A.)1 GO 5 SO B.)Answer the following questions: 1. What is Essential Intrapartum Newborn Care. 2.

Enumerate and provide each rationale the unnecessary and essential intervention during intrapartum and newborn care. 3. What is partograph and its purpose. 4. Provide a sample picture of a partograph.(This can be printed) 5. Stages of labor and its descriptions. 6. What is APGAR and Ballards Assessment. Write it in a regular size notebook. C.)Bring laundry powder,handsoap and downy for the group. D.)DR/NICU Paraphernalia s E.)Study regarding the assignment. F.)VS Monitoring Sheet. G.) Learning Feedback

1. The Essential Intrapartum and Newborn Care (EINC) are set of practices that upon recommendations of the Department of Health, PhilHealth, and the World Health Organization are adopted by Dr. Paulino J. Garcia Memorial Research and Medical Center because of its evidence based standards that reduce maternal and newborn mortality rate.
UNNESCESSARY Intrapartum period: Routine performance of enemas and shaving Rationale Have not been shown to improve maternal nor neonatal outcome ESSENTIAL having a companion during labor and delivery freedom of movement during labor monitoring progress of labor using partograh non-drug pain relief before offering labor anesthesia position of choice during labor and delivery spontaneous pushing in a semiupright position rationale Continuous maternal support

Episiotomy will not be done, unless necessary Active management of third stage of labor (AMTSL)

Restriction of fluid and food intake during labor

No evidence of improved outcomes for

Routine insertion of IV fluids Routine early amniotomy and oxytocin augmentation

Fundal Pressure to facilitate the second stage of labor

the mother or newborn. Have not shown to have a clear advantage over expectant management. Has been found to cause maternal and newborn injuries and even death

Within 1st 30 secs Immediate Thorough Drying after delivery of the baby

Stimulates breathing Prevents hypothermia

Routine suctioning Early bathing Routine separation from the mother Footprinting Application of various substances to the cord Giving artificial infant milk- formula or other breast milk subtitues. Immediately after birth of the babys head, suction out the infants mouth with a bulb syringe

Immediate skinto-skin contact (SSC) after drying the newborn

Provides warmth Increases overall duration of exclusive breastfeeding Allows colonization with good bacteria

Properly-Timed cord clamping When the cord pulsations stop Between 1 and 3 minutes Between 30 secs - 1 minute in preterms

Non-separation of Newborn from Mother for Early Breastfeeding

2. partograph and its purpose

Partogram is a composite graphical record of key data (maternal and fetal) during labour entered against time on a single sheet of paper. Relevant measurements might include statistics such as cervical dilation, fetal heart rate, duration of labour and vital signs

5. Stages of labor First Stage 3 phase: Latent Phase or Preparatory phase begins at the onset of regularly perceived uterine contractions and ends when rapid cervical dilation begins. Contrations- mild and short, lasts 20-40 seconds Cervical effacement- cervix dilates 0-3 cm

Active phase..Cervical dilatation occurs more rapidly, increasing from 4-7 cm Contractions grow stronger every 3-5 minutes Show (increase vaginal secretions) and perhaps spontaneous rupture of the membranes may occur

Transition PhaseContractions reach their peak of intensity, occurring every 2-3 mins with a duration of 60-90 sec and causing maximum dilatation of 8-10 cm. Membranes will rupture at a full dilatation (10 cm) and complete cervical effacement.

SECOND STAGE Period from full dilatation and cervical effacement to birth of the infant, with an uncomplicated birth this stage will take about 1 hour Contractions change from the characteristic crescendo-decrscendo pattern to an overwhelming, uncontrollable urge to push or bear down with each contraction a if to move her bowels. Crowning occurs

THIRD STAGE or placental stage Begins with the birth of the infant and end with delivery of the placenta. Placental separation and placental explusion.

What is APGAR and Ballards Assessment APGAR assessment of the health of newborn children immediately after birth

Score of 0

Score of 1

Score of 2

Component of Acronym

Appearance/Complexion blue or pale all over

blue at extremities body pink (acrocyanosis)

no cyanosis body and extremities pink

Appearance

Pulse rate

Absent

<100

>100

Pulse

Reflex irritability

no response to stimulation

grimace/feeble cry when stimulated

cry or pull away when stimulated Grimace

Activity

none

some flexion

flexed arms and legs that resist extension

Activity

Respiratory Effort

absent

weak, irregular, gasping

strong, lusty cry

Respiration

Ballards
Ballard Maturational Assessment, Ballard Score, or Ballard Scale is a commonly used technique of gestational age assessment. It assigns a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the baby.

This scoring allows for the estimation of age in the range of 26 weeks-44 weeks. The New Ballard Score is an extension of the above to include extremely pre-term babies i.e. up to 20 weeks. Physical Maturity of the Ballard Maturational Assessment of [2] Gestational Age Record Score Below:

-1

Skin

sticky, friable, transparent None

gelatinous, red, translucent Sparse

superficial smooth peeling &/or pink, visible rash, few veins veins Abundant Faint red marks Thinning Anterior transverse crease only Stippled areola 12 mm bud Well-curved pinna soft but ready recoil

parchment, cracking, deep pale areas, cracking, no rare veins vessels Bald areas Mostly bald Creases over Creases over anterior entire sole 2/3 of sole Raised areola 34 mm bud Formed & firm instant recoil Testes down, good rugae Majora large, minora small Full areola 510 mm bud Thick cartilage ear stiff Testes pendulous, deep rugae Majora cover clitoris & minora

leathery, cracked, wrinkled Sparse

Lanugo

Heel-toe >50 mm Plantar surface 4050 mm: -1 no crease <40 mm: -2

Breast

Imperceptible

Barely perceptible

Flat areola no bud Sl. curved pinna soft; slow recoil

Eye and Ear

Lids fused Loosely: -1 Tightly: -2

Lids open pinna flat stays folded Scrotum empty, faint rugae Prominent clitoris & small labia minora

Genitals (Male)

Scrotum flat, smooth

Testes in Testes upper canal, descending, rare rugae few rugae Prominent clitoris & enlarging minora Majora & minora equally prominent

Genitals (Female)

Clitoris prominent & labia flat