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ABC of BirthEmergency delivery and newborn stabilization

PALS Paediatric Advanced Life Support – IRC Italian Resuscitation Council

SIMEUP Società Italiana di Medicina d'Emergenza e D'Urgenza

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Guidelines for Physicians and Nurses inMATERNAL/FETAL TRANSPORTPrepared by the Maternal-Fetal Medicine Committee of theSociety of Obstetricians and Gynaecology of Canada, 1992

Pediatric education for prehospital professionals (PEEP)/ American Academy of Pediatrics., 2000

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Care and outcome of out-of-hospital deliveries

[Acad Emerg Med 2000]

Prospective study 1 NICU III1991-199491 birthMortality 10%

New Haven - Connetticut

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Testo

Objectives• Discuss triage of the laboring patient

• Outline the newborn resuscitation-oriented history

• Describe the steps for performing a vaginal

delivery and the steps performed immediately

post-delivery for every newborn

• Describe the steps in newborn resuscitation

TestoTesto

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Triage of the laboring patient

• 1. is this your first delivery?

• 2. Du you feel the urge to push?

• 3. Is the child’s head crowning?

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Risk factors = emergency transport w-out delay

• previous cesarean

• placenta previa

• severe maternal diseases

• known fetal malformations

• Loss of blood (> 2 cups)

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Mother’s care during transport

• offer to lie on the her left side

• assist during hyperventilation

• care in case of vomit

• obtain a peripherall venous access

Venentropf

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Triage of the laboring patient

• = imminent birth

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The newborn resuscitation-oriented history

3 questions

• 1. are they twins?

• 2. expected birth date?

• 3. coloured amniotic fluid?

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Equipment

• eye-wear and glove

• 5 dry towels

• 1 thermoblanket

• Betadine

• sterile scissors

• 2 Klemmer• 2 cord -clamp• 1 plastic bag to store the placenta • suction unit • Syntocinon 5U

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• prepar an area for

the baby

• Make sure that the

rooms is warm and

free from drafts

• Several acceptable

ways to position the

mother are available

Position the mother for vaginal delivery

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Points for vaginal delivery • allow the mother to push the head out

• refrain from pulling too hard

• keep the baby at level of the vaginal opening

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• Tie the cord in two

places and cut between

the ties

• Do not pull the cord

The cord care

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• 12-14% Newborns

• thin = of little

significance

• thick = potentially

dangerous

Special situation: Meconium

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• 1. Is the amniotic fluid clear of meconium?

• 2. is the baby breathing or crying?

• 3. is there good muscle tone?

• 4. is the color pink?

• 5. was the baby born at term?

At birth:

Visual Inspection

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the initial steps of the newborn resuscitation

• warm

• position

• suction

• drying

• stimulate

• oxigen (if necessary)

BreathingHeartrate

color

Check

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Seldom

Always

Airway Breathing Circulation

No often

Visual inspection with one look

To warm, positionate, keep free the airways, drying, stimulate, repositionate, O2

ventilationBMV

Intubation

Heartcompressions

Drugs

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the initial steps newborn resuscitation

Clear the airway : position

position the infant on her back and

slightly extend the head

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suction the

mouth and nose

the initial steps newborn resuscitation(30”):

Clear the airway: suction

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• have several pre-warmed towels available

• a new pre-warmed second towel should be use for continued drying and stimulation

• keep the head in the sniffing position

the initial steps newborn resuscitation(30”):

drying

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The act of drying the infant may supply stimulation to breathe.

Alternative methods: -massage of thye back -flickin the soles of the feeds

the initial steps newborn resuscitation(30”):

stimulate

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• Oxigen delivered

by tubing held in

cupped hand over

baby’s face

• at least 5L/min

the initial steps newborn resuscitation(30”):

oxigen

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No breathing or gasping

TestoTesto

BMV Ventilation+ O2 30 sec.

check Breathing

check HF

HR<60 s/min30”

Ventilation+

Heartcompressions

60 - 100

30”ventilation

>100stop ventilation

spontanous Breathingo

check HR< 100

check Color

Pink

CyanosisO2oxygen

Afterthe first steps (30”)

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bag and mask • 40 - 60 breaths pro Minute

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• stethoscope

• palpation of the pulse at

the base of the umbilical

cord

heart rate

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• central cyanosis. This is seen when the body and/or lips are blue, as opposed to just the extremities

assess color

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Chest compressions

• one ventilation

interposed after

every three

compressions 1:3 • total of 30 breathe and

90 compressions per minute

2 sec

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• Meconium suctioning

• bag and mask ventilation not

effective

• endotracheale drugs route

• Transport

Endotracheal Intubation

extreme Fruehgeburt

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• umbelical venous

• endotracheale

way

• Intraossea

Drugs route

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• effective for ventilating newly born full-term infants

• not been evaluated in small, preterm infants

Laryngeal mask

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Adrenaline

• Indication: heart rate<60 /Min. .

• Dose: 0.1 - 0.3 mL/kg of 1:10.000 IV, ET, IO (0.01 - 0.03 mg/kg).

• every 3-5 Minutes

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• prematurity

• congenital upper airway obstruction

• esophageal atresia

• congenital diaphragmatic hernia

• peumothorax

• pleural effusions/ascites (fetal hydrops)

• sepsis

• congenital heart disease

• multiple births

• maternofetal hemorrhage

Special resuscitation circumstances

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After birth

• Apgar score

• Transport

• Placenta

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• <500 mL

• Syntocinon 1A (3-4 mal)

Blood Loss

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Conclusion

• 2-3/1000 birth

• high morbidity

• “basic maternity skills”

• education