PBL3 - Birth Asphyxia

Question 1

Indications of birth asphyxia (5)

Answer 1

Poor apgar score
Prolonged time of onset spontaneous respirations 
Low umbilical vessel pH
Abnormal foetal heart rate patterns 
Abnormal neurological scores

Question 2

Foetal heart rate tracing - CTG - signs of hypoxia: (5)

Answer 2

Flat trace 
Tachycardia 
Type I dips
Type II dips
Unprovoked dips

Question 3

Type I dips

Answer 3

Decelerations which occur with contractions

Question 4

Type II dips

Answer 4

Decelerations which persist after the contractions

Question 5

Unprovoked dips

Answer 5

Decelerations not associated with uterine contractions

Question 6

Criteria for instrumental delivery of foetus: (forceps, ventouse) (6)

Answer 6

Full cervical dilation, engaged foetal cephalon presentation, ruptured membranes, empty bladder, no pelvic contracture, obstruction to delivery of the foetus

Question 7

Meconium is made of

Answer 7

Desquamated bowel cells and bowel secretion

Question 8

Foetal hypoxia causes foetus to evacuate bowel causing …

Answer 8

Meconium to pass into the liquor and gasping foetus can inhale matter preventing physiological changes from foetus to neonate

Question 9

Birth asphyxia:
Neurological symptoms (2)
Organ failure (3)

Answer 9

Neuro - fits, coma

Organ - renal failure, hepatic failure or cardiac failure

Question 10

Apgar assesses health of an infant at 1 min and 5 mins after birth
5 components

Answer 10

Heart rate
Respiratory effort
Muscle tone
Reflex irritability
Cloud

Question 11

Hypoxia effects on the brain - carried out at 24 hours

Grade I, II, III

Answer 11

I - hyperalert, tachycardic, jittery, hyper reflexive, 100% survival, neurologically normal
II - Lethargic, non composed, bradycardia, hypotonic, convulsions, 5%die, 20% neurological deficits
III - Flaccid, stuporose, poorly reacting pupils, prolonged fits, 75% die, 100% will have neurological deficits

Question 12

Neurological outcome of baby in scenario

Answer 12

Develop microcephaly + spastic quadriplegia, difficult to control fits, learning difficulties

Question 13

Therapeutic hypothermia cooled to … For …. Hours. Then rewarmed …. Per hour. Hypothermia reduced (3)

Answer 13

33-34oC for 72 hours
Rewarmed 0.5oC over hour
metabolic needs, damaging processes and inflammatory responses

Question 14

Birth asphyxia accounts for …. Cases of sever handicap

Answer 14

7-10%