Outcomes

  1. I had a birth the other night that scared the daylights out of me. There was nothing terribly concerning about the labor other than it was very long. Baby looked good; pushing took one and a half hours. There were some deep variables and one decel to about 90 bpm for 3-4 minutes which resolved with mom's position change. (She'd had an epidural but it never took and she had full mobility. Since it was a midwife patient we were able to get her on her hands and knees and have her stand at the side of the bed; FHR rebounded beautifully with great variability). Meanwhile mom had O2 10L Fm on, fluids running, etc. Turns out baby was direct OP and was born floppy, Apgars 1/7. Talk about scary, and, for me, talk about guilt. Was there something I missed? Was there something I should have done differently? Cord gases were 7.19 and 7.20. I can't stop thinking about potential problems for this baby, even though when I left he was on room air and stable in the NICU. It was just one of those shifts where I think: "I don't want to do this anymore."

    Altalorraine
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  2. 7 Comments

  3. by   SmilingBluEyes
    I would want to see the monitor strip...often subtle changes can be predictive of fetal outcomes and indicate acidosis (or not).

    Anyhow I am sorry for all your worry. I would be worried, too, about long-term consequences for this baby.

    Anyhow, I guess I would just need more information here to help you out more......I hope you get some answers. Ob can really be a scary place to work.
  4. by   fergus51
    I would not be particularly worried about long term outcomes. A decel into the 90s isn't ideal, but for a term baby it isn't terrible. Every neonatologist I know pretty much ignores the one minute apgar. As long as you did the right stuff according to NRP (bagged the baby, got the HR up, etc) it's the 5 minute that has predictive value and 7 is decent. 7.20 isn't fabulous, but it isn't terrible either and as long as baby recovered well in the NICU, I don't think it's a big problem. This type of delivery would have concerned me a lot more in my pre NICU days, but having worked NICU for a couple of years now that type of baby would not worry me much. It's amazing how strong babies can be. I assume the baby will get good follow up monitoring and that's all that hospitals can do.
  5. by   SmilingBluEyes
    I have seen it go both ways, actually fergus. Hopefully this kid will do just fine.
  6. by   fergus51
    Quote from SmilingBluEyes
    I have seen it go both ways, actually fergus.
    Sure, I've seen kids with good deliveries do poorly too. This one just doesn't scream "train wreck" to me. 7.20 is the low end of normal, but I don't know any research that would point to that as a signifigant predictor of poor long term outcomes, and the apgar score at 5 minutes is good (though apgars were never meant to be predictors of long term outcome and aren't great at that anyways unless they are signifigantly low for long periods of time). These last few years have led me to a new normal I guess because it would have worried me a lot more before. It doesn't sound like a great delivery, it would definitely be stressful, but room air and stable in the NICU by end of shift is a good sign. All you can do at that point is provide good follow up care and as long as that was being done, I wouldn't be obsessing about it. Hopefully the baby will continue on that course and Altalorraine can find out next time she's at work.
    Last edit by fergus51 on Dec 11, '05
  7. by   Altalorraine
    Quote from fergus51
    Hopefully the baby will continue on that course and Altalorraine can find out next time she's at work.
    I checked today, and baby is fine so that was a big relief. Mom had chorio so that could explain part of the baby's "transition difficulty". I also did some research which said that acute hypoxia at delivery is not correlated with long term disability in children, though chronic hypoxia (e.g. from chronic htn or smoking) is. It made me feel better.

    I went over the events with the midwife who delivered today, and we reviewed the strip and all events. There was nothing untoward except for what I mentioned in my OP, so there isn't much that we would have done differently.

    Altalorraine
  8. by   SmilingBluEyes
    Sounds great, Altalorraine. Glad baby will be fine!
  9. by   fergus51
    Quote from Altalorraine
    I checked today, and baby is fine so that was a big relief. Mom had chorio so that could explain part of the baby's "transition difficulty". I also did some research which said that acute hypoxia at delivery is not correlated with long term disability in children, though chronic hypoxia (e.g. from chronic htn or smoking) is. It made me feel better.

    I went over the events with the midwife who delivered today, and we reviewed the strip and all events. There was nothing untoward except for what I mentioned in my OP, so there isn't much that we would have done differently.

    Altalorraine
    Glad to hear it

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