neonatal assessment rc 290. labor: 3 stages stage 1 : cervical dilatation stage 2: birth of baby...
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Neonatal Assessment
RC 290
Labor: 3 Stages
Stage 1 : Cervical dilatationStage 2: Birth of babyDelivery of placenta
Normal time for all three stages is 12-20 hours
Dystocia
Caused by:Uterine dysfunctionImpaired fetal descent
Abnormal presentation or CPD
Dystocia Complications
Increased chances of:Placenta AbruptioCord compressionPROM
May cause infection and/or hypothermia
Falsely low fetal scalp pH
Normal Delivery: Vertex Presentation
Abnormal Presentations
Complete BreechFootling Breech
Breech Complications
Trauma to neonate and/or motherAsphyxia due to cord compressionProblems associated with premature birth
Cord Problems
Nuchal CordCord around infants
neckMay compress cord
Prolapsed CordCord comes out
before babyCord compression
and asphyxia
A & P Changes: Respiratory
Chest compression in birth canal expels fluid from airways. The re-coil of the chest helps initiate the first breath
-60-80 cmH2O generated for first breath
First Vt is about 80 ml Take four breaths to
establish FRC After 4th breath FRC is
about 80 ml Initial breath “helped”
by: Chest wall re-coil Tactile stimulation Temperature change ABG changes
A & P Changes: Circulatory
Left heart pressure increases when cord is clamped and placenta is no longer part of system
Right heart pressure drops as lungs expand and make PVR decrease
Shunts close
Shunt ClosuresForamen Ovale
Increased left heart pressure functionally closes itMay take two months to seal anatomicallyAn increase in RIGHT heart pressure could cause it to re-open
in the first two monthsDuctus Arteriosus
Rising PO2 causes it to constrictFunctionally closes in 15 hoursAnatomic close takes three weeksA decrease in PO2 in the first three weeks may allow it to
reopenDirection of shunt will be from higher pressure vessel to lower pressure
vessel
Delivery Room Assessment: Apgar Score
Apgar Score (cont.)
Taken at 1 and 5 minutes after birthHeart rate, Respiratory rate, and Color are
used as the basis for resuscitation need
Totals:0-2 = severe distress3-6 = moderate distress7-10 = minimal distress
Apgar Score and scalp pH
Apgar may be low with a normal scalp pH is mother has too much anesthesia
Apgar may be normal with a low scalp pH if fetus sustained chronic, low grade stress in utero
Silverman-Anderson Score-assess respiratory status only-
High score shows problems – just the opposite of the Apgar
Assessment of Gestational Age: The Dubowitz and
Ballard Exams- gestational age based on physical and
neurologic signs-
Intrauterine Growth Rate
After gestational age is determined, it is compared to birth weight to determine if intrauterine growth is appropriate
AGA: Appropriate for Gestational Age80% of all births
SGA: Small for Gestational Age10% of all births
LGA: Large for Gestational Age10% of all births
AGA
A preemie can be AGA (yet still premature!
LGA
Usually seen with diabetic mothersMay cause dystociaA preemie can still be LGA!
SGA
A preemie, a term, or a post-term can all be SGA!
Chronic, low-grade stress in utero causes SGASmoking, pre-eclampsia, malnutrition, infection,
opiate drugs, placental problems, renal disease, and hypertension
These factors are also the same ones that cause L/S ratios to hit 2:1 prior to 35 weeks!
SGA Appearance
ThinLoose, dry skinMinimal sub-Q fatMinimal hair
SGA Problems
AsphyxiaMeconium aspirationPulmonary HemorrhageIntracranial HemorrhageHypoglycemiaHypothermiaPolycythemia
Application Time