tailieunhanh - Examination of the Newborn - part 4

Ngoài màng cứng Trong một nghiên cứu tiến hành bởi Lieberman và cộng sự. (1997) liên quan đến phụ nữ đã kết luận rằng trẻ sơ sinh có mẹ nhận được màng tế lao động có nhiều khả năng để yêu cầu điều trị bằng kháng sinh. Điều này có thể liên quan đến một thực tế rằng gây tê ngoài màng cứng trong lao động có liên quan | RISKS TO THE FETUS DURING CHILDBIRTH 53 Epidural In a study conducted by Lieberman et al. 1997 involving 1 657 women it was concluded that neonates whose mothers received epidurals in labour were more likely to require treatment with antibiotics. This may be related to the fact that epidural analgesia in labour has been associated with an increase in maternal temperature Mercier and Benhamou 1997 which may lead to the precautionary measure of admitting her baby to a special care baby unit with suspected infection Pleasure and Stahl 1990 . In general however epidural use in labour is not associated with a poor neonatal outcome and is the preferred method of anaesthesia for Caesarean section. Water birth In many maternity units a birthing pool is available for women to use for its analgesic effects. There is no evidence to suggest that such an option for women results in a higher risk to the neonate Alderice et al. 1995 Brown 1998 . An unusual case of neonatal polycythaemia was reported Odent 1998 in an infant who remained in a birthing pool for 30 minutes after delivery before the cord was cut when a baby is born on dry land the effect of the air causes the cord to constrict thereby limiting the amount of blood transfused from the placenta. Presentation of the fetus in labour Knowledge of how the fetus presented during labour and its relevance to the clinical examination is required so that the practitioner can reassure parents and look for specific features. The following presentations will be considered 1 occipito-posterior 2 face 3 brow 4 compound 5 breech. Occipito-posterior This is a relatively common presentation affecting approximately 10 of babies Bennett and Brown 1999 . Moulding of the fetal 54 EXAMINATION OF THE NEWBORN skull results in a characteristically elongated head which resolves in a few days. Face presentation For vaginal delivery to take place this requires the fetus to extend its head and neck. The face is usually very bruised and may have a .