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Neonatal Assessment

Neonatal Assessment. RC 290. Labor: 3 Stages. Stage 1 : Cervical dilatation Stage 2: Birth of baby Delivery of placenta Normal time for all three stages is 12-20 hours. Dystocia. Caused by: Uterine dysfunction Impaired fetal descent Abnormal presentation or CPD. Dystocia Complications.

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Neonatal Assessment

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  1. Neonatal Assessment RC 290

  2. Labor: 3 Stages • Stage 1 : Cervical dilatation • Stage 2: Birth of baby • Delivery of placenta Normal time for all three stages is 12-20 hours

  3. Dystocia Caused by: • Uterine dysfunction • Impaired fetal descent • Abnormal presentation or CPD

  4. Dystocia Complications Increased chances of: • Placenta Abruptio • Cord compression • PROM • May cause infection and/or hypothermia • Falsely low fetal scalp pH

  5. Normal Delivery: Vertex Presentation

  6. Abnormal Presentations Complete Breech Footling Breech

  7. Breech Complications • Trauma to neonate and/or mother • Asphyxia due to cord compression • Problems associated with premature birth

  8. Cord Problems • Nuchal Cord • Cord around infants neck • May compress cord • Prolapsed Cord • Cord comes out before baby • Cord compression and asphyxia

  9. 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: Respiratory

  10. 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

  11. Shunt Closures • Foramen Ovale • Increased left heart pressure functionally closes it • May take two months to seal anatomically • An increase in RIGHT heart pressure could cause it to re-open in the first two months • Ductus Arteriosus • Rising PO2 causes it to constrict • Functionally closes in 15 hours • Anatomic close takes three weeks • A decrease in PO2 in the first three weeks may allow it to reopen • Direction of shunt will be from higher pressure vessel to lower pressure vessel

  12. Delivery Room Assessment: Apgar Score

  13. Apgar Score (cont.) • Taken at 1 and 5 minutes after birth • Heart rate, Respiratory rate, and Color are used as the basis for resuscitation need Totals: • 0-2 = severe distress • 3-6 = moderate distress • 7-10 = minimal distress

  14. 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

  15. Silverman-Anderson Score-assess respiratory status only- High score shows problems – just the opposite of the Apgar

  16. Assessment of Gestational Age: The Dubowitz and Ballard Exams- gestational age based on physical and neurologic signs-

  17. 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 Age • 80% of all births • SGA: Small for Gestational Age • 10% of all births • LGA: Large for Gestational Age • 10% of all births

  18. AGA • A preemiecan be AGA (yet still premature!

  19. LGA • Usually seen with diabetic mothers • May cause dystocia • A preemie can still be LGA!

  20. SGA • A preemie, a term, or a post-term can all be SGA! • Chronic, low-grade stress in utero causes SGA • Smoking, 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!

  21. SGA Appearance • Thin • Loose, dry skin • Minimal sub-Q fat • Minimal hair

  22. SGA Problems • Asphyxia • Meconium aspiration • Pulmonary Hemorrhage • Intracranial Hemorrhage • Hypoglycemia • Hypothermia • Polycythemia

  23. Application Time

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