Question

This is a term pregnancy, 40 weeks GA, amniotic fluid is clear, singleton; for emergency cesarean birth due to prolonged fetal bradycardia. Mom is in labor for about 8 hrs. Variability started to decrease with some decelerations and the HR went down due to prolonged deceleration. OB team able to back up HR to 70 bpm. Delivery C/S is imminent. You may need additional team members to come in and help resuscitate the baby. Also, additional equipment and supplies may be needed. Mention at least 6 things that you will do the most for this patient. What are important questions to ask when paged for this delivery? Once the baby is delivered, what is the first thing you do? What is the targeted pre-ductal SpO2after birth? What are some corrective steps you can take when resuscitating a newborn?

Answer 1

The 6 things that should do to the patient is

- Maintained proper position to reduce of cord compression

- checked the fetal heart rate frequently

- check the blood pressure of the patient because hypotension can lead to fetal bradycardia

- Check the heart rate of the mother also.

- Do a vaginal examination to see any cord prolapse

- Provide psychological support and prepared for the surgery

Once the baby is delivered the first thing to do is clear the airway by the suction of the nose and mouth to established the breathing and prevent blockage of the airway and also to take the baby in radiant wormer.

The pre-ductal target after birth is 60-65% by 1 minute, 65-70% by 2minutes, 70 -75% by 3 minutes, 75-80% by 4 minutes, 80-85% by 5 minutes, and 85-95% by 10 minutes.

The steps of neonatal resuscitation is that

1. Check the baby is a term or not, cry immediately or breathing, is the baby having a good tone?

2. If no then warm the baby, clear the airway, dry the skin and stimulate

3. Check the heart rate, if below 100 or presence of apnea or presence of gasping

4. If yes, then provide PVV and oxygen support

5. Check again the heart rate, if still less than 100

6. Take ventilation corrective steps

7. check the heart rate, it coming below 60

8. Start intubation, chest compression, coordinate with PPV, compression can be done by two-finger method on the chest or thump method by holding the baby with fingers and two thumbs in the chest and give the compression. Breath can be given by mouth or Ambu bag. The ratio is 30: 2

8. Check the heart rate, still below 60, then administered IV epinephrine and continue with CRP.