A 19-year-old woman is in spontaneous labour at 37 weeks 2 days’ gestation. At 4 cm cer- vical dilatation there is thick meconium liquor and a fetal heart deceleration to 70/min is heard lasting for 2 min. The woman is immediately placed on the continuous cardio- togograph (CTG), which confirms regular deep late decelerations.
A decision is made to deliver the baby by immediate Caesarean section under general anaesthetic. The baby is delivered within 20 min.
· How do you interpret the Apgar and cord blood results?
· What action would you take in these circumstances?
The Apgar score is a simple scoring system to record the initial assessment of neonates in the first few minutes after delivery. For each variable a score of 0, 1 or 2 may be allocated (see Table 96.1).
In this case the baby is clearly showing no respiratory effort and is bradycardic at birth. The arterial cord blood shows an acidosis.
Most babies, even with low Apgar scores respond to initial resuscitation measures:
· immediately dry the baby with warm towels, replacing any wet towels with dry ones
· warm by wrapping in a warm dry towel and placing under the heated rescuscitaire
· stimulate by rubbing (during drying)
· if no immediate respiratory effort is made then proceed to 5 inflationary breaths with oxygen via a self-limiting pressure bag and appropriately sized face mask (most babies will respond and immediately increase their heart rate and begin to make some respira- tory effort)
· recheck the respiration and heart rate. If they have not recovered, clear the airway with gentle suction (this baby has been exposed to thick meconium which may have been inhaled and be causing a mechanical obstruction)
· if the heart rate is above 60/min, continue ventilation with bag and mask until heart rate increases to above 100/min
· if the heart rate is below 60/min begin chest compressions, continue bag and mask ven- tilation and check that the neonatal resuscitation team has been called.
This baby recovered its heart rate and respiratory effort with the first three measures but continued to display ‘grunting’ respiratory effort, and 3 h later deteriorated and needed ventilation. A diagnosis of meconium aspiration and pneumonitis was made and anti- biotics and supportive measures were initiated with final extubation after 7 days and dis- charge home 5 days later.