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

1.Six things to adopt in this case :

• Assess the blood type and be prepared with the appropriate blood group if incase the patient requires blood transfusion.
• Monitoring and maintenance of fetal and the mother' s heart rate .
• Should be careful about avoiding surgical injuries to infant.
• Monitoring and limitation of hemorrhage during and postpartum.
• Appropriate dosage of anesthesia and aid to protect from adverse effects of anesthesia.
• Discussion about any permanent or reversible birth control procedure that should be taken.

2.Important questions to ask for cesarean delivery:

• Confirm if the appropriate blood type is available.
• Team members if they are ready for surgery and the resuscitation.
• 3. Once the baby is delivered by the cesarean section both the mother and the fetus are shifted to the recovery room and monitor for vitals. Provide skin to skin contact with the mother for establishment of bonding. The baby will cough out mucus and find feeding difficult which is normal as the mucus is not pushed out automatically as in vaginal delivery.

4. Targeted preductal SpO2 after birth of the fetus in cesarean section in one minute is 60% to 65% and in ten minutes it should be 85% to 90%.

5.Corrective measures after resuscitation of the baby:

• Delayed cord clamping should be avoided.
• Maintenance of vitals and normal temperature.