Statistical Analysis : Neonatal Weight, Neonatal Sex Distribution

Neonatal RDS is a condition of increasing respiratory distress commencing at or shortly after birth (BAPM-2006). It’s the single most important cause of morbidity and mortality in preterm infants (Greenough, et al 2004). Typically RDS affects preterm infants with the incidence being inversely proportional to the gestational age (Stewart 2005) Approximately 60% of those born before 28 weeks gestation are affected (Fraser, et al 2004) Incidence also increases in infants of diabetic mothers those born via elective caesarean section (Fraser, et al 2004) and perinatal asphyxia (Rodriguez, 2003).

Pitocin is a hormone used to stimulate uterine contractions and prevent hemorrhage from the placental site. Prior

Randomization was used to generate what patient went to which group. The way the patients were chosen eliminated bias because “Randomization was performed according to a computer-generated list by means of sequentially numbered, opaque, sealed envelopes which revealed the allocation of the subject to either induction or expectant management”(Nielsen et al. p. 60). This secure randomization added a great strength to the study. The sample size seemed fairly large, 226 patients were split into 116 for elective induction and 110 to expectant management, although the power analysis was disclosed in this study and determined that 600 patients were required. Only 226 patients were used and because it would take 4 years to reach the required amount of patients, the study was discontinued. This was both a strength and weakness because disclosing this information made the study more honest but the quota needed to reach the best answers was not attained. The study for the 226 patients was pretty standard with the 80% power and alpha at 0.05. T-test and chi square tests were used to compare the proportions between the groups of people. The women were chosen based on the inclusion criteria of being 39 weeks gestation or older, maternal age of more than 17, fetal cephalic presentation, singleton gestation, a candidate for vaginal delivery, and a Bishop score of 5 or greater in nulliparous women and 4 or greater for multiparous women. This inclusion criterion was a concern because both nulliparous women and multiparous women were being tested together. This was a weakness because the labor patterns of a nulliparous woman compared to a multiparous woman are very variable and sure to distort study data. It was also disclosed how gestational age was achieved which included the crown rump test measured in 6-12

When baby is still in the womb, the oxygen saturation is well below what it should be

Over the years birthing methods have changed a great deal. When technology wasn’t so advanced there was only one method of giving birth, vaginally non-medicated. However, in today’s society there are now more than one method of giving birth. In fact, there are three methods: Non-medicated vaginal delivery, medicated vaginal delivery and cesarean delivery, also known as c-section. In the cesarean delivery there is not much to prepare for before the operation, except maybe the procedure of the operation. A few things that will be discussed are: the process of cesarean delivery, reasons for this birthing method and a few reasons for why this birthing method is used. Also a question that many women have is whether or not they can vaginally

According to the World Health Organisation [WHO] (2014) pre-term babies are at increased risk of illness, disability and death. It also states that globally 15 million babies are born pre-term and the figures are rising. In England and Wales during 2012 7.3% of live births were pre-term under 37 weeks nearly 85% of all babies born prematurely will have a very low birth weight (Office for National Statistics, 2012). Pre-term birth is associated with respiratory complications and lung disease, long-tern neurological damage and problems with bowel function (Henderson & Macdonald, 2011). Neonatal services provide care to babies who are born prematurely or are ill and require specialist care. It is seen that sixty per cent of infant deaths occur in the neonatal period (DH,

She is without complaints. She has not noted any increase in preterm labor. No signs/symptoms or change in pelvic pressure. She is compliant with bedrest and has help taking care of her son. She is otherwise aware that she should discontinue Motrin next week and is aware of the signs/symptoms that we are monitoring. The placental cord insertion does appear marginal as noted on prior ultrasound and we are following monthly growth. She is aware that after surveillance of cervical length which will the last one we would anticipate would be next week at 32 weeks and after that we would still recommend monthly evaluation of fetal growth. Preterm labor precautions were reviewed. She is scheduled to return in one

When a baby is in Utero, the oxygen saturation is well below what it should be after birth (Lee, 2015). There is a

Delivering a baby at 40 weeks gestation is optimal for mother and for baby. Spontaneous deliveries decrease the incidence of maternal and/or fetal complications (Bingham, Ruhl, & Cockey, 2013). Exploring ways to decrease elective deliveries that are not medically necessary in the current obstetric clinic setting is the point of interest. An important step in the reduction of non-medically necessary inductions is to develop and implement standardized protocols that can be used by all providers in any setting. The use of a standardized guideline offers advanced practice nurses (APN), certified nurse midwives (CNM), physicians and other providers a document to reference when scheduling induction procedures for patients. The World Health Organization (WHO) recommendations for induction of labor (World Health Organization [WHO], 2011) provides guidance and offers specific instances of induction, methods used to induce, management of complications and safe settings for induction. The purpose of this paper is to appraise an existing guideline to determine if the guideline might be used in the current obstetric clinic as it is written or if the guideline needs modifications.

This essay will critique and integrate the pathophysiological aspects of birth asphyxia and postnatal acidosis of a newborn under my care in the neonatal care unit (NNCU) at the Alice Springs Hospital. Immediate and subsequent medical and midwifery management and treatment will be compared and contrast with the reviewed literature relevant to these conditions. Recommendations will be outlined based on the findings. All discussed information has been acquired from the neonatal medical record to develop this case study. Confidentiality is maintained in accordance with the code of professional conduct for midwives (2008) and a pseudonym will be used to de-identify the baby’s details.

At each delivery, obstetricians or midwifes decide when to clamp and cut the umbilical cord. Early cord clamping has become the routine practice in the developed world without scientific assessment of its potential impact on an newborn’s health and development. Several systematic reviews have recommended that clamping the umbilical cord in all births should be delayed for at least 30-60 seconds, with the infant kept at or below the level of the placenta because of the related neonatal benefits, including increased blood volume, decreased incidence of intracranial hemorrhage in preterm infants, reduced need for blood transfusion, and lower percentages of iron deficiency anemia in full-term infants. Clear evidence to guide a obstetrical provider’s

If the bishop score is high, the possibility of vaginal delivery is similar whether labor is induced or spontaneous. Whereas a low bishop score increases the possibility of failed induction to result in vaginal delivery. The thresholds for low and high bishop scores vary among trials, but in general, a score of ≤6

The changes in the principal metabolites (urea, creatinine, malonate, methylguanidine and hydroxyisobutyric acid) have been found in the piglets with hypoxic insult and in piglets resuscitated with different oxygen concentrations [12]. A recent metabolomics analysis of urine has shown the gestational age related differences in metabolic profiles of phenylalanine and tryptophan biosynthesis, urea cycle, tyrosine metabolism, arginine and proline metabolism [8]. The differences in neonates with IUGR and normal controls have been found in urinary metabolic profiles of myo-inositol, sarcosine and creatinine [29]. Recently, a metabolomic analysis of urine has shown to identify the children affected by nephrourological disorders. The development and function of renal system in neonates could be affected by metabolic changes (associated with other genetic factors) in prenatal and neonatal period. The maturation and development of nephrons is critically dependent on gestational age and intrauterine environment. The abnormal changes during gestational age may affect the metabolic status of newborns [7,9,42].

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.

Neonatal jaundice is a disease which has been known since ancient times (figure _). It is visibly seen when bilirubin levels surpass 5 mg/dl (85 mmol/l) in the blood. Bilirubin is a waste product of fetal blood transitioning to adult blood and causes brain damage or even death when left untreated. It accumulates due to the inability of the undeveloped liver to process the waste product. According to the worldwide statistics, jaundice is detected in 60% of full-term babies and 80% of preterm babies. That’s between 60–70 million babies worldwide (1).