Birth and first breath

Question 1

An hour after delivery, an infant born at 33 weeks gestation is noted to have an increasing respiratory rate, with a grunting pattern during expiration. A pulse oximeter is applied, which shows on oxygen saturation of only 84% (normal > 97%).

What is the likely cause of this?
How might it be treated?
How could this have been prevented?

Answer 1

Infant respiratory distress syndrome secondary to surfactant deficiency

Question 2

what is Infant respiratory distress syndrome secondary to surfactant deficiency

Answer 2

Newborn respiratory distress syndrome (NRDS) happens when a baby’s lungs are not fully developed and cannot provide enough oxygen, causing breathing difficulties. It usually affects premature babies. It’s also known as infant respiratory distress syndrome, hyaline membrane disease or surfactant deficiency lung disease.

Question 3

What makes HCG

Answer 3

placental trophoblast cells

Question 4

function fo HCG

Answer 4

support CL

Question 5

function of progesterone

Answer 5

releases all smooth muscle
promotes cervical plug development
inhibits uterine contractibility ( prevents explusion)

Question 6

function of oestrogen

Answer 6

produce PGE2
softens the cervix before labour
promotes connexin
stimulates oxytocin receptors in uterus - to create strong uterine contraction

Question 7

oestrogen synthesis in preg

Answer 7

CRH released from placenta goes to foetus brain release corticotropin to adrenal cortex and release cortisol which helps in lung maturation
DHEA makes oestrogen which support pregnancy in the mother
CRH also acts on mother pituitary relating corticotrophin to produce cortisol from the adrenal glands

Question 8

function of relaxin

Answer 8

softens cervix via labour and softens pelvic ligaments in preparation for delivery

Question 9

what hormone drops during the onset of labour

Answer 9

progesterone

Question 10

what does the posterior pituitary release to stimulate further uterine contraction both directly and indirectly via PGF2alpha

Answer 10

oxytocin - positive feedback

Question 11

what are prostaglandins derived from

Answer 11

arachidonic acid

Question 12

function fo PGE2

Answer 12

relaxes the Cervix

Question 13

function of PGF2

Answer 13

contracts the uterus

Question 14

what device can be used to record a fetal heart beat and uterine contractions in pregnancy

Answer 14

CTG
cardiotocogrpahy
each uterine contraction decreases fatal heart rate - should rise after

Question 15

can fetal oxygenation be compromised during labour and contraction

Answer 15

yes uterine contraction produce extrinsic compression of the uteroplacental blood vessels reducing flow and oxygen delviery to the foetus

Question 16

in the 3rd stage of labour the delivery of placenta occurs
what don’t you want to leave inside of the mother and what can you give to enhance uterine contractility and trade post parts bleeding

Answer 16

cotyledon

oxytocin and PGF2alpha

Question 17

I baby has increases respiratory rate , grunting during expiration and lower oxygen saturation levels - what things could have triggered this hypoxia ?

Answer 17

Inadequate surfactant

baby aspirated to much amniotic fluid

Question 18

surfactant secretion occur at first breath what is the function of it

Answer 18

coat alveoli and prevents them sticking together

Question 19

what is compliance

Answer 19

the ease at which something can be stretched - lungs are poor at first

Question 20

surface tension

Answer 20

tendency of liquid surfaces to pull together by molecular forces
if there is surface tension in fluid lining the alveoli it will reduce lung compliance and increases chance of alveolar collapse

Question 21

pressure = surface tension/ ?

Answer 21

radius of alveoli

Question 22

what cells secret surfactant

Answer 22

type 2 alveolar cells

Question 23

what hormones stimulate surfactant production

Answer 23

cortisol
thyroxine
prolactin

Question 24

in neonates pulmonary surface is in the alveoli lining which reduces ST and increases compliance and lung stability and reduces risk of what

Answer 24

pulmonary oedema

Question 25

if there is no surfactant what happens

Answer 25

pressure in a smaller alveoli will be more so air moves into another alveoli making it bigger an leading to fatal respiratory distress and collapse at low lung volumes

Question 26

how does infant respiratory distress syndrome secondary to surfactant deficiency present on an X-ray

Answer 26

bilateral hazy ground glass appearance on X-ray will be shaped thorax

Question 27

how can you treat how does infant respiratory distress syndrome secondary to surfactant deficiency

Answer 27

supportive continuous airway pressure
instillation of artificial surfactant
administer O2

Question 28

how can infant respiratory distress syndrome secondary to surfactant deficiency be prevented

Answer 28

corticosteroid treatment to the mother before 24 hours before delivery

Question 29

Episiotomy

Answer 29

an incision is made into the wall of the vagina to increase the diameter to accommodate the baby’s head during birth

• avoids tearing and pain

Question 30

back passage/rectocele - prolapse of the rectum through the posterior wall of the vagina

• cyctocele/bladder – prolapse of the bladder through the pelvic floor, pushing through the anterior wall of the vagina
• uterine prolapse – exactly what it sounds like

all type of what

Answer 30

prolapses

Question 31

during the birthing process the chance of infection is increased, why is this so?

Answer 31

during the birthing process the bladder and rectum are compressed and therefore empty.

• This causes an increased chance of infection due to the abrasion caused by the birthing process