Question

Client Profile

Baby Martin was born via a normal spontaneous vaginal delivery (NSVD) at 36 weeks gestation. The mother arrived at the emergency room dilated to 9 centimeters and 100 % effaced. The mother also reports ruptured membranes for the past 22 hours. The fetal heart rate upon admittance to the emergency room is 170 bpm. The mother delivered in the emergency room 30 minutes after being examined. This is her seventh pregnancy, and she did not have prenatal care.

Case Study

Martin was admitted to the observation nursery from the emergency room where he was born. He weighed 5 pounds and was 19 inches long. His APGAR scores were 6 at one minute, and 8 at five minutes. Points were initially taken off for tone, reflexes, and color. His initial glucose was 35 and vital signs were heart rate 150, respirations 76, and temperature 97.2. The nurse noted some nasal flaring, grunting, and coarse breath sounds. He was given 1 ounce of D5W orally; oxygen therapy, and his skin and pharynx were cultured. The orders also included that he be placed on a warmer with skin probe for temperature monitoring.

At two hours the baby's glucose was 40, the nasal flaring continued, respiratory rate was 100 with continued coarse breath sounds. He exhibited acrocyanosis, and his temperature was 96.8. The baby was treated for transient tachypnea of the newborn with oxygen therapy and a warm environment.

At four hours the nurse noted that the baby was lethargic and difficult to arouse. He appeared pale with circumoral cyanosis, nasal flaring, and grunting with sternal retractions. The nurse notified the doctor, an IV was started, and the baby was transferred to the neonatal intensive care unit at a hospital in the next town.

At six hours the mother called the NICU to check on his progress and was told that he had subsequently developed jaundice and was on a ventilator.

Questions

1. What is the significance of the fact that this mother had no prenatal care? ( Please explain in detail)

2. What are the risks involved in a precipitous delivery? What do you think might have been done differently for this delivery had the mother come in at 4 to 6 cm instead of 9 cm? ( please explain in detail and if you use a source please cite it)

Answer 1

1. The significance of the fact that the mother had no prenatal care is that the baby had respiratory distress on birth and developing other problems flowing that. The baby had a premature birth.

If the lady had received prenatal care it would helps to avoid the birth complications that had develop to baby. Lack of prenatal care is associated with a 40% increase in the risk of neonatal death overall and a doubling of the risk women delivering at or after 36 weeks.

Women without prenatal care are seveb times more likely to give premature birth, here baby Martin had premature birth at 36 weeks. The baby has low birth weight( 5 pounds). The other consequence is poor health. Here baby Martin develops respiratory distress and development of jaundice.

Prenatal care helps the doctors to spot riskfactors and health issues early.

2. Risk involved in precipitous labor

It may increases the risk of hemorrhage, vaginal and cervical tearing, infection of newborn if the labor occurs in a unsterile environment.  

If the mother had come in at 4- 6 cm dilatation itvmay take long time for labour and there will be featal death.