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Present 10 Newborn Care Contents Immediately After Birth

Lesson 86

POSTNATAL NEWBORN CARE


TARGET

1. Present 10 contents of newborn care immediately after birth

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2. Present 5 contents of newborn care in the days after birth

Present 10 Newborn Care Contents Immediately After Birth


CONTENT

Infant morbidity and mortality rates depend on immediate postnatal care.

give birth

The care and feeding of children must ensure sterility and breastfeeding. This is

The principle must be thoroughly applied in maternity homes, hospitals, neonatal units, medical staff as well as the child's family.

I. Care immediately after birth

1. Clear the airways

Immediately after the baby's head comes out, the midwife uses clean gauze or a soft sterile cloth to wipe the baby's mouth and nose, or uses a suction tube to suck out the fluid and amniotic fluid in the baby's throat, pharynx, and two nostrils to prevent the baby from inhaling these fluids.

2. Clamp and cut the umbilical cord

Normally, wait until the umbilical cord stops pulsing before clamping and cutting the umbilical cord (in case of fetal distress, the umbilical cord needs to be cut immediately for emergency treatment without waiting for the umbilical cord to stop pulsing).

- Take the first clamp in the umbilical cord cutting box and clamp it 15-20cm from the umbilical cord. Use your hand to stroke the umbilical cord towards the mother, then use the second clamp, clamping it 1-2cm from the first clamp towards the mother.

- Using sterile scissors to cut between the two clamps, the midwife carries the baby to the umbilical cord table, dries and warms the baby.

3. Dry and keep the baby warm

Need to do it urgently to avoid losing heat from the baby, the navel table must have an electric heater (in places without a heater, use a light bulb to warm the navel table).

- Order of steps:

+ Dry head, face and neck area.

+ Dry the baby's armpits, stomach, buttocks, legs, back and arms, then dress and put on a hat.

4. Make navel

After draining the fluid, drying and keeping the baby warm, check to see if the baby is rosy and crying loudly, then change into a new pair of sterile gloves in the umbilical cord box and proceed with the umbilical cord.

* Steps to make navel:

- Lift the umbilical clamp, place a sterile gauze pad around the base of the umbilical cord.

- Use 700 alcohol to disinfect from the base of the umbilical cord up to the umbilical clamp. If using thread to tie the umbilical cord:

- Tie thread 1 (sterile) around 3cm from the umbilical cord, tie tightly to prevent bleeding. Cut the excess thread 1cm from the knot.

- Use thread 2 (sterile) to tie 0.5 - 1cm away from the first thread towards the umbilical clamp and do not cut the excess thread.

If using plastic clips to clamp :

- Use plastic clamps to clamp the navel instead of thread.

- Use sterile scissors to cut the remaining umbilical cord above the second knot.

- Check if the cutting edge is bleeding. If bleeding, tie it off (do not touch the cutting edge with your hands, even if you are wearing sterile gloves).

- Disinfect the cutting tip again with 70 0 alcohol .

- Use sterile gauze to cover the umbilical cord.

- Cut off the excess thread of the second thread.

- Bandage the navel moderately, not too tightly, using elastic bandage to ensure that the gauze covering the navel is completely covered.

5. Observe abnormalities

Pay attention to abnormalities such as: cleft lip and palate, extra or fused fingers and toes, no anus, genital abnormalities

6. Dress and diaper

Make sure clothes and diapers are clean and warm enough.

7. Weighing

8. Eye drops

Often use 1% Acgirol solution for eye drops to prevent neonatal conjunctivitis.

9. Vitamin K Injection 1

Vitamin K 1 is often used in 10mg x 1/10 ampoule intramuscular injection to prevent cerebral hemorrhage in children.

10. Give the baby to the family

II. Postpartum care

In the days after giving birth, you need to pay attention to the following issues:

1. Bathing a newborn baby

Bathing must be done with boiled and warm water, temperature from 35 - 37 0 C, bathroom must be closed without drafts, room temperature 25 0 C, bathing time under 5 minutes. Be careful not to let water get into the baby's ears, nose, eyes, or navel.

2. Keep warm

The baby's room must have a temperature > 25 0 C, wet diapers must be changed immediately, it is best to let the baby lie with the mother to take advantage of the mother's body heat.

3. Umbilical cord care

This is a continuous process and must be done immediately after birth until the umbilical cord falls off.

Principle: Asepsis during navel care.

- Normally the navel will fall off after 6-8 days. If the navel does not fall off after 10 days, the navel needs to be checked.

- If the navel is bleeding, it must be tied.

- If the navel is wet, smelly, the navel skin is red and swollen, it must be disinfected daily with 70 % alcohol or 10% Betadin solution (do not sprinkle antibiotic powder on the navel).

4. Encourage early breastfeeding

If the mother has enough milk, the baby should be breastfed exclusively until 6 months of age.

5. Monitor children daily

- Skin color: rosy.

- Breathing rate: 40 - 60 times/minute. If < 40 or > 60 times/minute is abnormal.

- Heart rate: 120 - 140 times/minute is normal.

- Body temperature: normal: 36.5 0 C – 37.4 0 C (armpit).

- Digestion: Children defecate 3-4 times/day with yellow stools.

- Urinary: Children must urinate after 24 hours, otherwise they must monitor for urinary and genital abnormalities.

Note : Signs to watch out for that require taking the child to a medical facility immediately:

- Children stop breastfeeding.

- High fever or hypothermia.

- Lethargic sleep difficult to wake up.

- Convulsion.

- Vomit a lot.

If your child has one or all of the above signs, it means he or she is in critical condition.


VALUATION


Question 1. Describe the technique of tying and cutting the umbilical cord of a newborn after birth?

Question 2. Name 10 newborn care contents? Explain the steps to make a baby's navel?

Question 3. Describe skin care and bathing for newborns?

Question 4. Describe the process of checking, weighing and warming a newborn baby?

Choose short answers for questions 5 – 10:

Question 5: Name two types of medicine used to drop eyes for newborns: A: .................................

B: ..................................

Question 6: The substance on the skin of newborns has 2 effects: A: .................................

B : ..................................

Question 7: Two types of antiseptics used to change the umbilical cord bandage for newborn babies are: A: .................................

B : ..................................

Question 8: When tying and cutting the umbilical cord, two principles must be ensured: A: .................................

B : ..................................

Question 9: Two measures to keep babies warm in winter are often applied: A: .................................

B : ..................................

Question 10: In the newborn period, the umbilical cord falls off but is wet and has yellow fluid. What should be done? A: .................................

B : ..................................

Lesson 87

ectopic pregnancy


TARGET

1. Describe the concept, causes, and symptoms of ectopic pregnancy.

2. Describe the treatment of ectopic pregnancy at primary health care facilities and how to prevent ectopic pregnancy .


CONTENT

Normally, after fertilization, the egg will nest in the bottom of the uterus. If for some reason the egg nests outside (fallopian tube, ovary, in the abdomen), it is called ectopic pregnancy.

This is an obstetric bleeding emergency that can be fatal if not detected and treated promptly.

1. Cause

- Salpingitis.

- Multiple abortions.

- Compressive tumors: mesenteric tumors, ovarian tumors, etc.

- Congenital fallopian tube stenosis

- Abnormal contraction of the fallopian tubes.

- In addition, it is possible that sperm move quickly or that the egg develops strongly.

2. Clinical symptoms of ruptured ectopic pregnancy

2.1. Potential energy

- Amenorrhea, delayed menstruation or menstrual disorders.

- Bleeding: This is a common symptom. Blood comes out in small amounts, black in color.

- Abdominal pain: usually dull pain in the lower abdomen, sudden severe pain can cause dizziness or fainting.

2.2. Whole body

Hemorrhagic shock

2.3. Entity

- Look: Abdominal distension.

- Palpation: abdominal wall reaction

- Percussion: Low-level dullness.

- Vaginal examination: Blood comes out through the hand. The Douglas pouch is swollen and painful, called Douglas's cry.

Douglas pouch puncture revealed dark, thin, non-coagulated blood.

3. Clinical morphology

3.1. Unruptured ectopic pregnancy

- Patients have symptoms: Amenorrhea, abdominal pain, vaginal bleeding.

- Examination: Next to the uterus there is a soft mass, clear boundary, painful to touch, soft fornix.

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- Ultrasound. There is no pregnancy in the uterus, there is a pregnancy mass in one fallopian tube.

3.2. Ectopic pregnancy with hematoma into cyst

- Based on the patient's medical history, there was a delay in menstruation, vaginal bleeding, lower abdominal pain, which suddenly became sharp and then decreased.

Expression.

- Little bleeding, black color.

- Pain in lower abdomen.

- Signs of compression: Difficulty urinating, constipation.

- Whole body: Anemia, pale skin.

- Examination: There is a mass in the lower abdomen with unclear boundaries.

-Internal examination: Solid tumor, unclear boundary, painful to touch, tumor puncture can see black blood.

3.3. Abdominal pregnancy : rare.

4. Diagnosis

4.1. Definitive diagnosis

- Based on symptoms of amenorrhea, abdominal pain and vaginal bleeding

- Sudden abdominal pain and possible dizziness.

- The pouch of Douglas is full and painful.

- Douglas pouch puncture revealed dark, non-clotted blood.

4.2. Differential diagnosis

4.2.1. Adnexitis

The patient had clear symptoms of infection. Pain on both sides of the pelvis, negative biological reaction, vaginal examination showed thickened ipsilateral pouch, unclear boundary. Antibiotic treatment reduced symptoms.

4.2.2. Miscarriage

The uterus is large in proportion to the gestational age. Uterine curettage shows pregnancy. Pathology shows ectopic pregnancy and chorionic villi.

4.2.3. Appendicitis

If the pregnancy is on the right side.

5. Treatment and prevention

5.1. Treatment

* Primary health care

Ectopic pregnancy is an emergency that requires surgery as soon as possible. Therefore, when thinking about ectopic pregnancy, the following tasks need to be performed:

- Things not to do: Do ​​not use pain relievers Do not have frequent vaginal exams Do not keep the patient for follow-up.

- What to do: Measure blood pressure.

Advise patients to limit travel.

Transfer the patient to a facility with surgical facilities.

If the ectopic pregnancy ruptures and causes shock, intensive resuscitation and then transfer to a surgical facility is required.

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* Upline: Depends on the case.

- For sudden rupture of ectopic pregnancy, surgically cut the ruptured pregnancy and suture it.

blood is cut and returned to the patient.

- Other ectopic pregnancies: Clamp and cut the pregnancy mass and suture to stop the bleeding, remove the blood clot if it is a cystic hematoma.

5.2. Reserve

- Regular gynecological examination, detect cases of gynecological diseases (especially adnexitis) and treat promptly and thoroughly.

- Procedures must be performed in a sterile manner (abortion, curettage, intrauterine device placement).

.etc). After finishing, must give prophylactic antibiotics.

- Encourage pregnant women to register their pregnancy early to detect abnormalities, including ectopic pregnancy.


VALUATION

1. Describe the causes and symptoms of ruptured ectopic pregnancy?

2. Describe the treatment of ectopic pregnancy at primary health care facilities and how to prevent it?

* Short answer questions 3 - 5:

3. Functional symptoms of ruptured ectopic pregnancy are: A. ........................

B. ........................

C. ........................

4. Ectopic pregnancy needs to be differentiated from 3 cases: A. ........................

B. ........................

C. ........................

5. Three things that should not be done to a patient with ectopic pregnancy at the primary care level are: A. ........................

B. ........................

C. ........................

* Choose the best answer for questions 6-7 :

6. Which of the following locations of ectopic pregnancy usually does not show signs of delayed menstruation: A. Fallopian tube

B. Ovaries C. Cervix

D. Abdominal cavity E. Uterine isthmus

Lesson 88

Fetal death in the uterus


TARGET

1. Describe the causes, symptoms, and progression of complications of intrauterine fetal death.

2. Describe the treatment of fetal death in the uterus and how to prevent it.


CONTENT

1. General

A fetus that dies before labor begins at 22 weeks or more is called an intrauterine death (A fetus that dies before 22 weeks is considered a miscarriage).

Traditionally: A fetus that remains in the uterus for more than 48 hours is called an intrauterine death. A fetus that remains in the uterus for less than 48 hours is considered a death during labor.

The fetus is dead but sterile because of the amniotic membrane protection. If the amniotic membrane ruptures, it can cause infection to the mother.

A fetus in the uterus for a long time can cause blood clotting disorders. A dead fetus greatly affects the mother's psychology.

2. Clinical morphology

- Spontaneous absorption: Occurs in fetuses under 2 months.

- Atrophied form: Occurs in 3-4 month fetuses.

- Waterlogged form: Due to amniotic fluid absorption.

- Middle rot: Due to bacterial infection.

3. Causes

3.1. On the mother's side

- Acute infection influenza, pneumonia.

- Chronic diseases: Chronic nephritis, high blood pressure, heart failure

- Endocrine diseases: Diabetes.

- Due to uterine malformation.

3.2. On the fetal side

- Fetal malformation.

- Post-term pregnancy.

- Blood group incompatibility (Rh factor).

- Intrauterine malnutrition.

3.3. On the fetal appendages

- Short umbilical cord.

- Vegetable vine around the neck.

- Polyhydramnios, oligohydramnios.

4. Symptoms

- Function: No fetal movement, breast milk secretion, abdomen becomes smaller

- Entity: Uterus is smaller than gestational age

Can see the height of the uterus decrease after 2 examinations. No fetal heartbeat can be heard.

- Paraclinical.

+ Ultrasound: Has definite diagnostic value. The fetus does not move, no fetal heartbeat, there are signs of 2 rings in the skull due to the scalp peeling off. The skull is overlapping, little or no amniotic fluid.

+ X-ray (rarely used) skull superimposed (Spalding sign, flexed spine)

corner).

+ Blood test: Fibrinogenesis may be reduced.

5. Diagnosis

5.1. Definitive diagnosis . Based on:

- No fetal movement.

- Uterine height is reduced compared to gestational age.

- Can't hear fetal heartbeat.

- Ultrasound helps confirm the diagnosis.

5.2. Differential diagnosis

- Live fetus: Fetus moves normally.

Positive fetal heart rate.

Uterine height is proportional to gestational age.

- Molar pregnancy:

The patient had morning sickness.

Uterine height is larger than gestational age. Biological reaction is strongly positive.

Ultrasound: Image of ovarian cyst.

- Uterine fibroids: Patients have menorrhagia, uterine ultrasound shows fibroids

6. Progression - Complications

6.1. Progression : If not detected and treated, it can lead to miscarriage: Usually occurs at gestational age < 12 weeks.

Stillbirth: Same as normal birth.

6.2. Complications

- Bleeding

- Infection.

7. Treatment

7.1. Commune level ; Consulting on transfer to higher level

7.2. Upline. No rush.

- Test for fibrinogenesis, platelet count, bleeding time, clotting time, blood type.

If the fibrinogen is < 2g or the pregnant woman has other internal diseases, it is necessary to prevent bleeding complications during placental delivery (Prepare blood of the same group. Use Transamin 250 mg x 2 tubes/24 hours, intravenous injection twice).

- There are 2 ways to stimulate the fetus to come out.

Method 1: Oxytocin infusion.

How to use: Use Misoprostol (Citotex 200mg) to induce abortion.

* Note:- Do not break the amniotic sac. After the fetus is delivered, the uterus must be checked to be clean and uterine contractions must be increased with medication:

- Oxytocin 5 units x 2 intramuscular injections to prevent bleeding.

- Use antibiotics to fight infection.

- Mental support for mothers.

8. Disease prevention .

- Do a good job of protecting pregnant mothers.

- When pregnant, eat well and limit heavy labor.

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