Reference no: EM133922691

Question

After a failed induction after a normal pregnancy, the baby was born three hours ago via cesarean section.The woman had been suffering moderate intermittent Braxton Hicks contractions for the previous 24 hours when she arrived at the hospital with her membranes intact. A vaginal examination revealed a long, thick cervix that was somewhat anterior and closed, as well as a long and thick cervix. Because of the unclear LMP, the baby's gestational age was determined at 37 weeks via late ultrasound. Because she was towards the end of her pregnancy and her exam revealed she was not in active labor, the decision was taken to try to induce labor. She was given a prostaglandin (Cervidil) to help with cervical ripening, followed by IV Pitocin to induce and enhance labor.

She received an epidural shortly after Pitocin was administered. Contractions lasted 90 seconds and occurred every two minutes. Her cervix had effaced 60% and only dilated to 1 cm after more than eight hours of labor. The newborn experienced multiple profound late decelerations with poor recovery and little short-term variability. Because of the fetal distress, the Pitocin was turned off and an emergency cesarean surgery for fetal distress and failure to progress was performed. The baby was very pale at birth, with a very slow heart rate, no respiratory effort, and no tone. Positive pressure breathing with a bag and mask, as well as short-term CPR, were used in the resuscitation.

The baby's Apgar scores were 3 after one minute, 6 after five minutes, and 8 after ten minutes, with no need for epinephrine or sodium bicarbonate. The following physical traits were observed by the nurse at the time of birth: large amounts of lanugo and vernix, flat breasts without buds, faint plantar wrinkles alone, equally prominent clitoris and minora, sluggish recoil of ears, and the neuromotor exam was not completed due to the infant's tone and reflexes status being persistently depressed during resuscitation.

Baby was introduced to her parents before being transported to the special care nursery for further observation and assistance, which included oxygen and oxygen saturation monitoring. The newborn was pallid and breathing at 88 breaths per minute under the radiant warmer at 30 minutes of life, with some nasal flaring and audible grunting present, as well as some rales heard bilaterally using a stethoscope. Blow-by oxygen, warmth, and suctioning were continued daily for the baby.

The respirations remained 88 to 100 at 45 minutes, with audible grunting, sternal retractions, and nasal flaring. Even on 100% oxygen, the newborn was pale, cyanotic, and dusky, with a pulse ox saturation of 87 percent. Despite active warming, her heart rate was 190, and her temperature remained low at 96. One hour later, the random blood glucose level was 25. The doctor instructed that an IV be begun with 10% glucose and that blood cultures be taken.

1. What do you think the most likely reason of this baby's suffering is?

2. Make a list of the risks of elective induction. 

3. Are late ultrasounds reliable for determining gestational age?

4. What is a neonate's normal respiratory rate at this age? How does baby fare in comparison? Why does the nurse believe this is happening?

5. Check the temperature of the baby. Is this usual for someone of this age? Why do you think this is happening, nurse?

6. What is the usual glucose range for newborns? How does baby fare in comparison? What makes the nurse think this is going on, and what difficulties could occur if it isn't fixed?

7. Explain the compensatory principles behind tachypnea, nasal flaring, grunting, and retractions in respiratory distress?

8. How does the temperature of the surroundings affect a baby's chances of survival?

9. What was the purpose of the cultures?

10. What could have been done to avert this situation?

11. What is the difference between a preterm and a full-term infant's APGAR score?

12. What parenting effects might be predicted because of the birth problems and infant's condition?

13. What can the nurse do to reduce the severity of these consequences?