Neonate Delivery Flashcards
What is the primary source of oxygen for a fetus in utero?
The placenta via the umbilical cord
In utero, the lungs do not supply oxygen.
What happens to fetal circulation after birth?
The ductus arteriosus and Foramen Ovale close, establishing normal circulatory flow
This change is driven by ventilation and oxygenation of the fetal lungs.
What stimulates the umbilical cord to vasoconstrict after birth?
A decline in temperature
This puts the burden of neonatal oxygenation on the neonate.
What marks the beginning of the first stage of labor?
The first true contraction
ENDs with full dilation (10cm)
It ends with full dilation of the cervix.
What is the usual duration of the first stage of labor?
Up to 18 hours
Less for patients who have had multiple deliveries.
What begins the second stage of labor?
Full dilation of the cervix
It ends with the delivery of the baby.
How often do contractions occur during the second stage of labor?
About every 2-4 minutes
Labor pains are felt as a ‘bear down’ feeling.
What is expected during the third stage of labor?
Delivery of the placenta
Usually lasts no longer than 30 minutes.
What are the immediate risks to the neonate during delivery?
Hypothermia and hypoxia
It is essential to prepare warmth and oxygen.
What are the criteria for imminent delivery?
- Contractions 2-4 min apart
- Crowning
- Perineal bulge
- Urge to bear down
- Maternal indication
What does ‘Meconium’ signify during delivery?
Fetal distress
It can lead to respiratory distress if inhaled by the neonate.
What is the definition of ‘Multipara’ in obstetrics?
A woman who has given birth two or more times
It can affect fetal lie and birth weight.
What is considered premature delivery?And postmature?
< 37 weeks greater than 42 weeks
> 42 weeks is considered postmature.
What should you never do when the placenta is delivering?
Pull on the cord
This could lead to complications.
What must be done with the placenta after delivery?
Inspect it for intactness and place it in a plastic bag
Retained pieces can cause infection.
What is a ‘Nuchal Cord’?
The umbilical cord is wrapped around the newborn’s neck
It may require careful handling during delivery.
What is a ‘Prolapsed Cord’?
The umbilical cord presents from the vagina before the infant
It can be compressed against the birth canal.
What should be done if a prolapsed cord is identified?
- Place mother in knees-to-chest position
- Elevate hips during transport
- Notify receiving hospital
- Raise presenting part off cord with gloved fingers
What is the role of the 4 Ms in imminent delivery?
- Meconium
- Medication
- Multipara
- Maturity
These factors help assess the need for neonatal resuscitation.
What is the maximum time the baby should take to deliver after crowning?
30 minutes
This is critical for the safety of both mother and neonate.
What is the position called when the fetus is laying across the cervical opening not engaged with head down?
Breech
What should be applied to maintain flexion of the fetal head during a breech delivery?
Suprapubic pressure
When should the fetus be rotated face down in a breech delivery?
After delivery of the arms and NEVER before spontaneous delivery of the umbilicus
What action should be taken if there is no progression for 2-3 minutes during a breech delivery?
Place fingers in a V to make an air pocket for the fetal mouth and transport to appropriate facility.
What type of presentation requires a C Section?
Footling/Limb Presentation
What should not be done with the presenting limb during a footling presentation?
Do not touch the presenting limb
What position should the mother be in while preparing for transport in a footling presentation?
Knees to chest
What should be done to alert the receiving hospital during a footling presentation?
Alert receiving hospital (RAH)
What are some potential complications during labor?
- Non-progressing
- Extended labor time
- Small mom with big baby
- Drug induced
- Explosive delivery
What indicates shoulder dystocia during delivery?
No forward progress of the neonate
What is the turtling sign in delivery?
Mild advancement of the head during crowning, then the fetal head retracts
What is the primary objective if the neonate is doing well after delivery?
KEEP BABY WARM
What should be done with the blankets for a healthy neonate?
Blankets MUST be dry
What is the APGAR score used for?
Assess the health of the neonate at 1 and 5 minutes after birth
What does an APGAR score of 0 indicate for appearance?
Blue
What is the recommended action if APGAR remains 0 after 15 minutes of CPR?
Call OLM for possible discontinuation of resuscitation
What can oxygen create in the body during neonatal resuscitation?
Reactive oxygen species (ROS/free radicals)
What is the most important treatment you can provide to a neonatal patient?
Room air ventilation
What is a major cause of the need to resuscitate a neonate?
Meconium Aspiration
What should be done to the baby after delivery to prevent hypothermia?
Keep baby warm
What is the purpose of fundal massage postpartum?
Assist in decreasing postpartum hemorrhage
What are potential complications for neonates related to the mother?
- Respiratory depression
- Mother narcotic use
- Gestational age
- Cardiovascular system compromise
- Thermo regulation
- Meconium aspiration
Where should umbilical cord be clamped post delivery?
At 6” and 9”
APGAR score name the categories and scores
Apperance
Blue = 0
pink body/blue extremities=1
Completely pink = 2
Pulse
below 60 =0
60-100=1
100 above=2
Grimace
No Response=0
Grimace=1
Cough, cry, sneeze=2
Activity
Limp=0
some flexion=1
Active motion=2
Respiration
Absent =0
Slow regular =1
Good Crying = 2
Targeted SPO2 for neonates 1min through 10min
1min - 60-65%
2min - 65-70%
3min - 70-75%
4min - 75-80%
5min - 80-85%
10min - 85-95%
Fundal massage how often should be assesed
5,10 & 15min
Should be firm, not soft spongy
