i 'oku vave mai, toto 'i he trimester hono tolu, pe ngaahi faka'ilonga 'o e eclampsia; telefoni ki ho falemahakí ki he Laine Tokoni houa ʻe 24 ʻa e NHS Maternity Triage / Delivery Suite (ʻoku paaki ʻi muʻa ʻi hoʻo NHS Maternity Notes / BadgerNet app - kole maʻu pē ki hoʻo fakafanau ʻi he koló ha pepa kuo paaki ʻo hoʻo lekooti BadgerNet ʻi he uike ʻe 34).
• Iunioni 'a 'Iulope:
• Taila 112 'i he ngaahi fonua memipa kotoa 'o e EU. 'Ave ho'o pepa Mutterpass (Siamane/'Aositelelia) pe Carnet de Sante Maternite (Falanisē) 'i loto 'i ha nima 'oku 'ikai ke 'i ai ha vai 'i he taimi kotoa pe lolotonga 'a e tolu 'o e tolu 'o e feitama.
• Aositelelia mo Nu'usila:
• Aositelelia: Ta ki he 000 ki he fefononga'aki 'o e me'alele fakahaofimo'ui; 'ave ho'o pepa Lekooti Nima 'o e Feitama (Green/Yellow Book) lolotonga e ngaahi fakatokanga vela vao pe tafea (ngaahi fakahinohino 'a e RANZCOG). Laine Tokoni ki he Feitama, Fanau mo e Pepe (1800 882 436).
• Nu'usila: Ta mai ki he 111 'i ha taimi fakatu'utamaki pea fetu'utaki ki ho'o Taki Tauhi Fa'ee (LMC fakafanau) fakahangatonu; ʻave hoʻo ngaahi tohi fakafaʻē pepa ʻi hoʻo kato puké.
• 'Initia, Siapani, mo 'Esia-Pasifiki:
• Siapani: 'Ave ho'o municipal faka'ofisiale Tohi Fakahinohino ki he Mo'ui Lelei 'a e Fa'ee mo e Tamasi'i (Boshi Kenko Techo) ‘i ho’o kato fetukutuku fakavavevave ‘i he taimi kotoa pe; prefecturel Ngaahi Netiueka Fakamatala Fakafaito'o 'o e Fanau (MFICU) fakafekau'aki 'a e ngaahi fe'ave'aki fakafanau fakatamaki (119).
• 'Initia: Taila ki he 112 pe 108 / 102 (Janani Shishu Suraksha Karyakram / JSSK me'alele fakahaofi mo'ui ta'etotongi 'a e fa'ee) pea 'ave ho'o MCP kuo paaki (Mother and Child Protection) Kaati. Vakai ki he ngaahi fika fakavavevave.

Ngaahi fehu'i 'oku toutou 'eke .¶

Ko e hā ʻoku ʻalu ai ha kakai fefine tokolahi ki he fāʻelé ʻi he taimi pē ʻoku tō ai ha afā pe ʻahiohio?¶

'Oku converge 'a e ongo fakatupu physiological kuo fakatohi lolotonga 'a e ngaahi matangi lalahi: 'uluaki, 'oku fakalahi 'e he steep **to 'i he 'ea barometric 'a e 'ea** 'i loto 'i he lotolotonga 'o ha afā pe saikolone 'o e fa'ahita'u momoko 'a e gradient 'o e 'ea 'i tu'a 'i he tafa'aki 'o e amniotic sac, 'o fakalahi 'a e tu'unga 'o e **Premature 'o e Membrapne (`water breaking`)**. Uá, **ko e mafasia ‘i he fetukutuku mo e ‘ikai ha vai ‘i he sinó** ‘oku fakatupunga ai ‘e he kēleni ‘o e ‘utó ke ne tukuange mai ‘a e **homoni fakafepaki ki he ‘utó (`ADH`)**, 'a ia 'oku kemikale tatau mo e **oxytocin** pea 'oku ne faka'ai'ai 'a e ngaahi faka'au'auhifo 'o e 'uto. Ko e ‘uhinga ia ‘oku fale‘i ai ‘e he kau toketā fakafanaú ‘a e kakai fefine ‘oku nau . `36+ weeks pregnant` (pe high-risk 'i ha fa'ahinga uike pe) ke fetukutuku **houa 'e 36 ki he 48 kimu'a pea** toki a'u mai 'a e matangi.

Ko e hā ʻoku fuʻu mahuʻinga ai ke ʻi ai haʻaku pulusi pepa ʻo ʻeku ultrasound uike ʻe 20 ʻo fakahaaʻi ai ʻa e feituʻu ʻoku tuʻu ai hoku foʻi pēpeé?¶

Kapau te ke a'u ki ha falemahaki fakafetongi 'oku 'ikai ke ke maheni mo e toto pe ngaahi faka'auha 'o e vagina 'i he trimester hono tolu lolotonga 'oku 'ikai ke ngaue 'a e ngaahi netiueka fakakomipiuta, kuo pau ke 'ilo'i vave 'e he toketaa ER pe fakafanau pe 'oku ke ma'u 'a e **Placenta Previa** (`where the placenta covers the cervix`). Kapau ‘oku ‘ikai ke ‘ilo‘i ‘a e placenta previa ‘a ha tokotaha mahaki pea ‘oku fakahoko ‘e ha tokotaha tokoni ha sivi vaginal angamaheni ‘aki ‘a e louhi‘i nima ‘e ua ke vakai‘i ‘a e fakalahi ‘o e cervical, ‘e lava ke perforate ‘e honau louhi‘i nimá ‘a e placenta pea fakatupunga ‘a e toto fakatu‘utāmaki ki he mo‘uí ‘i ha ngaahi sekoni. Ko hono ma'u ho'o lipooti ultrasound uike 'e 20 kuo paaki 'o fakamo'oni'i ha **mu'a, mui, pe fundal placenta** angamaheni (pe faka'ilonga'i ha **previa**) 'oku fakahaofi 'a e taimi mahu'inga mo ta'ofi 'a e ngaahi faingata'a fakatupu mate.

Kapau ʻe fāʻeleʻi ʻeku pēpeé ʻi ʻapi lolotonga ha ʻahiohio pe tāfea lolotonga ʻemau tatali ki ha meʻalele fakahaofimoʻui, kuo pau nai ke u motuhi ʻa e uho ʻo e ʻuhiki?¶

**Ikai.** Kapau 'e a'u atu 'a e kau toketaa pe kau tauhi falemahaki kiate koe 'i ha ngaahi houa si'i, **'OKU 'IKAI fiema'u ke ke motuhi 'a e umbilical cord** (pea ko e faka'ehi'ehi mei hono motuhi ia 'aki 'a e ngaahi siisi 'i 'api 'oku 'ikai ke 'i ai ha me'a 'oku ne ta'ofi 'a e tetanus 'a e fanau kei valevale mo e ngaahi mahaki 'o e uho 'o e pekitilia). Tatali pe **miniti 'e 1 ki he 3** hili 'a e fanau'i kae 'oua kuo tuku 'a e pulse 'a e maea pea liliu 'o hinehina, nono'o pe fakama'u fefeka 'a e maea 'i ha feitu'u 'e ua (`15 cm / 6 inches` pea . `20 cm / 8 inches` mei he kete ʻo e pēpeé), pea ʻi he taimi pē ʻe fāʻeleʻi ai ʻe he foʻi pēpeé ʻiate ia pē, takaiʻi ʻa e foʻi pēpeé ʻoku kei ʻi ai pē ʻi loto ʻi ha taueli maʻa pe kato pelesitiki pea tauhi ia ke maʻolunga ʻi he tafaʻaki tonu ʻo e pēpeé kae ʻoua kuo motuhi ʻe he kau toketā fakafaitoʻó ʻa e afo ʻaki ha ngaahi meʻangāue ʻoku ʻikai ke ʻi ai ha meʻa ʻe ʻi ai.

Ko e hā ʻoku totonu ai ke u fakafonu ʻa e fomula vai ʻo e pēpē ʻoku Mateuteu ke Fafangaʻí kapau ʻoku ou palani ke tauhi pēpē ʻi he 100% ʻo e taimí?¶

Ko e tauhi fānaú ko e me‘akai malu taha ia ki he pēpeé ‘i ha fakatamaki koe‘uhi ‘oku ‘ikai fiema‘u ‘e he hu‘akaú ha vai ma‘a, ‘ikai ha ‘uhila, pea ‘oku fonu ia ‘i he ngaahi me‘a fakafepaki ‘a e fa‘eé. Kae kehe, lolotonga ‘a e ‘uluaki . `48 to 72 hours` hili ‘a e fā‘elé (kimu‘a pea toki hū mai ‘a e lahi kakato ‘o e hu‘akaú), pe kapau ‘oku faingata‘a‘ia ‘a e fa‘eé ‘i ha faingata‘a‘ia hili ‘a e fā‘elé, ‘ikai ha vai ‘i he sinó, pe mavahe mei he pēpeé, ‘o ‘i ai ‘a e **single-use sterile . `59-mL (2-ounce)` Ko e ngaahi hina fomula vai mateuteu ke Fafanga mo e ngaahi nipples 'oku 'ikai ke 'i ai ha me'a 'oku lava ke li'aki** 'oku ne malu'i 'a e pepee toki fanau'i mei he hypoglycemia pe dehydration 'o 'ikai ke ne ala ki he vai 'o e tafea 'oku 'uli.

Ko e hā e ngaahi fakaʻilonga fakatokanga "Postpartum Preeclampsia" hili ʻa e fāʻelé ʻe lava ke ne taaʻi ʻo aʻu ki he uike ʻe 6 hili ʻa e fāʻelé?¶

Ko hono fanau'i 'o e pepee 'oku **'ikai** ke ne fakangata 'a e fakatu'utamaki 'o e preeclampsia pe eclampsia: **Ko e preeclampsia hili 'a e fanau'i** 'oku lahi taha 'ene hoko 'i he vaha'a 'o e **houa 'e 48 mo e 'aho 'e 14 hili 'a e fanau'i** (pea a'u ki he uike 'e 6 hili 'a e fanau'i). Ngaue'aki ho'o me'a faka'ata toto 'i 'api kapau 'oku ke ongo'i 'oku 'ikai ke ke mo'ui lelei hili ho'o fanau'i, pea telefoni leva ki he **911 / 112 / 999** kapau 'e a'u ho toto ki he ** .`140/90 mmHg` pe ma’olunga ange** mo e **mamahi ‘ulu ‘oku tetetete, sio fakapo’uli pe ngaahi fo’i ‘uto ‘oku ulo, fula ‘a e fofonga mo e nima, nounou ‘a e manava, pe mamahi ‘i he kete to’omata’u ‘i ‘olunga** (vakai ki he’etau [eclampsia mo e fakahinohino ki he kimu'a 'i he hili 'a e fanau'i](../first-aid/eclampsia-seizures-hellp-syndrome-postpartum-preeclampsia-and-magnesium-triage.md)).

Ngaahi fakahinohino fekau'aki¶

• Ko e fā‘ele fakavavevave mo e fā‘ele fakavavevave ‘i tu‘a mei he falemahakí
• Dystocia ‘i he umá, maea umbilical takatakai ‘i he kiá (maea nuchal), mo e tu‘uaki ‘o e breech .
• Ko e ngaahi puke ‘i he ‘ekilamisí, mahaki HELLP, mo e preeclampisia hili ‘a e fā‘elé .
• Palani fetukutuku mo e kato fakavavevave ki he pēpeé mo e kiʻi tamasiʻí
• Ngaahi fika fakavavevave

Ngaahi ma'u'anga fakamatala mo e fakahinohino faka'ofisiale .¶

• Kolisi 'Amelika 'o e kau toketaa fakafanau mo e kau toketaa fefine (ACOG): Fakakaukau 'a e Komiti Fika 726: Mateuteu ki he Fakatamaki 'a e Falemahaki ki he Kau Toketaa Fakafanau mo e Ngaahi Fale 'Oku Nau Tokanga'i 'a e Fa'ee pea mo e Fakahinohino ki he Mahaki ki he Teuteu ki he Fakatamaki Lolotonga 'a e Feitama.
• Senitā ki hono Puleʻi mo e Taʻofi ʻo e Ngaahi Mahakí (CDC, ʻIunaiteti Siteiti): Moʻui Lelei Fakafanau ʻi he Mateuteu mo e Tali Fakavavevavé: Ngaahi Pōpoaki Malu ki he Kakai Fefine Feitama, Hili ʻa e Fāʻelé, mo e Huhú Lolotonga e Ngaahi Fakatamaki Fakanatulá (cdc.gov/reproductive-health/emergency-preparedness).
• Kautaha Mo'ui 'a Mamani (WHO) & Pa'anga Tokoni 'a e Pule'anga Fakatahataha (UNFPA): Tohi Fakahinohino Fakavaha'apule'anga 'a e Ngaahi Potungaue ki he Mo'ui Fakafanau 'i he Ngaahi Feitu'u Tokoni Fakaetangata: Kit Tu'uaki Ma'a ("Ko e Ngaahi Fakama'a 'e Ono") mo e Tokanga'i Fakavavevave 'o e Fakafanau mo e Fānau Toki Fanau'i (EmONC).
• Akatemi 'Amelika 'o e Fanau (AAP): Fakafafanga 'o e Pepe 'i he Ngaahi Fakatamaki mo e Fakatu'utamaki: Poupou ki he Fafanga mo e Ngaue'aki Malu 'o e Fomula Vai 'o e Pepe 'oku Mateuteu ke Fafanga.
• Ma'asi 'o e Dimes: Mateuteu ki he Fakatamaki ki he Kakai Fefine Feitama: Ngaahi Tu'unga 'o e Feitu'u Vave, Ngaahi Lekooti Fakafaito'o 'o e Fanau 'oku lava ke to'oto'o, mo e Ngaahi Faka'ilonga Fakatokanga ki he Fanau 'i he taimi te'eki ai.