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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
Increased chances of:
�Placenta Abruptio
�Cord compression
�PROM
�May cause infection and/or hypothermia
�Falsely low fetal scalp pH
Normal Delivery: Vertex
Presentation
Abnormal Presentations
Complete Breech
Footling Breech
Breech Complications
�Trauma to neonate and/or mother
�Asphyxia due to cord compression
�Problems associated with premature birth
Cord Problems
�Nuchal Cord
�Cord around infants
neck
�May compress cord
�Prolapsed Cord
�Cord comes out
before baby
�Cord 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 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
Delivery Room Assessment:
Apgar Score
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
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 Age
�80% of all births
�SGA: Small for Gestational Age
�10% of all births
�LGA: Large for Gestational Age
�10% of all births
AGA
�A preemie can be AGA (yet still
premature!
LGA
�Usually seen with diabetic mothers
�May cause dystocia
�A 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 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!
SGA Appearance
�Thin
�Loose, dry skin
�Minimal sub-Q fat
�Minimal hair
SGA Problems
�Asphyxia
�Meconium aspiration
�Pulmonary Hemorrhage
�Intracranial Hemorrhage
�Hypoglycemia
�Hypothermia
�Polycythemia
Application Time
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