Initial Birth Examination Flashcards
What are the two components to the initial birth examination?
The APGAR score
Top to toe examination
Why do we do the APGAR score?
According to skills to midwifery practice, the apgar score is for the midwife to determine how well the baby is adjusting from intrauterine to extrauterine life
When do we carry out the APGAR score?
Skills for midwifery practice state at 1 minute and then further scores are undertaken at 5 and 10 minutes
The score can be assessed more frequently if any of the scores are low and resuscitation is required
What does APGAR stand for?
Appearance (colour) Pulse (heart rate) Grimace (response to stimuli) Activity (muscle tone) Respiratory rate
What is the scoring system for the APGAR score?
Each variable is assigned a score of 0,1 and 2
There is an overall score out of 10
Explain the procedure when carrying out the APGAR score
- Ensure good, effective lighting to allow good visualisation of colour
- Note time of delivery, wait 1 minute then undertake 1st assessment. Assess the five variables quickly and simultaneously, totalling the score
- Act promptly and appropriately according to the score. For example a score of 0-3 would need immediate resuscitation
- Repeat at 5 minutes (the score should increase if previously 8 or below)
- Study for midwifery practice states to repeat again at 10 minutes
- Document findings and act accordingly
Why is the birth examination carried out?
According to NICE pathways, an initial examination is undertaken to detect any major physical abnormality and to identify any problems that require referral. It will also reassure the parents
When is the physical examination carried out?
Within the first 72 hours of birth
According to NICE 2007, it is usually undertaken after the first hour of life to enable baby to have a long period of skin to skin contact.
NICE 2020 also states that the examination must be undertaken with the patents consent and either in their presence or knowledge
What must you take into account before carrying out the examination?
History- antenatal, medical and intrapartum
Birth outcome- mode of delivery
Informed consent- ensure enough information is given to make informed decisions
Room temperature- around 26C. Babies lose heat through conduction, convection, evaporation and radiation
How would uou carry out the birth examination?
- Following the NMC code 2018, uou must explain the procedure to the parents and gain their informed consent. Also ensure at least one parent is present
- Wash hands and don PPE
- Confirm infants name and date of birth
- Ensure adequate lighting to allow clear visualisation
- Adequately expose the infant for assessment- only uncover the part being examined to maintain temperature
- Work systematically and thoroughly- from top to toe
- Wash hands and document findings
What would we look for when examining the head?
Shape (excessive moulding)
Size
Trauma (from an assisted delivery)
Bruising (may increase the risk of physiological jaundice occurring)
What would we look for examine the face?
Should appear symmetrical
Size and position of ears, mouth, chin and eyes should be noted in relation to each other
What should the head circumference be?
Bastion and Dunward 2017 suggest it should be between 34-35cm
What would we look for when examine the eyes?
There are 2 present Assess size, shape and any slanting Cataracts Discharge Conjunctival haemorrhage Round pupils Symmetry Redness Swelling Stickiness
What do we look for when examining the nose?
Shape and width of bridge should be observed
More if squashed (it is not unusual but aware if it is affecting breathing)
Nostrils shouldn’t flare
What do we look for when examining the mouth?
Lips formed and symmetrical Cleft lip cleft palate Sucking reflex Teeth Signs of thrush (white spots on the tongue)
What do we look for when examine the ears?
2 fully formed
Correct position
Any skin tags?
What do we look for when examine the neck?
Symmetry
Move fingers around to detect any swelling
Be able to move head to both sides
Skin folds at back suggest trisomy 21
What do we look for when examine the clavicles?
Feel along to ensure they are intact
Inability to move arms?
What do we look for when examine the arms?
Same length Moving freely Count digits Polydactyly (extra digits) Syndactyly (webbing) 2 creases on the palm (1 crease suggest trisomy 21)
What do we look for when examine the chest?
Symmetry of movement
Respiration rate
Nipples well formed and symmetrical not widely spaced
What do we look for when examine the abdomen?
Rounded and move in synchrony with chest during respirations
Cord securely clamped and in tact
What do we look for when examining the genitalia?
Check the sex
Scrotum gently palpated for presence of 2 testes
Length of penis usually 3cm
Check testicles have descended into the scrotum
Gently part labia to ensure clitoris
Urethra is open and in correct place
Vaginal skin tags?
What do we look for when examining the legs?
Same length Symmetry Size, shape and posture Moving freely Note shape of feet Count number of toes Webbing (syndactyly) Extra digits (polydactyly)
What do we look for when examining the spine?
Any obvious abnormality (spins bifida)
Swelling, dumpling, hairy patches
Curvature of spine (scoliosis)
Gaps in vertebrae
What do we look for when examining the anus?
Confirm anal sphincter
Ensure still comes from correct place
Colour of stool
What is the head size in a full term infant?
32-36cm
What should the newborns temperature be?
Between 36.5-37.5C
How many wet nappies should there be in 24 hours?
4-6
Why do we give babies the Vitamin K injection?
Babies don’t get enough vitamin K from their mothers during pregnant and breastfeeding.
It decreases the risk of a Vitamin K deficiency bleeding called haemorrhaging disease of the newborn
What is Jaundice?
It is when the baby’s skin is yellow and it is caused by a build up of bilirubin in the blood
It is common
The baby’s liver is not fully developed so it’s less effective at removing the bilirubin from the blood
Why do we treat jaundice?
There is a small risk that the bilirubin could pass into the brain and cause brain damage
What is vernix?
It is a bio film layer consisting of anti-microbial proteins and fatty acids
It provides a layer of protection.
Define the neonatal period
From birth to 28 days
What is the average heart rate for a newborn?
110-160bpm
What is the average real rate for the newborn?
30-60bpm should be quiet
When would we carry out the newborn blood spot test?
On day 5
What conditions does the blood test screen for?
Sickle cell
Cystic Fibrosis
Metabolic diseases
Congenital hypothyroidism
What is meant by Caput succedaneum?
It is swelling caused by pressure at birth
It’s benign
Must inform parents
Should settle within a few days
What is meant by Cephal Haematoma?
It is firm swelling or bump caused by bleeding below the periosteum
Benign
Will gradually resolve
