Pregnancy History

Prior to examining the newborn baby, it is important to review the records of the baby and the mother for information that might predict pathology in the newborn. Information on the history of the pregnancy, labor, and the delivery has implications for the health of the newborn.

Did the mother have:

  1. prenatal care? (If no prenatal care, be on the lookout for problems!)
  2. infections?
    • Was there screening for intrauterine infection
    • Were there infections that can be transmitted during delivery such as group B strep, hepatitis B, genital herpes, HIV.
  3. diabetes during pregnancy?
  4. hypertension, toxemia, or renal disease? (places infant at-risk for prematurity, growth retardation, asphyxia, hypoglycemia)
  5. drug use: illicit, alcohol, smoking, medications? (depressant/opiate medications associated with increased risk to newborn for respiratory depression; smoking associated with increased risk for low birthweight)
  6. multiple pregnancy? (risk for increased perinatal mortality, breech presentation, premature birth, small for gestational age babies, birth asphyxia, twin-to-twin transfusion)
  7. pre-or-post-term pregnancy? (these babies have specific problems)
  8. amniotic fluid problem - oligohydramnios (a lack of amniotic fluid)? (lack of fetal urine from renal agenesis or urethral obstruction; may lead to inadequate lung development)
  9. amniotic fluid problem - polyhydramnios (excess of amniotic fluid)? (risk for esophageal or duodenal atresia, maternal diabetes, anencephaly, diaphragmatic hernia, hydrops fetalis)
  10. rupture of membranes (prolonged or premature)? (risk for perinatal infection)
  11. caesarean delivery? (risk for transient tachypnea of the newborn).

Did the baby have:

  1. evidence of fetal distress? (suggestive of intrauterine hypoxia)
  2. meconium staining?(indicator of fetal distress or post-mature birth)
  3. low Apgar score?
  4. cord prolapse (around the neck)
  5. low birthweight (suggest maternal smoking)

More Info: Low APGAR score

A low Apgar score may be due to intrauterine asphyxia, hypovolemia, drugs administered to the mother that depress fetal respiratory efforts, severe perinatal infection, or congenital abnormalities involving the lungs, heart, of the central nervous system.

Score

0

1

2

Appearance of extremities

blue/pale

pink/

pink/blue

Pulse

absent

< 100 bpm

> 100 bpm

Grimace

absent

grimace

crying actively

Activity

limp

some flexion

moving actively

Respiration

absent

irregular

regular, crying

The one minute Apgar score serves as a guideline for the degree of intervention. The five-minute score is an indicator of the efficacy of the resuscitative efforts, if any were necessary. In and of itself, the one- and five-minute Apgar scores are not good predictors of long-term outcome, but may predict a complicated neonatal course, which then increases risk for poor long-term outcome.

 

 Mnemonic

Make your own mnemonic for remembering this list. The list has:

1 A: Apgar

1 B: Birthweight

2 D's: Diabetes, Drugs (legal, illegal, alcohol, smoking)

2 C's: Cord (prolapse, around the neck), Caesarean

3 F's: Fluid x2 (too much, too little) fetal distress

1 H: Hypertension, (toxemia, renal disease)

1 I: Infection (intrauterine or acquired from birth canal)

2 M's: Multiple pregnancy, Meconium

1 P: Prenatal care

1 R: Rupture

1 T: Term

Need a break? Read about mnemonics and Greek mythology


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