A 40-year-old G4P5 at 39 weeks’ gestation has progressed rapidly in labor with a reassuring fetal heart rate pattern. She has had an uncomplicated pregnancy with normal prenatal laboratory tests, including an amniocentesis for advanced maternal age. The patient begins the second stage of labor, and after 15 minutes of pushing, starts to demonstrate recurrent variable heart rate accelerations. You suspect that she may have a fetus with a nuchal cord. You expediently deliver the baby by low-outlet forceps, and hand the baby over to the neonatologists called to attend the delivery. As soon as the baby is handed off to the pediatric team, it lets out a strong spontaneous cry. The infant is pink with slightly blue extremities that are actively moving and kicking. The heart rate is noted to be 110 beats per minute on auscultation.
What Apgar score should the pediatricians assign to this baby at 1 minute of life?
The Apgar scoring system, applied at 1 minute and again at 5 minutes, was developed as an aid to evaluate infants who require resuscitation. Heart rate, respiratory effort, muscle tone, reflex irritability, and color are the five components of the Apgar score. A score of 0, 1, or 2 is given for each of the five components, and the total is added up to give one score. The following table demonstrates the scoring system.
The baby described here receives an Apgar score of 9. One point is deducted for the baby not being completely pink and having blue extremities.
A 32-year-old G2P1 at 41 weeks’ gestation is undergoing an induction of labor for oligohydramnios. During the course of her labor, the fetal heart rate tracing demonstrates recurrent variable decelerations that do not respond to oxygen, intravenous fluid, or amnioinfusion. The patient’s cervix is dilated to 4 cm. A low-transverse cesarean delivery is performed for a nonreassuring fetal heart tracing remote from delivery. After delivery of the fetus, you send a cord gas, which comes back with the following arterial blood values: pH 7.29, Pco2 50 mm Hg, and Po2 20 mm Hg.
What condition does the cord blood gas indicate?
The blood gas results described in this case are normal. Normal values for umbilical arterial samples are pH 7.25 to 7.3, Pco2 50 mm Hg, Po2 20 mm Hg, and bicarbonate 25 mEq. Acidemia is generally defined as a pH less than 7.20. Birth asphyxia generally refers to hypoxic injury so severe that the umbilical artery pH is less than 7.0, a persistent Apgar score is between 0 and 3 for more than 5 minutes, neonatal sequelae exist such as seizures or coma, and there is multiorgan dysfunction.
You are asked to assist in the well-born nursery with neonatal care.
Which of the following is a part of routine care in a healthy infant?
The Centers for Disease Control recommends that all newborns receive routine immunization against hepatitis B prior to being discharged from the hospital. Only if the mother is positive for hepatitis B surface antigen should the neonate also be passively immunized with hepatitis B immune globulin. According to the Centers for Disease Control, all newborns should receive eye prophylaxis against chlamydia and gonorrhea with either silver nitrate, erythromycin ophthalmic ointment, or tetracycline ophthalmic ointment. Vitamin K is routinely administered to prevent hemorrhagic disease of the newborn; breast milk contains only very small amounts of vitamin K. Since the temperature of newborns drops very rapidly after birth, newly delivered infants must be monitored in a warm crib. All neonates must be accurately identified via identification bands.
A 35-year-old G2P2 presents for her routine postpartum visit. Her pregnancy was complicated by gestational diabetes, which was diagnosed in the second trimester during routine screening. She has no other medical problems, and she has no family history of diabetes. She gained 25 pounds during her pregnancy, and her gestational diabetes was managed with diet modification.
She asks whether she is at an increased risk for diabetes later in life. How should you counsel her?
It is estimated that 15% to 50% of women with gestational diabetes will develop type 2 diabetes later in life. Postpartum screening at 6 to 12 weeks is recommended to identify women with diabetes, impaired fasting glucose, or impaired glucose tolerance. Women with GDM have a sevenfold increased risk of developing type 2 diabetes when compared to women without GDM. Either a fasting plasma glucose or the 75-g oral glucose tolerance test may be ordered in the postpartum period. Offspring of mothers with gestational diabetes are at an increased risk for obesity later in life. There is some data that development of type 2 diabetes may be impacted by intrauterine exposure to hyperglycemia. Both types 1 and 2 diabetes have a large genetic component.
The patient asks if the fact that she had gestational diabetes might have any long-term effects on her baby.
How should you counsel her?
© 2010-2030 Your Doctor - Dr.Khalil Al-Yousifi - Kuwait - Contact Us