Ok, I have a question for all you experienced L&D RNs...
We did a c/s for a patient with fetal distress, late and variable decels into the 60s and FTP. We get into the uterus and the cord is an occult cord, coming down with the head of the baby who was asynclitic (sp?)...So out comes the cord first. VERY difficult delivery of the head, the way the baby was lying the face was coming out of the incision first, didn't fit, tried to push the baby back up into the uterus, rotate the head so that they could get the vertex out first, still no luck, something like 5+ minutes trying to get this kid out, all the time the cord is out and compressed, flasid and pale, the baby's face was blue+, we heard a cry when we first got into the uterus, but than, nothing no movement, nothing. SO doc finnaly takes the bandage scissors from me and extends the uterine and cutaneous incisions, finnaly making enough room to get this kid out. This is some 8-10 minutes after the first incision into the uterus and the baby's first breath. The baby is dark blue on delivery, and basically looks dead Apgar of 1 at 1 minute...Neo for delivery and codes the baby Apgar of 9 at 5 minutes. We send gases which come back good venous was something like 7.4 and normal base excess (-1.5) PO2 and CO2 were both in normal range as well. Arterial gases were good as well.
My question is are these gases really accurate? This cord was compressed and flacid for more than 5 minutes, most likely there was little to no perfussion, the baby did take it's first breath when we got into the uterus (5+ minutes before delivery), and the gases were obtained from a section of the cord below where the cord was compressed and out of the uterus, and the OB had to squeez blood from the placental end into the section that was sent for gases.
Can anyone explain this to me? Some of the nurses said that this was accurate, but can't really explain why? I don't think that they are, d/t the above facts, but would really like to understand this better.
I am in nursing school
and have a pretty good understanding of the physiology. This was the scarriest delivery I ever attended, I really thought we were watching this baby die in front of us! I got teary eyed when I saw that this baby was doing good in NICU. The little guy did well and went home with mom on schedule.
Thanks to any of you all that could explain this one!