Neonatal Resuscitation and Neonatology

1、 labor and delivery terms departments: l it may be vertical or more commonly, horizontal. also called abdominal delivery; commonly called c-section. labor and delivery terms colostrum: this is a thin, white fluid discharged from the breasts in the early stage of milk production, and usually noticeab

2、le during the last couple weeks of pregnancy complete breech: the babys buttocks are presenting at the cervix, but the legs are folded “indian style,” making vaginal delivery difficult or impossible. contraction: the regular tightening of the uterus, working to push the baby down the birth canal. cr

3、owned/crowning: when the babys head has passed through the birth canal and the top or “crown” stays visible at the vaginal opening. labor and delivery terms dilation: the extent to which the cervix has opened in preparation for childbirth. it is measured in centimeters, with full dilation being 10 c

4、entimeters. effacement: this refers to the thinning of the cervix in preparation for birth and is expressed in percentages. you will be 100% effaced when you begin pushing. epidural: a common method of anesthesia used during labor. it is inserted through a catheter which is threaded through a needle

5、, into the dura space near the spinal cord. episiotomy: an incision made to the perineum to widen the vaginal opening for delivery. labor and delivery terms fontanelle: soft spots between the unfused sections of the babys skull. these allow the babys head to compress slightly during passage through

6、the birth canal forceps: tong shaped instrument that may be used to help guide the babys head out of the birth canal during deliver frank breech: the babys buttocks are presenting at the cervix and the babys legs are extended straight up to the babys head. induced labor: labor is started or accelera

7、ted through intervention, such as placing prostaglandin gel on the cervix, using an iv drip of the hormone oxytocin (pitocin), or by rupturing the membranes. labor and delivery terms lightening: when the baby drops in preparation for delivery (engagement). meconium: this is the greenish substance th

8、at builds up in the bowels of a growing fetus and is normally discharged shortly after birth nubain: synthetic narcotic pain reliever commonly used in labor and delivery. oxytocin: hormone secreted by the pituitary gland that stimulates contractions and the milk-eject reflex. pitocin is the syntheti

9、c form of this hormone. perineum: the muscle and tissue between the vagina and the rectum. labor and delivery terms phenergan: a sedative administered that also controls nausea and vomiting. placenta previa: when the placenta partially or completely covers the cervix. prostaglandin cream: medication

10、 used to ripen the cervix before induction. ruptured membranes: usually refers to the breaking of the fluid filled sac surrounding the baby. the fluid may come as a gush of water or as a slow leak. slow leaks are sometimes mistaken as incontinence. speculum: an instrument used to open the vagina sli

11、ghtly wider so that the cervix can be seen more easily. labor and delivery terms timing contractions: contractions are measured from the beginning of one contraction until the beginning of the next contraction. tocolysis: inhibition of contractions used to suppress premature labor with medications,

12、magnesium sulfate, terbutaline, ritodrine transverse: babys body length is horizontal in the uterus. if the baby cannot be moved, it will have to be delivered by cesarean . vacuum extractor: instrument that attaches to the babys head and helps guide it out of the birth canal during delivery. betamet

13、hasone: glucocorticoid drug which greatly accelerates fetal lung maturity, but takes one to two days to work. labor and delivery terms chorioamnionitis : an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. prelabor rupture of membranes (prom) or premature ruptur

14、e of membranes as it is sometimes known, is a condition that occurs in pregnancy when there is rupture of the membrane of the amniotic sac and chorion more than one hour before the onset of labor umbilical cord prolapse happens when the umbilical cord precedes the fetus exit from the uterus. it is a

15、n obstetric emergency during pregnancy or labor that imminently endangers the life of the fetus. cord prolapse is rare labor and delivery terms para the number of births (alive or not) with a viable infant 22 weeks and at least 500 grams gravida the number of pregnancies pre-eclampsia (toxemia)-usua

16、lly occurs at 24 weeks gestation, acute hypertension, edema, renal impairment (proteinuria), sudden weight gain, occurs in 7% of pregnancies, more common in low socioeconomic groups eclampsia; toxemia, seizures, coma, convulsions, hemolysis, renal failure, 5% of women with pre-eclampsia develop ecla

17、mpsia, 15% die from complications; associated with high fetal mortality due to premature delivery dystocia: difficult birth neonatal resuscitation newly born infant at time of birth newborn within first few hours of birth neonate within first 30 days of delivery pre-term less than 37 weeks of gestat

18、ion term 38 to 42 weeks of gestation post-term (post-date) greater than 42 weeks of gestation http:/ general pathophysiology and assessment approximately 10% of newborns require assistance to begin breathing extensive resuscitation needed in less than 1% of newborns rate of complication increases as

19、 the newborn weight and gestational age decrease 80% of 30,000 babies born each year weighing less than 3 lbs. (1,500 grams) require resuscitation factors that indicate high risk delivery factors can be divided into maternal and fetal. maternal factors include age (younger than age 15, older than ag

20、e 35) weight (pre-pregnancy weight under 100 lb or obesity) height (under five feet) history of complications during previous pregnancies (including stillbirth, fetal loss, preterm labor and/or delivery, small-for-gestational age baby, large baby, pre-eclampsia or eclampsia) more than five previous

21、pregnancies bleeding during the third trimester abnormalities of the reproductive tract uterine fibroids hypertension rh incompatability gestational diabetes infections of the vagina and/or cervix kidney infection fever acute surgical emergency (appendicitis, gallbladder disease, bowel obstruction)

22、post-term pregnancy pre-existing chronic illness (such as asthma, autoimmune disease, cancer, sickle cell anemia, tuberculosis, herpes, aids, heart disease, kidney disease, crohns disease, ulcerative colitis, diabetes) factors that indicate high risk delivery fetal factors include exposure to infect

23、ion (especially herpes simplex, viral hepatitis, mumps, rubella, varicella, syphilis, toxoplasmosis, and infections caused by coxsackievirus) exposure to damaging medications (especially phenytoin, folic acid antagonists, lithium, streptomycin, tetracycline, thalidomide, and warfarin) exposure to ad

24、dictive substances (cigarette smoking, alcohol intake, and illicit or abused drugs) a pregnancy is also considered high-risk when prenatal tests indicate that the baby has a serious health problem (for example, a heart defect). in such cases, the mother will need special tests, and possibly medicati

25、on, to carry the baby safely through to delivery. furthermore, certain maternal or fetal problems may prompt a physician to deliver a baby early, or to choose a surgical delivery (cesarean section) rather than a vaginal delivery. the birth process at the onset of true labor, the contractions will fe

26、el like a tightening of abdominal muscles, a dull ache or a pressure on the lower pelvis or back. at about this time the baby drops down into the pelvis; this is known as engagement because the baby has settled into its position for birth. another term aptly used is lightening because the babys new

27、position means the mother has now more space to breathe and digest food. with time the contractions start to come at a more regular pace and the pain intensifies. the sensation is like a belt tightening around your back which spreads round underneath the baby. as the labor progresses the contraction

28、s last longer and occur at decreasing intervals. the birth process bloody show: a plug of mucous which seals the top of the vagina acts as a barrier against infection from invading the uterus. sometimes this plug dislodges itself before the contractions commence and you will notice a show i.e. thick

29、 vaginal discharge mixed with blood in the patients underwear. this however is no indication that you are into proper labor; it may be several days before the action commences. in other instances, the contractions begin well before the expulsion of the mucous plug. the birth process water break: in

30、about 20% of women, the pressure of the babys head can puncture the amniotic bag causing the fluids to leak out before labor. often it occurs in later part of labor. there is no mistaking a rupture; the leakage is clear and watery from the vagina and you can lose as much as 2 pints of fluid. the wat

31、er can gush out or come in a slow trickle. the baby is in risk of infection and chance of umbilical cords descent into the birth canal. water breaking can pose a risk in the form of infection or the oxygen supply being affected. the birth process other symptoms; nausea, diarrhea and backache. someti

32、mes tightening the whole day before labor begins; this is indicative of the cervix ripening and shortening at a gradual pace or your baby could be probably lying with its back to your back. in the case of the latter the tightening occurs as the baby rotates round to assume the right position before

33、making its entry into the world. stages of birth the first stage begins with the first contraction and ends when the cervix is fully dilated. the cervix undergoes many changes: it becomes softer, spongier, the cells thin out and the cervix shortens. this shortening and thinning is termed effacement.

34、 before effacement the cervix is 1.5 inches in length and after effacement it somewhat disappears. stages of birth force from the contractions combined with the pressure from babys head slowly compels the now thin cervix opening to widen. this is termed as dilation, which basically means the widenin

35、g of the opening. full dilation is at 10cm, about the width of a hand. when the cervix is beginning to dilate most mothers will feel the contractions in the back. you will be conscious of this ache but you can still go about with your normal activities. if you do not experience this, the mucous plug

36、 will soon dislodge instead. stages of birth the rate of dilation varies; tends to be slower in first time mothers. on average it will take about 9 hours for the cervix to dilate 2.5 cm (the latent phase). the time varies; some women take longer, some with lesser time. next comes the active phase wh

37、ich causes the cervix to dilate from 3 - 10 cm; this phase lasts between 2 - 4 hours. again the time varies. the pain is intense and the urge to bear down and push the baby out starts now. on average one hour is taken up for every centimeter that the cervix dilates stages of birth the second stage b

38、egins at full dilation and ends when the baby makes an entry into the world. uterine contractions are now even more pronounced; they help in the dilation and force the baby down and out. the contractions now occur every 2-3 minutes, lasting between 1 to 1.5 minutes. as the baby makes its descent, th

39、e mother works hard on the pushing. in a typical, normal situation, first the head descends followed by the rest of the body through the vagina. stages of birth it takes a first baby close to an hour to make its way down the birth canal, through the vagina to the vulva the appearance of the babys he

40、ad at the mouth of the vagina is called crowning. http:/ following the crowning, the doctor may make a small cut into the area between the vagina and the rectum; this is called episiotomy. episiotomy stages of birth in the final stage, the placenta dislodges from the uterus and is expelled. after th

41、e baby is delivered, the uterus sheds the placenta contractions continue even after baby is born. the uterus begins to get smaller and its walls thicker. this reduces the surface the placenta was attached. the placenta then separates and is pushed down and out of the vagina. blood clots form immedia

42、tely at the site of separation preventing any excessive bleeding. bleeding is also controlled by the uterus contracting and closing the blood vessels that previously supported the placenta. antepartum risk factors multiple gestation pregnant patient 35 years of age post-term 42 weeks preeclampsia, h

43、tn, dm polyhydraminos premature rupture of amniotic sac (prom) fetal malformation (cdh, gastroscesis) inadequate prenatal care history of prenatal morbidity or mortality maternal use of drugs or alcohol fetal anemia oligohydraminos risks of multiple gestation preterm labor and birth about half of tw

44、ins and nearly all higher-order multiples are premature (born before 37 weeks). the higher the number of fetuses in the pregnancy, the greater the risk for early birth. pregnancy-induced hypertension women with multiple fetuses are more than three times as likely to develop high blood pressure of pr

45、egnancy. this condition often develops earlier and is more severe than pregnancy with one baby. it can also increase the chance of placental abruption (early detachment of the placenta). risks of multiple gestation anemia is more than twice as common in multiple pregnancies as in a single birth. bir

46、th defects multiple birth babies have about twice the risk of congenital (present at birth) abnormalities including neural tube defects (such as spina bifida), gastrointestinal, and heart abnormalities. risks of multiple gestation a phenomenon called the vanishing twin syndrome in which more than on

47、e fetus is diagnosed, but vanishes (or is miscarried), usually in the first trimester, is more likely in multiple pregnancies. this may or may not be accompanied by bleeding. the risk of pregnancy loss is increased in later trimesters as well. twin-to-twin transfusion syndrome twin-to-twin syndrome

48、is a condition of the placenta that develops only with identical twins that share a placenta. blood vessels connect within the placenta and divert blood from one fetus to the other. it occurs in about 15 percent of twins with a shared placenta. age related complications 35 years more likely to have

49、a multiple pregnancy. the chance of having twins increases with age. the use of assisted reproductive technologies such as in vitro fertilization also can play a role. youre more likely to develop gestational diabetes. this type of diabetes occurs only during pregnancy, and its more common as women

50、get older. tight control of blood sugar through diet, physical activity and other lifestyle measures is essential. age related complications youre more likely to develop high blood pressure during pregnancy. some studies suggest that high blood pressure that develops during pregnancy before 20 weeks

51、 (chronic hypertension), after 20 weeks (gestational hypertension) or after 20 weeks and accompanied by protein in the urine (preeclampsia) might be more common in older women. the risk of chromosome abnormalities is higher. babies born to older mothers have a higher risk of certain chromosome probl

52、ems, such as down syndrome. preeclampsia, htn, dm preeclampsia is a condition that occurs only during pregnancy. diagnoses is made by the combination of high blood pressure and protein in the urine, occurring after week 20 of pregnancy. preeclampsia may also be called toxemia; who is at risk: a firs

53、t-time mom previous experience with gestational hypertension or preeclampsia women whose sisters and mothers had preeclampsia women carrying multiple babies; women younger than 20 years and older than age 40 women who had high blood pressure or kidney disease prior to pregnancy women who are obese o

54、r have a bmi of 30 or greater preeclampsia mild preeclampsia: high blood pressure, water retention, and protein in the urine. severe preeclampsia/leading to eclampsia: headaches, blurred vision, inability to tolerate bright light, fatigue, nausea/vomiting, urinating small amounts, pain in the upper

55、right abdomen, shortness of breath, and tendency to bruise easily. seizures and associated symptoms placenta previa placenta previa is a condition where the placenta lies low in the uterus and partially or completely covers the cervix. the placenta may separate from the uterine wall as the cervix be

56、gins to dilate (open) during labor. requires c-section delivery signs and symptoms of placenta previa vary, but the most common symptom is painless bleeding during the third trimester. other reasons to suspect placenta previa would be: premature contractions baby is breech, or in transverse position

57、 uterus measures larger than it should according to gestational age hellp syndrome hellp syndrome is a series of symptoms that make up a syndrome hellp syndrome is thought to be a variant of preeclampsia, but it may be an entity all on its own. there are still many questions about the serious condit

58、ion of hellp syndrome. the cause is still unclear to many doctors and often hellp syndrome is misdiagnosed. it is believed that hellp syndrome affects about 0.2 to 0.6 percent of all pregnancies. hellp syndrome what is hellp syndrome? the name hellp stands for: h- hemolysis ( breakdown of red blood

59、cells) el- elevated liver enzymes (liver function) lp- low platelets counts (platelets help the blood clot) hellp syndrome the most common symptoms of hellp syndrome include: headaches nausea and vomiting that continue to get worse (this may also feel like a serious case of the flu.) upper right abd

60、ominal pain or tenderness fatigue or malaise a woman with hellp may experience other symptoms that often can be attributed to other things such as normal pregnancy concerns or other pregnancy conditions. these symptoms may include: visual disturbances high blood pressure protein in urine edema (swel