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 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 Prolapsed Cord Cord around infants neck
May compress cord
Prolapsed Cord
Cord comes out before baby
Cord compression and asphyxia

9. A & P Changes: Respiratory
Chest compression in birth canal expels fluid from airways. The re-coil of the chest helps initiate the first breath
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

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 Ductus Arteriosus
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

19. AGA
A preemie can be AGA (yet still premature!

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

21. 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!

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

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

24. Application Time