Question

After 20 minutes of being brought to the birthing suite, Molly birthed her baby. She had a healthy baby girl who immediately cried at birth, heart rate of 96bpm, active motion, cried on stimulation, and had a pink trunk and blue extremities, Initiation of skin to skin contact. The placenta was delivered intact with minimal bleeding.

Question:

1. Discuss APGAR Scoring of the newborn

2. Outline the five (5) immediate needs of the newborn

3. Outline the steps of the ACTIVE management of the third stage of labour

Answer 1

1.APGAR scoring is the tool used to assess the newborn activity and health immediately after birth.Thus used to assess respiratory and cardiac activity of baby. This Acronym stands for A- Appearance . P-Pulse. G-Grimace A-Activity . R-Respiration. This is used immediately after birth to summarize baby condition ,each one is given score based on condition .Normal APGAR score is 8-10 baby with apgar less than 8 need cae. Appearance of the baby means skin color .Pulse heart rate ,so it used to assess activity of cardiac system,Grimace means expression of baby, Activity means body movements of baby ,Respiration is respiratory rate used to assess respiratory system function . A table with scoring

INDICATOR/SCORE	0	1	2
Appearance	Blue /Pale skin color	pink body ,blue extremities	pink body and extremities
Pulse	Absent	less than 100	Over 100 beats per minute
Grimace	floppy	minimal response to stimulation	promptly responds to stimulation
Activity	Absent	Flexed arms and legs	Active ,moving extremities
Respiration	Absent	Slow and low pitched cry ,irregular chest movements	vigorous activity,and Strong cry present.

Based on this scoring was allotted to each indicator .Based on the baby score baby condition was summarized . Minimal apgar score indicate baby need immediate intervention like ventilation.

Based on given data baby cried immediately after birth active (2) it indicate active respiration (2),cried to stimulation( 2)trunk was pink and extremities are blue (1),Heart rate96 beats/Minute(1). Based on this baby APGAR Score is 8.baby is healthy.minimal care like skin to skin contact is enough .

2.Immediate needs of baby .Immediately after birth baby need comfortable environment to survive .those needs are . *Warmth (Temperature) :Baby need time to adjust for external environment,because inside womb temperature was high. To provide warmth dry the baby with warm towels after delivering baby on to mother abdomen. Provide skin to skin contact. *Maintenance of respiration is needed. *Prevent infection. *Brest feeding . These are the needs of baby.

3.There are 4 stages of labour . 1. First stage starts feo. starting of labor pains to full dilatation of cervix. 2.Second stage is full dilatation of cervix to delivery of baby. 3. Third stage is from after delivery of baby to delivery of placenta . 4. Fourth stage is immediately after delivery of palcemto 2 hours.

Active management of Third stage of labor is important to prevent Maternal mortality,its a crucial time ,in third stag of labor complications may arise like post partum hemorrhage. Steps involved in active management: *Immediately after delivery of baby on to the mother abdomen ,assess the APGAR score. *Immediately after delivery of baby ,give uterotonic drug (Oxytocin)5 unist intramuscular route ,it helps for uterine contractions and separation of placenta *Clamp the Cord by using 2 clamps , in 5 to 10 centimeters width between two clamps after cord pulsation was stopped. It helps to drain more amount of blood to baby from mother. *Cut the cord bet ween 2 clamps. *In active management,controlled cord traction was done. Hold the cord with clamp which is attached to placenta on right hand, place the left hand on lower abdomen juts above the pubic bone,to identify uterine contractions ,by observing uterine contractions ,slowly rotate the Cord for easy separation of placenta and membranes from uterine muscles. And deliver the placenta . *Provide uterine massage to reduce bleeding and for active healing *Assess the placenta for full members present or not ,and any clots present ,examination of the cord needs to identify abnormalities. These are steps in active management of third stage of labor. In expectant management no need to do control cord traction ,wait till separation of placenta and deliver the placenta.