Ballard Maturational Assessment

It is developed in 1979. A commonly used tool to determine the gestational age of a neonate.

Two criteria: PHYSICAL and NEUROMUSCULAR

(image courtesy of www.merckmanuals.com)

APGAR

APGAR scoring was devised in 1952 by an anesthesiologist named Virginia Apgar. It was a method used to easily assess the health of the newborn immediately after birth using 5 criteria: Appearance,Pulse, Grimace, Activity, Respiration.

Taken 2 times

• within the first minute after birth
• 5 minutes after

you can also take it later if necessary

                                                                                                  SCORE

CRITERIA            INDICATOR                   0                              1                               2

APPEARANCE         COLOR                Blue all over           acrocyanosis              no cyanosis

                                                                                              

PULSE                    PULSE RATE           < 60                  >60 but < 100                   >100

GRIMACE               Reflex Irritability      no response         grimacing/feeble cry       vigorous cry                            

                                                                                                                          

ACTIVITY                MUSCLE TONE        Flaccid                Some flexion          Active movement

RESPIRATION         BREATHING         not breathing               weak cry                 vigorous cry

INTERPRETATION

7- 10    Normal Result

4- 6      Moderately low

0- 3      Critically low (needs resuscitation) 

UNANG YAKAP

FOUR CORE STEPS 

• Immediate and thorough drying
• early skin to skin contact
• properly timed cord clamping
• non separation of the mother and the newborn for the initiation of breast feeding

IMPORTANT THINGS TO REMEMBER

Immediate and thorough drying:

• Dry newborn for 30 seconds
• do a quick check of breathing while drying
• DO NOT SUCTION unless mouth and nose are blocked with secretions
• Do not ventilate unless baby is floppy/limp and not breathing
• NOTES:
• DO NOT REMOVE VERNIX CASEOSA
• DO NOT BATHE INFANT
• NO FOOT PRINTING
• NO SLAPPING
• NO HANGING UPSIDE DOWN
• NO SQUEEZING OF CHEST

IF NEWBORN IS BREATHING OR CRYING:

Early skin to skin contact

• Position the newborn PRONE to the mothers chest or abdomen
• cover back with dry blanket and put bonnet on the head

Properly timed cord clamping

• wait until pulsations stop
• clamp 2 cm from umbilical base
• then clamp again at 5 cm from the base
• cut the cord near the first clamp
• NOTES
• do not MILK!!!
• after first clamp you may strip the cord of blood before applying the second clamp
• do not apply any substances on the cord

Early breastfeeding

• Counsel on positioning
• newborn's neck is not flexed nor twisted
• newborn is facing the breast
• newborn's body is close to the mother
• newborn's whole body is supported
• Counsel on attachment and sucking
• mouth wide open
• lower lip turned outwards
• baby's chin is touching the breast
• sucking is slow deep with some pauses
• NOTES
• do not give sugar water, formula or other prelacteals
• do not give bottles or pacifiers
• do not throw away colostrum
• minimize handling by health workers
• All other newborn care will be done after initial breast feeding is complete
• hepa B
• weighing
• eye care
• examinations
• injections
• postpone washing until at least 6 hours

Stages of Labor

1st stage- from onset of true labor until full cervical dilatation

2nd stage- from full cervical dilatation until birth of infant

3rd stage- from birth of infant until placental expulsion

1st stage- Divided into three phases: latent, active and transition phase.

PHASE                       frequency                                  duration                        cervical dilatation

latent                   5-10 minutes or longer                   20-40 seconds                         0-3 cm

Active                       3-5 minutes                              30-60 seconds                         4-7 cm

transition                   2-3 minutes                              60-90 seconds                         8-10 cm

2nd stage of labor

contractions change characteristic from a cresendo-decresendo pattern to an overwhelming uncontrollable urge to push or bear down.

As fetal head pushes against perineum , the vaginal introitus opens and the fetal scalp appears at the opening to the vagina. the circle enlarges in size from a dime, to a quarter, to half a dollar. this is called crowning. (pillitteri)

3rd stage of labor- divided into 2 phases: placental separation and expulsion

signs that the placenta has loosened and is ready to deliver:

lengthening of the cord

sudden gush of vaginal blood

change in the shape of the uterus

firm uterine contraction

placental appearance at the vaginal opening

if separates first at the center- schultze(shiny and glistening appearance)

if separates first at the edges -duncan(raw, red and irregular)

Bartholomew's rule

determining the age of gestation by assessing the level of the fundus.

3 landmarks to remember:

symphisis pubis

umbilicus

xiphoid process

when the fundus is palpable at the level of the:

symphisis pubis- 12 weeks

umbilicus- 20 weeks

xiphoid- 36 weeks

midway between umbilicus and symphisis pubis- 16 weeks

on the 38th to 40th week lightening will occur so the fundus will be below the xiphoid process