We discussed breaking bad news to parents in our feedback session where we talked about how important it is for doctors to be able to break bad news, and that it is a vital skill to have. In my opinion, the conversation with the parents will be to say that there is little hope for survival and no hope for survival without serious handicap in this child as I’ve highlighted above, and that the resuscitation should be abandoned.
The process of therapeutic hypothermia involves the baby being cooled to a temperature between 33 to 34°C, from 6 hours and continued until 72 hours after birth. The initial hypothermia is then followed by slow rewarming at 0.5°C per hour. Hypothermia significantly reduces mortality by reducing metabolic needs, damaging …show more content…
When the baby is born with asphyxiation problems and MSL, oxygen must be given either with a bag and mask ventilation or by intubation with an endotracheal tube. It is vital to remove any of the meconium visible in the upper airway and larynx before attempting the assisted ventilation.2
Hypoxic-ischaemic encephalopathy (HIE) is associated with birth asphyxia and is a reliable indicator of future handicap. Sarnat and Sarnat devised a grading for the hypoxic effects on the brain usually carried out at 24 hours, which can also be used as a broad guide to outcome:
̶ Grade I: Neonate is hyperalert, tachycardic, jittery, hyper-reflexic and dilated pupils. 100% of babies with grade I survive with intact neurology.
̶ Grade II: Babies are lethargic, not comatose but suffer convulsions, bradycardic and hypotonic. 5% of babies will die, and, of the remaining 95%, 20% of survivors will have some neurological deficit.
̶ Grade III: Baby is flaccid, stuporose, has poorly reacting pupils and will suffer from prolonged fits. 75% of babies with grade III hypoxia will die and 100% of survivors will have neurological deficits, principally spasticity and cognitive …show more content…
If the cervix is fully dilated, the fetus may be delivered either by using obstetric forceps or the vacuum/ventouse extractor as I mentioned above in the terms. Criteria that should be satisfied before instrumental delivery is considered include, full cervical dilatation, engaged fetal cephalic presentation, ruptured membranes, empty bladder, no pelvic contracture or obstruction to delivery of the fetus, adequate analgesia and an operator who is experienced in these deliveries.5
Traditional methods of monitoring foetal well-being in labour include observations of meconium stained liquor (MSL) and auscultation of the foetal heart. Fetal hypoxia can cause the fetus to evacuate the bowel allowing the meconium to pass into the liquor and also causes the development of deep gasping movements so that the meconium passes into the airways. If this meconium gets into the lung it may prevent the onset of normal respiration, the baby will remain hypoxic and the normal process of physiological change from the fetal to neonatal circulation will fail to occur. The incidence of MSL is 0.5-20% of all births, and Apgar scores may be low in the presence of thick MSL as seen with the baby in our case presentation. Meconium aspiration is associated with a 20-fold increase in neonatal morbidity and
The process of therapeutic hypothermia involves the baby being cooled to a temperature between 33 to 34°C, from 6 hours and continued until 72 hours after birth. The initial hypothermia is then followed by slow rewarming at 0.5°C per hour. Hypothermia significantly reduces mortality by reducing metabolic needs, damaging …show more content…
When the baby is born with asphyxiation problems and MSL, oxygen must be given either with a bag and mask ventilation or by intubation with an endotracheal tube. It is vital to remove any of the meconium visible in the upper airway and larynx before attempting the assisted ventilation.2
Hypoxic-ischaemic encephalopathy (HIE) is associated with birth asphyxia and is a reliable indicator of future handicap. Sarnat and Sarnat devised a grading for the hypoxic effects on the brain usually carried out at 24 hours, which can also be used as a broad guide to outcome:
̶ Grade I: Neonate is hyperalert, tachycardic, jittery, hyper-reflexic and dilated pupils. 100% of babies with grade I survive with intact neurology.
̶ Grade II: Babies are lethargic, not comatose but suffer convulsions, bradycardic and hypotonic. 5% of babies will die, and, of the remaining 95%, 20% of survivors will have some neurological deficit.
̶ Grade III: Baby is flaccid, stuporose, has poorly reacting pupils and will suffer from prolonged fits. 75% of babies with grade III hypoxia will die and 100% of survivors will have neurological deficits, principally spasticity and cognitive …show more content…
If the cervix is fully dilated, the fetus may be delivered either by using obstetric forceps or the vacuum/ventouse extractor as I mentioned above in the terms. Criteria that should be satisfied before instrumental delivery is considered include, full cervical dilatation, engaged fetal cephalic presentation, ruptured membranes, empty bladder, no pelvic contracture or obstruction to delivery of the fetus, adequate analgesia and an operator who is experienced in these deliveries.5
Traditional methods of monitoring foetal well-being in labour include observations of meconium stained liquor (MSL) and auscultation of the foetal heart. Fetal hypoxia can cause the fetus to evacuate the bowel allowing the meconium to pass into the liquor and also causes the development of deep gasping movements so that the meconium passes into the airways. If this meconium gets into the lung it may prevent the onset of normal respiration, the baby will remain hypoxic and the normal process of physiological change from the fetal to neonatal circulation will fail to occur. The incidence of MSL is 0.5-20% of all births, and Apgar scores may be low in the presence of thick MSL as seen with the baby in our case presentation. Meconium aspiration is associated with a 20-fold increase in neonatal morbidity and