Perinatal Asphyxia Flashcards
Perinatal asphyxia
Derived from the Greek term “ Sphyzein” which means “ _________________”. It is a condition caused by _____________ in inspired air, resulting in impending or actual cessation of apparent life.
Simply put as failure of the newborn to ____________________________________ following complete delivery associated with hypo_________, hyper________ and __________.
a stopping of the pulse
lack of oxygen
resume or sustain spontaneous respiration
hypoxaemia ; hypercapnia ; acidosis.
Essential characteristics of perinatal asphyxia
The following should be present
Profound metabolic ________ (Ph <_____) on umbilical cord arterial sample
Persistence of an Apgar score of ≤____ for >_________
Neurologic manifestations in the immediate neonatal period to include __________ , ______tonia, coma, or _______________________ (HIE)
Evidence of multiorgan system dysfunction in the immediate neonatal period (CVS, renal, GIT, haematological, pulmonary)
acidosis ;<7.00
3 ;5mins
seizures ; hypotonia
hypoxic ischaemic encephalopathy(HIE)
Apgar Score
The ICD (10th revision) classifies birth asphyxia with reference to APGAR scores at one minute of age (APGAR _____ mild birth asphyxia, ______ moderate ; APGAR _______: Severe birth asphyxia)
6-7; 4-5 ; ≤ 3
Apgar score
Is a score conceived to report on the state of the newborn and effectiveness of resuscitation. However, is a ________ tool for assessing asphyxia. It is quite subjective.
• It grades ____ clinical features. It is assessed at _____ and at _____.
• Minimum score is _____ , and maximum score is ______
poor
5: 1mins ;5mins
0;10
Things in APGAR score?
Heart rate
Respiration
Color
Muscle tone
Response to Pharyngeal catheter
1st min Apgar—Is an index of ____________ . Denotes need for _________________ .
5 min Apgar- ____________ of resuscitative efforts. May determine the possibility of long term _______________
intrapartum asphyxia
extent of resuscitation
Effectiveness; neurological deficits
Major causes of asphyxia
Intrauterine
•Hypoxia Ischaemia_ _____________ insufficiency, _____________, _____________, maternal ____________ ff anaaesthesia
•Anaemia-_____________, fetomaternal haemorrhage
uteroplacental ; abprutio placentae
cord prolapse ; hypotension ff anaaesthesia
placenta praevia
Major causes of Asphyxia
Intrapartum
Birth trauma-____________ disproportion, shoulder _________ , _________ presentation, _________ _________ labour
interruption of the umbilical circulation (__________________)
cephalopelvic ; dystocia
breech ; prolonged obstructed
cord compression
Major causes of Asphyxia
Post partum
•Central Nervous System depression—maternal ___________ , ___________
•Airway obstruction-choanal _________, obstructing ________, __________ aspiration
•Pulmonary disorder—severe Immaturity, pneumothorax, diaphragmatic hernia. Also shock, severe anaemia
medication ; trauma
atresia ; goitre ; meconium
Pathophysiology ff asphyxia 1
Well defined sequence of events:
• 1. Primary apnoea: ___________ period of ______ breathing followed by cessation of _____________, ________ begins to fall, _________ decreases. __________ can help
An initial brief period
rapid ;respiratory movements
heart rate ; muscle tone
Stimulation
Pathophysiology ff asphyxia 1
Well defined sequence of events:
• 2. Secondary apnoea: With _________ after the primary apnoea, the infant develops ______________ respiration (3-6 b/min), _______ decreases further, ______ begins to fall, and baby becomes ________. Stimulation will ___________. Must have IPPV
persistent asphyxia
deep rapid gasping; heart rate
BP; flaccid
not help
Pathophysiology ff asphyxia
Well defined sequence of events:
- Circulatory adaptive responses- With the hypoxia, bradycardia and hypotension, there is ______eased shunting of blood thro the _____,______,______ in order to maintain O2 delivery to vital organs (brain, heart, and adrenals) at the expense of the liver, kidneys and intestines (_________ reflex).
• Initial increase in BP, cardiac output, CBF due to this redistribution of blood. Later all 3 decrease with prolonged asphyxia, and with decreased CBF, _______- ensues (ischaemia, later ——————- ).
increased
DV, DA, FO ; Diving reflex
brain damage ensues ; cortical atrophy
Pathophysiology ff asphyxia 1
Well defined sequence of events:
- There is severe metabolic ________ (lactic acidosis due to ______ accumulation) ff anaerobic respiration.
•The lactic acidosis causes further myocardial __________ , significant reduction in ____________ and eventual failure to perfuse even the vital organs.
Furthermore, chronic fetal hypoxia pulmonary arteriole smooth muscle hyperplasia which can lead to ____________________________ . Affected babies present with ___________________ after birth.
acidosis; CO2
depression ; cardiac output
pulmonary hypertension.
persistent fetal circulation
Management
LABOUR WARD ASSESSMENT
Anticipation is the key to good care – adequate preparation (skilled birth attendant and materials)
____________ and _____________ before and during labour
FHR, use of _________________ to monitor variability in FHR and foetal scalp blood pH
At delivery, assess heart rate and respirations, colour (_______________ – gold standard) to determine resuscitation needs
Maternal and foetal monitoring
cardiotocograph
pulse oximetry
MANAGEMENT
Resuscitation in delivery room A: keep ______, if not breathing or crying, _____________ as necessary, ____________ , reposition
Ensure ventilation (bag and mask), start with ________ for term infants, b/w room air & _____% O2 for preterms Golden Minute !!!!!!!
warm
clear airway
dry/stimulate; room air
30
Management
C: ensure circulation - chest compressions
D: __________ if HR <_____ despite C Give _____________ if in shock & other drugs as indicated
Post resuscitation – stabilization, monitoring and appropriate intervention (STABLE) before transport
Watch out for signs of organ dysfunction
Adrenaline ; 60
volume expanders
POST RESUSCITATION MONITORING
CNS Cranial ______ – serial _____
Monitor sensorium & muscle tone (_____,___________ Score)
Look out for seizures + adequate doses of appropriate anticonvulsants if there are seizures
Brain (or TBC) ________ for encephalopathy within ______ of injury
USS; EEG
Sarnat, Thompson
cooling;6 hrs
