fetus/newborn

Question 1

biophysical profile of the fetus

Answer 1

• Scoring system used to access fetal well being

Biophysical variable
Normal ( 2 ) Abnormal ( 0 )

1. amniotic fluid volume
   Fluid pocket at 1cm or more ?? one pocket
   Oligohydroamnions or no measureable po
2. non stress test
   Reactive Non-reactive
3. fetal breathing movement
   At least 1 episode for 30s in 30 min Abscent or < 30s in 30 min
4. gross body movement
   > 3 body / limb movements in 30 min 2 or < movement in 30 min
5. fetal tone
   At least 1 episode of limb / body extension + flexion, open close cycle of fetal hand
   Stops or abscent extension-flexion of body / limbs

• normal score 8 – 10
• 0 – 2 high suspicious of asphyxia, evaluated for immediate delivery

Question 2

nonstress test

Answer 2

• no stress on mother, on fetus – stress and check CTG
• changes of fetal HR with time
  1. check fetal HR
  2. physical stress is applied
• palpate uterus
• balotate fetal pulse pressure
• tell mother to stop respiration
  3. check fetal heart rate
• no changes – subcompensated fetal distress
• FHR increased by 10 – 15%, returns to normal 1 min 🡪 normal ( compensated )
• FHR decreased 🡪 decompensated fetal distress

Question 3

stress test

Answer 3

• contraction stress test
  1. conduction ??? or check FHR
  2. stimulate contraction by oxytoxin infusion 🡪 oxytoxin release
• 3 contraction in 10 min are necessary
  3. check FHR
• no changes – subcompensated fetal distress
• FHR increased by 10 – 15%, returns to normal 1 min 🡪 normal ( compensated )
• FHR decreased 🡪 decompensated fetal distress

Question 4

apgar score

Answer 4

• usually awarded at one and five minutes post partum
• as score of 3 or less at one min 🡪 need resuscitation
• a score of 6 or less at 5 min 🡪 perinatal asphyxia

Good : 8 – 10
Mild asphyxia : 6 – 7
Moderate : 4 – 5
Severe : 0 – 3

Score
0
1
2

A. Appearance : central trunk color
Pale
Blue
Pink ( extremities often blue )

P. Pulse rate
Abscent
< 100
> 100

G. Grimace
Nil
Grimace
Cry or cough

A. Activity ( muscle tone )
Limp / flacccid
Some flexion
Well flexed / active

R. Respiratory effort
Abscent
Gasping or irregular
Strong cry

Question 5

newborn in term

Answer 5

1. ?? mucous, meconium + blood must be sucked out before inhalation ( mech suction )
2. check Apgar score – at 1 min + 5 min after birth
   - as score of 3 or less at one min 🡪 need resuscitation
   - a score of 6 or less at 5 min 🡪 perinatal asphyxia
   - Good : 8 – 10
   Mild asphyxia : 6 – 7
   Moderate : 4 – 5
   Severe : 0 – 3
3. head circumference : 33 – 38.5 cm, covered with lanugo
4. length : 51 cm, measure with ( 2.5 - ???? )
5. respiratory rate : 30 – 40 / min
6. pulse : 120 – 140 / min
7. skin temperature : 36.4 – 37.0 oC, covered with vernix caseosa
8. dry eyes, concave abdomen, palpable liver 1 – 2 cm below gut
9. limbs : ???, well ??? , pink
10. male : testis should have descended in scrotum
    Female : vaginal bleeding due to withdrawal with meihows hormone
11. meconium is passed within 36 hrs