A 38-year-old mother of three is admitted to the labor and delivery unit for induction of labor. She is 39 1/7 weeks’ gestation and was diagnosed in her second trimester with preeclampsia. She had an artificial rupture of the membranes 2-hours ago, which was meconium-stained. The fetal heart monitor shows early-onset early deceleration with each contraction.
1.What information about this prenatal and perinatal history makes it a high-risk delivery??
You assume the position at the head of the bed and intubate with a 3.5 cm ETT within 10 seconds of his placement on the warmer. You verbalize that you see meconium on the vocal cords. A meconium aspirator is used to suction moderate amounts of greenish-brown fluid from the lungs. You make a second attempt at intubation while asking the RN to monitor the patient’s heart rate at the umbilical stump. The ETT is placed a second time, and the meconium aspirator is used, but minimal amounts of fluid are returned during suctioning. The RN notes the heart rate to be 60 bpm. The team begins drying, stimulating, and clearing the upper airway. At approximately 45-seconds of life, you begin bag-mask ventilation at a rate of 40 breaths per minute. Fifteen seconds later, the heartbeat is 110 bpm. BB Diaz’s lips, trunk, hands, and feet are blue. He is unresponsive to stimulation and he is making no respiratory effort. An additional 30 seconds of PPV is given and after 30 seconds, he is breathing spontaneously at a rate of about 25 breaths per minute and has a weak cry. BB Diaz is moving his extremities spontaneously and has an occasional grimace. You discontinue PPV but begin blow-by oxygen via small-bore oxygen tubing, which you maintain for about 2-minutes; then you remove the blow-by oxygen. BB Diaz maintains the pink coloring of his lips and trunk, although his feet remain blue. At 5 minutes of life, another assessment is made. BB Diaz’s respiratory rate is approximately 60 breaths per minute, and his heart rate is 140 bpm. He is moving actively, crying, and with every exhalation is making a grunting noise. He is pink through the torso and head, with a blue coloring of his hands and feet.
2.Using the Apgar scoring system, what are BB Diaz’s 1-and-5 minute Apgar scores??
Sample Solution
