Obg mudaliar ppt resuscitation and examination of new born

Obg mudaliar ppt resuscitation and examination of new born ppt

1. Mudaliar and Menon’s Clinical Obstetrics 13 th edition

2. Chapter 50 RESUSCITATION AND EXAMINATION OF NEWBORN

3. The most important event after birth is the establishment of spontaneous respiration If babies fail to breathe at birth, require help in the form of resuscitation Universities Press Pvt. Ltd

4. DELIVERY ROOM PREPARATION Every delivery should be attended by a person trained in resuscitation A resuscitation kit should be kept ready All equipment should be checked and prepared for use A suitable team should be organised Additional help should be called for if necessary A pre-resuscitation checklist should be referred to The delivery room should be clean and warm (26 – 28 ◦ C ) Universities Press Pvt. Ltd

5. DELIVERY ROOM PREPARATION Resuscitation equipment should be checked during every shift Fans should be switcHed off to avoid cold draughts All members and staff should wash their hands with soap and water before entering the labour room Universal precautions for asepsis should be taken for all deliveries Universities Press Pvt. Ltd

6. MATERNAL, OBSTETRIC AND FAMILY HISTORY The following should be recorded:; Outcomes of previous pregnancies Gestational age and fetal assessment Results of fetal growth monitoring and fetal size Evidence of fetal maturity and any malformations Current status of maternal complications and details of fetal intrapartum monitoring Universities Press Pvt. Ltd

7. NEONATAL RESUSCITATION FLOWCHART Universities Press Pvt. Ltd

8. IMMEDIATE CARE AT BIRTH Universities Press Pvt. Ltd

9. VENTILATION The baby needs positive pressure ventilation in the following scenarios: The baby is apneic or gasping Fetal heart is less than 100 Before applying PPV, the airway should be cleared, and the head should be placed in sniffing position with a help of shoulder roll IPPV is performed using an appropriately sized ambu bag and face mask Universities Press Pvt. Ltd

10. INDICATONS FOR INTUBATION Antenatally diagnosed congenital diaphragmatic hernia Depressed newborn with a history of meconium-stained liquor For the administration of drugs through an endotracheal tube Prolonged/ineffective bag and mask ventilation Universities Press Pvt. Ltd

11. CHEST COMPRESSIONS If the heart rate does not increase to more than 60/min after effective ventilation for 30 secs, chest compressions are required along with PPV at the rate of 90 compressions and 30 ventilations (3:1) The chest is compressed on the lower third of the sternum to a depth of 1/3 rd of the chest diameter There are two techniques: The most common is thumb technique and the other one is two-finger technique. Universities Press Pvt. Ltd

12. DEE LEE MUCUS EXTRACTOR Suction is provided only if needed Suction of the mouth is followed by the suction of the nose Universities Press Pvt. Ltd

13. APGAR SCORE Universities Press Pvt. Ltd

14. ASSESSMENT OF NEWBORN AT BIRTH Routine examination of the newborn includes the following: General physical examination which includes a head-to-toe examination Recording of vital parameters (heart rate, respiratory rate, colour, temperature and oxygen saturation) Gestational age assessment Any kind of malformation Signs of respiratory distress, presence of a murmur, any stigmata of intrauterine infection and hepatosplenomegaly Universities Press Pvt. Ltd

15. BABIES WHO NEED SPECIAL CARE Babies <35 – 7 weeks old Babies who weigh <1.8 – 2 Kg Babies who have perinatal asphyxia or respiratory distress Small for gestational age (SGA) babies <2SD Babies born to diabetic mothers Babies who have hypoglycemia Babies who have suspected sepsis/meningitis Babies who have seizures Babies who have major congenital malformations Universities Press Pvt. Ltd

16. ASSESSMENT OF GESTATIONAL AGE There are various methods available for the accurate assessment of gestational age The New Ballard score (NBS) is a widely accepted method This score is dependent on two major criteria – physical parameters and neurological parameters. This score can be used for extremely preterm babies as the lowest score denotes 20 weeks of gestation. Universities Press Pvt. Ltd

17. CLASSIFICATION OF NEWBORNS AS PER GESTATIONAL AGE Early preterm: Less than 34 weeks Preterm: Less than 37 weeks Term: 37 – 41 weeks Early term: Between 37 0/7 and 38 6/7 weeks Full term: Between 39 0/7 and 40 6/7 weeks Late term: Between 41 0/7 and 41 6/7 weeks Post-term: After 42 weeks or more Universities Press Pvt. Ltd

18. BREASTFEEDING The baby should be put directly to the breast and fed within half an hour of birth The mother should be counselled about the advantages of breastfeeding in the antenatal period No prelacteal feeds in the form of honey, glucose, water or tea should be given to the infant Colostrum must never be discarded as it is rich in proteins, protective antibodies, cellular elements In the subsequent postnatal days, if the baby sleeps well for 2 hours following a feed, voids 5 – 6 times/day, passes 1 – 2 soft stools and gains 20 – 30 g/day, breastfeeding is considered adequate Universities Press Pvt. Ltd