Clinical Management of Mother and Newborn

280 Pages·1979·9.501 MB·English

by  Gerard M. Bassell, Prasanta Chandra (auth.), Gertie F. Marx M.D. (eds.)

Clinical Management
of Mother and Newborn
Clinical Management
of Mother and Newborn
Gertie F. Marx, Editor
Springer-Verlag
New York Heidelberg Berlin
Gertie F. Marx, M.D.
Department of Anesthesiology
Albert Einstein College of Medicine
1300 Morris Park Avenue
Bronx, New York 10461
With 30 illustrations
Library of Congress Cataloging in Publication Data
Marx, Gertie F
Clinical management of mother and newborn.
Includes index.
1. Infants (Newborn)-Diseases. 2. Puerperal
disorders. I. Title. [DNLM: 1. Infant, Newborn,
2. Infant, Newborn, Diseases. 3. Postnatal care.
WS420 C641]
RJ254.~,.~37 618.9'201 79-12344
All rights reserved.
No part of this book may be translated or reproduced in any form
without written permission from Springer-Verlag.
© 1979 by Springer-Verlag New York Inc.
Softcover reprint of the hardcover 1st edition 1979
987 6 5 4 3 2 1
The use of general descriptive names, trade names, trademarks, etc., in this
publication, even if the former are not especially identified, is not to be taken
as a sign that such names, as understood by the Trade Marks and
Merchandise Marks Act, may accordingly be used freely by anyone.
ISBN -13 :978-1-4612-6175-9 e-ISBN -13: 978-1-4612-6173-5
DOl: 10.1007/978-1-4612-6173-5
Preface
The birth of a baby is the culmination of months of anticipation and plan
ning. Most often, mother and infant are healthy and readily able to estab
lish close contact-a bond. However, in some situations either mother or
baby or both present complications. The more prompt and rational the
treatment, the sooner the normal parent-infant relationship will commence.
This book is devoted exclusively to the first days following birth. In its
15 chapters, postpartum and postnatal physiology and pathophy[ i:.;logy are
reviewed by 18 specialists. Normal and abnormal development of mother
and child is correlated with proven means of clinical management.
Chapters 1 through 3 cover maternal postpartum developments and
complications. Chapter 4 stresses the importance of a normal parent
newborn relationship, a concept of increasing concern in modern society.
The following ten chapters discuss neonatal physiology and pathophysi
ology; the effects of obstetric anesthesia on infant behavior, pulmonary
function measurements in the postnatal period and treatment of the sick
newborn are discussed in detail. The final chapter reviews maternal and
perinatal mortality; the data, based on extensive surveys in New York City,
indicate that current management is effecting an overall decline in mortality.
I wish to thank my collaborators and our publisher for their help in this
endeavor to enhance the care given to mothers and their newly born infants
-for the benefit both of the young family and of society in general.
Contents
Contributors xiii
1
Postpartum Uterine Activity and Anesthesia 1
GERARD M. BASSELL, PRASANTA CHANDRA, AND GERTIEF. MARX
Uterine Muscle Physiology 1
Methods of Intrauterine Pressure Measurement 3
Uterine Activity During Pregnancy 5
Analysis of Uterine Activity 6
Effects of Oxytocin and Anesthetic Agents 7
Conclusion 9
References 10
2
Pathophysiology and Therapy of Postpartum
Complications 13
GERTIE F. MARX
Obstetric Complications 13
Iatrogenic Complications 18
Complications from Coincidental Medical Disease 21
Conclusion 22
References 23
viii Contents
3
Headache in the Postpartum Period 27
GERARD W. OSTHEIMER
Anesthesia-Related Headaches 27
Non-Anesthesia-Related Headaches 37
Conclusion 39
References 39
4
The Normal Parent-Newborn Relationship:
Its Importance for the Healthy Development of the Child 43
W. GODFREY COBLINER
Maternal Deprivation 43
Systemadc Studies on Large Samples 44
The Content of the Parent-Newborn Relationship 47
Theoretic:,1 Considerations 49
The Dimer lions of the Caregiver-Neonate Relationship 51
Conclusion 52
Reference~ 52
5
Reflections on the Apgar Scoring System 55
J. SELWYN CRAWFORD
Resuscitation 56
Individual Components of the Score 57
The Time Factor 59
Prognostic Value 61
Summary 62
References 62
6
Clinical Neonatal Neurobehavioral Assessment:
Methods and Significance 65
JOHN W. SCANLON
Scoring the Early Neonatal Neurobehavioral Scale 69
Methodologic Issues 73
Contents ix
Clinical Uses of the Early Neonatal
Neurobehavioral Examination 75
Acknowledgments 81
References 81
7
Effects of Obstetric Analgesia-Anesthesia
on Neonatal Neurobehavior 85
ROBERT HODGKINSON
Wakefulness 86
Electroencephalography 86
Attentiveness 87
Sucking 87
Habituation 88
Brazelton Neurobehavioral Scale 89
Scanlon's Early Neonatal Neurobehavioral Scale 91
Other Neurobehavioral Scales 93
Parental-Neonate Interaction 94
Discussion 94
References 97
8
Drug Sensitivity of the Neonate 101
SIMON HALEVY
Drug Absorption 102
Drug Distribution 102
Drug Metabolism 103
Drug Elimination 104
Receptor Sensitivity 105
Conclusion 105
References 106
9
Pulmonary Function in the Perinatal Period 109
EMILE M. SCARPELLI
The Prenatal Lung (Liquid Lung) 109
x Contents
The First Breaths (Foam Lung) 113
The Neonatal Lung (Air Lung) 117
References 131
10
The Meconium Aspiration Syndrome 137
JEAN F. HOBBS AND ARTHUR I. EIDELMAN
Incidence 137
Pathophysiology 138
Clinical Presentation 139
Radiographic Features 141
Management Considerations 143
Prognosis 149
References 150
11
Treatment of Neonatal Metabolic Acidosis 153
ARTHUR I. EIDELMAN AND JEAN F. HOBBS
Acid Base Regulatory Mechanisms 153
Neonatal Limitations 154
Clinical Conditions 155
Normal Labor and Delivery 155
Perinatal Asphyxia 159
Respiratory Distress Syndrome 161
Blood Transfusions 161
Hypothermia 162
Consequences of Acidosis 163
Treatment of Acidosis 166
TRAM 169
Asphyxia Neonatorum 170
Respiratory Distress Syndrome 172
Blood Transfusions 174
Conclusion 175
References 175
Contents xi
12
Respiratory Treatment of the Neonate 183
ELIZABETH D. STEIN
General Principles of Respiratory Support 184
Techniques of Supporting Ventilation 187
Conclusion 196
References 197
13
Exchange Transfusion of the Newborn Infant 199
ERMELANDO V. COSMI
Indications for ET 199
Laboratory Determinations 205
Criteria for ET and Basic Management 207
Conduct of ET 209
Selection of Donor Blood 210
Potential Hazards of ET 211
Conclusion 212
Acknowledgment 212
References 212
14
The Newborn of the Drug-Dependent Mother 221
STEPHEN R. KANDALL
Drugs and Pregnancy 222
Fetal Growth and Development 224
Transitional Period 225
Neonatal Drug Withdrawal 226
Management of Neonatal Drug Withdrawal 229
Later Complications of Neonatal Drug Dependency 232
Follow-up of Passively Addicted Infants 235
Conclusion 236
References 237
xii Contents
15
Maternal and Perinatal Mortality 241
JEAN PAKTER, MORTON A. SCHIFFER, AND FRIEDA NELSON
Methodology 243
Results 243
Conclusion 252
Recommended Standards for Obstetric Anesthetic Care 253
References 264
Index 265