Integrate ObPed GroupC

8/6/2019 Integrate ObPed GroupC

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Group C


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1

30 32

5


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G1P0 GA32 weeks by LMP . 6

Lab: VDRL non reactive, HBsAg negative, AntiHIV negative, Hct 33 gm%,thalassemia screening negative, Bloodgroup O, Rh positive, Urine albumin/sugar

negative, 50 gm Glucose challenge test= 120 mg/dL


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155. 45. BMI= 18.75kg/m2

55. BMI= 22.5 kg/m2


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V/S: Temp 37c, BP120/80 mmHg, PR90/min., RR 18/min.

General appearance: good consciousness,no pale conjunctiva, no icteric sclera.

HEENT: normal

Abdomen: Fundal Height

30cm

., large partat Left side, cephalic presentation, head

engagement


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Uterine contraction: interval 6 30, duration35-45, intensity moderate, fetal heart

sound148

BP

M, estimated fetal weight1500 gm.

Pelvic examination:

speculum examination gross leakage of

amniotic fluid,

cervical dilate 4 cm., effacement 80%,

station 0, membrane rupture, Vertex


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17.00 .

Observe uterine contraction, fetal heart

sound Lab: CBC, UA Ampicillin 2 gm. IV then 1 gm. IV q 4 hrs.

until delivery 5% D/N/21,000 ml. IV 120 ml/hr.


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ADMITTime

Uterine contraction

FHS (BPM)

Pelvic examnation

I (min) D (sec) Intensity Dilate (cm) Effecement (%) station MR/MI Presentation

17:00. 6 30 mod 148 4 80 0 MR Vx

17:30 5 35 mod 150

18:00 4 45 mod 144

19:00 3 50 mod 148 7 90 1+ MR Vx

19:30 3 50 mod 148

20:00 2 50 strong 152 FD 100 1+ MR Vx

20:50

Vaginal deliveryBaby BW 1660 gm

, , 120 BPM, ,


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1.


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G1P0 GA 32 Wks by LMP with Premature rupture of membranes

P

reterm labor Low birth weight fetus < fetus Low maternal weight gain


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2.APGAR score


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Apgar score


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Apgar score


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Apgar score


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Apgar score


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Apgar score


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Apgar score


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ApgarApgar scorescore 66

Apgar score 7-101

Apgar score 4-61

Apgar score 0-3 1

resuscitataion


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3.


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Problem lists offetus

G1P0 GA 32 Wks by LMP

Preterm delivery

Low birth weight fetus

Preterm delivery Prematurerupture of membranes Birth asphyxia

Respiratory distress


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Identifiable causes of preterm birth

Fetal preterm labor Fetal distress

Multiple gestation

Erythroblastosis

Non-immune hydrops

Placental

P

lacental dysfunction Placenta previa

Abruptio placentae


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Identifiable causes of preterm birth

Uterine

Bicornuate uterus

Incompetent cervix (premature dilatation)

Maternal

Preeclampsia

Chronic medical illness (cyanotic heart

disease, renal disease) Infection (Listeria monocytogenes, group

B streptococcus, urinary tract infection,bacterial vaginosis, chorioamnionitis)

Dru abuse cocaine


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Birth asphyxia

(Hypoxemia)

(Hypercarbia) (Acidosis) ,

Definitionbirth asphyxia WHO


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Birth

asphyxia (Maternal condition) Age 35 yr old

Maternal diabetes , GDM

Hypertension , Pre-eclamsia

Anemia

Maternal heart disease

Abruptio placenta, placenta previa,antepartum hemorrhage

Preterm labor

Prolonged rupture of membrane


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Birth

asphyxia (Labor and deliverycondition)

Cesarean section due to

Breech or abnormal presentation Cephalopelvic disproportion : Shoulder

dystocia, prolonged second stage

Prolapsed umbilical cord

Cord compression

Forceps delivery or vacuum-extraction

delivery

Maternal hypotension or hemorrhage


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Birth

asphyxia (fetal condition) Premature and postmature delivery

Intrapartum fetal status

Abnormal heart rate pattern or dysrhythmia

Meconium-stained amniotic fluid Oligohydramnios

Polyhydramnios

Decresed rate of growth

Macrosomia Fetal abnormalities

Immaturity of pulmonary surfactant system

Fetal malformations

Low biophysical profile


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Respiratory distress syndrome

hyaline membrane disease Incidence RDS

> 37 wks. RDS

5 32-36 wks. RDS 15 30

< 28 wks. RDS 60-80

reference


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Pathogenesis

(Surfactant)

(Alveoli) Structural immaturity

Sign and symptoms Dyspnea

Tachypnea

Moaning () Subcostal and intercostal retractions

Nasal flaring

Cyanosis

Systemic

hypotension


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GA < 34 Wks.

Cesarean section

Acute perinatal asphyxia

riskRDS


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1. 2. 3.


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16 35

DM, HT, anemia Infection

Polyhydramnios

Oligohydramnios

Twin pregnancy

PROM


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IUGR

Abnormal presentation

Immaturity of pulmonary surfactant system Fetal malformation determined by

sonography

Hydrops fetalis Low biophy


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5.


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(Resuscitation) guideline APGAR (Temperature control)

acute complication pretem

(Umbilical cordclamping)

- /

(Identification) (Measurement)

(General physicalassessment)


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6.


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1. GA

Chief complaint

() Risk factors

GDM , HT, Heartdisease

2. Antepartuminformation

Lab

3. Intrapartuminformation

FHR

Drugs Amniotic fluid Time

4. Route Baby body weight

APGAR score

Initial resusitation


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30 G1P0 GA 32 weeks by LMP

CC : 5

-


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Antepartum informationPreterm labor with spontaneous membrane rupture

Lab : VDRL - non reactive, HBsAg - negative, AntiHIV -negative

Hct 33 gm%, Thalassemia screening negative

Urine albumin /sugar- negative

50 gm. Glucose challenge test = 120 mg/dL (risk of

neonatal hypoglycemia)

Ultrasound: ? (congenital anomaly?)

Intrapartum information

Fetal heart sound 148-152 BPM.

ampicillin 2 gm. iv q 4 hrs. untildelivery ampi Normal vaginal delivery, vertex presentation


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Ampicillin (Amcill, Omnipen)

Uses: *Resp, GU, or GI tract Infxns, meningitis due to gram()

& gram(+) bacteria; endocarditis prophylaxis* Action: -Lactam

antibiotic; cell wall synthesis.Spectrum: Gram(+)

(Streptococcus sp, Staphylococcus sp, Listeria); gram()

(Klebsiella sp, E. coli, H. influenzae, P. mirabilis, Shigella sp,

Salmonella sp) Dose: Adults.500 mg2 g IM or IV q6h or250500 mg PO q6h.Peds. Neonates < 7 d: 50100 mg/kg/24 h IV

q8h. Term infants: 75150 mg/kg/24 h q68h IV orPO.

Children > 1 mo: 100200 mg/kg/24 h q46h IM or IV; 50

100 mg/kg/24 h q6h PO up to 250 mg/dose. Meningitis: 200

400 mg/kg/24 h q46h IV; in renal impair; take on emptystomach Caution: [B, M] Cross hypersensitivity w/PCN

Supplied: Caps 250, 500 mg; susp 100 mg/mL (reconstituted

as drops), 125 mg/5 mL, 250 mg/5 mL, 500 mg/5 mL; powder

for inj125

mg,250

mg,500

mg,1

g,2

g,10

g/vial SE: D, rash,aller ic Rxn Notes: Man strains of E. coli resistant


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Baby body weight -1660 gm.

(Low birth weight and appropriate gestational

age)APGAR score = 7

Normal vaginal delivery

No complication


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comment

Apgar Birth asphyxia WHO

avery or nelson andguideline neonatal resuscitation 2010

referencestandard ? resuscitation newborn Complication preterm acute

and long term

ampi

indication


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References

http://www.accessmedicine.com/content.a

spx?aID=2696159#2696159

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