ManagementofAsphyxiatedbabyafterbirth(deliver

y).
Equipment

 Sucker in kidney dish

 Kidney dish (4)
Rinse for section
 Forceps and scissor
 Cord tile and gauze for handing the cord
 Receiver for reusable equipment
 Galipot 2 - cotton ball

-Receive secretion

 Gauze
 Towel (4)&small(1)
 Baby cloth
 Diaper
 Cord tie
 Surgical glove (6)
 Clean glove
 PPE. (All)
 Ambu bag with large tube for connect with O2 source
 O2 cylinder
 H2O humidifier
 Distell water (N/s optional )
 Vaccine – polio, BCG, Vit k, %TTC
 Cold China
 Syringe BCG vit k
 wt scale
 meter (tap meter)
 resuscitation table
 identification bond(tag)
 PROCEDURE

 Collect equipment, close window & door, wash hands and wear PPE
 Connect ambu bag with the oxygen sources (cylinder)
 Wear surgical glove & gown
 Receive the baby and dry the baby= body by towel and change towel
 Place the baby on the resuscitation table and place small towel b/n shoulder
and neck=to support the shoulder &head
 Suck the MN method =mouth- nose by placing the baby lateral and support
the back and return to supine position.
 Ventilate the baby by using ambu bag which connected with O 2 source by
saying breath 1,2,3 breathe 1, 2, 3 breath  30-40 breath per minute.
 If return to normal breathing check the pulse on umbilicus & by using
stethoscope apical for six seconds X10,the minimum beat >10 result.
 Remove glove and change the next sterile glove
 Clean the eye with cotton swab distilled water or N/S optional inner to outer
cantus.
 Clean the mouth and face with gauze and change glove
 Give cord care measure 2 fingers and tie and place 1 finger above 2nd tie
and tie b/n the clamp cut the cord. And measure the weight. Place
identification bond(Tag)
N.B these is two ties remains on the cord of umbilicus. Don’t milk the cord.
 Sock glove for 20-30 min 0.5 % brachia and detergent then place on the red
pin.
 Apply 1%TTC on the e ye position at the baby head yourself at
the head of bay.
 P/E
Head:-
molding
Macro and micro cephalous
Mouth – cleft lip and palate
 _give Polio
Hand skin abnormality remaining:- fingers
BCG- underweight & symptomatic stage 3&4, HIV/Aids C/I
Abdomen – schaphoid abd
_Bleeding at cord
Scrotal= Undset ended test
= Hypo spades = urethral opening at lower middle fo pines
= Eispadesi = urethral opening at upper middle of pines
 Cup foot Vitk.
 Put lateral and support chest and abd. Check = mengiomycale
= = meningitis & head mass
=spinal bifida
 Anthropometric measurement head 34-36cm don’t measure MUAC less
than1 year
 Change towel wear cap t-shirt, diaper, shock to prevent hypothermia
 N.B 90% new born who develop birth Asphyxia= need breathing
( resuscitation)
o 10 % new born who develop birth Asphyxia=CPR & breath
o 1% new born who develop birth Asphyxia = Refer

Attend Labor & Delivery

Equipment
18.Suting set- lidocne

-Cutgut

1. modes 8. towel(6)
2. T-binder 9. glove (6)
3. Forceps(8) 10.oxytocin
4. kidney dish(8) 11.syringe
5. galipot 12.vaccine
6. cotton ball 13.0.5bleach(chlorine)
7. gown(sterile) 14.Baby cloth
15.Wt scale 21.TTC1%
16.Tap meter 22.VITK 0.1cc/ml
23.BCG 0.05cc/ml
17.Resuscatation table
24.Safet Box
18.Suturing set- lidocne 25. Identification tag
26. Cord tie, Fetoscope, Placenta
-Cut gut Bin, Rectal thermometer
-Scissor 27.Receiver(Red ,White)
-Tissue forceps -gauze 28.Screen
-Fensthreated towel and 29.PPE all
drop 30. scissor
-Safety box 32.Section builb
19.Cold chain 33.Distilled H2O
20.Dipper

Procedure
 Screen
 Wear PPE , V/S
 Perform P/E like ANC& count uterine contraction
 Place the mother on the delivery coat.
 Clean the perinea down struck –forceps gauze, N/s
 P/V (PV):-Hot infection ,cold spasm, warm normal
- To check position occipital posterior & anterior
-Station =Ischia spine below & above
=check molding of head

. -Cervical dilatation

 Place 6 towel
 -Support the perinea by using gauze to prevent laceration
 When the head expel support one head and clean the eye with cotton ball
 The mouth with gauze
 Check cord prolapsed over the head/neck
 Receive baby deliver baby on the mother abdomen and dry.
 cover a baby by another towel &Check another baby by abdominal
palpation.
  Give oxytocine=10IU on rectus femurs
 separate baby from mother by clamping cored and cut
 place kangaroo mother baby & initial bf & change glove.
 Remove the cord from mother by pulling down & apply pressure on the
abdomen until placenta observed. Then straight up and receive by holding
neat to the perinea the kidney dish b/c bleeding occur.(CCT)
 Place the kidney dish on the trolley
 Massage the funds by privies towel.
 Clean the genital area and check tear if tear suture
 Check the membrane of the placenta &place modes to the mother.
 Give ergomtrine =0.5mg
 Decontaminate the placenta in the 0.5 chemical 20-30min
 Place the placenta in the red placenta bin
 Remove pillow & position the mother comfortably
 provide immediate new born care
o Eye ointment
o Cord care
o Wt the baby
o Place identification bond / tag
o P/E  from head to foot
o Polio, VIT K, BCG, put on baby cloth &diaper
N.B Contraindication of BCG.
- Under weight
- Symptomatic HIV (Stage III&IV)
 Management of PPH
Equipment

- Oxygen cylinder

 Nasal catheters
 Paster
 Tip applicator
 Gauze
 Speculum
 Suturing set- catgut if tear
 Lidocine
 Catheter plain straight.
 Iv securing set
 Iv set ,Iv stand, cannula (2), cotton ball,
 R/L
 N/S
 towel (4)
o Abdomen
o Far tight
o Hear tight
o Lower perineum
 Forceps (6)
 xytocine
o 10 IU=IM injection
o 20 IU= to add on N/S field
 Pethadine =50-100 mg iv on the cannula
 Fenestrated towel for catheterization
 Safety box reciver
 R&D sheet
  PPE
 Ampicilline=2g.IV
 Kidney disk (4)
 Gallipots(2)
 Glove surgical (3)
 Clean glove
 Screen
 V/S equipment
 Syringe(6)

Procedure
 collect equipment
 screen the bed
 wear PPE
 measure V/S
 put pt in the shock position flat position
 emergency call
 Check ABC. A= air way B= breathing C= circulation
 Administer O2 nasal catheter
 Place R& D sheet
 Massage the funds
 Secure IV R/L hand N/S80gtt
 Add 20IU oxytoin on the N/S
 Give pethidin 50 -100mgIV push on the annual
 Give ampicillin 2 g IV
 Clean the external genital area by using N/S gauze & forceps down stroke.
 Place 4 towel on - genital area
-For
-Near
-Abdomen
 Clean the vulva again
 For
 Near
 Abdomen
  Separate & insert catheter= 1st clamp & then receive by using kidney dish
 Remove catheter after empty bladder
 Clean the area
 Wear elbow size glove(cut one or two finger of gloves to insert hand)
 Perform manual examination i.e. two finger roll with large bandage. Then
insert hand & clean two times (double) (to wise) by changing the gauze.
 Clean down stock.
 Give 10 IU oxytocin IM on rectus femora’s
 Squeeze by using clamp hand & one hand on the abd.
 Apply two /three fingers to feel femoral artery if feel no stopped blood
 Apply one hand on the abd (1cmtotheleftside&aboveto umbilicus) & apply
pressure.

 If tear – use speculum to identify site

 Use speculum to identify site
 Suture by using cut get
 If bleeding no stop give 0.2ml ergometrine (0.2% & add10%N/S or 0.5%
add5%N/S)
 Reposition comforts the pt.
 Remove R & d sheet.
 Measure V/S
 Document.
 Refer.

Steps of manual removal of the placenta

1. Review general care principles and start IV infusion.
2. Provide emotional support and encouragement.
3. Give pethidine and diazepam IV slowly (do not mix in the same syringe).
4. Give a single dose of prophylactic antibiotics:
Ampicillin 2 g IV PLUS metronidazole 500 mg IV; OR cefazolin/ceftriaxone 1 g IV
PLUS metronidazole 500 mg IV.
5. Hold the umbilical cord with a clamp; pull the cord gently until it is parallel to
the floor.
6. Wearing sterile long sleeve gloves or similar modification, insert a hand into
the vagina and up into the uterus.
7. Let ogo of the cord and move the hand up over the abdomen in order to
support the fundus of the uterus and to provide counter-traction during removal
to prevent inversion of the uterus.
Note: If uterine inversion occurs reposition the uterus.
8. Move the fingers of the hand laterally until the edge of the placenta is located.
9. If the cord has been detached previously insert a hand into the uterine cavity.
Explore the entire cavity until a line of cleavage is identified between the
placenta and the uterine wall.
10. Separate the placenta from the uterine wall by keeping fingers tightly
together and using the edge of the hand to gradually make a space between the
placenta and the uterine wall.
11. Continue slowly all around the placental bed unti