Physiological changes of neonate at birth and how midwife can optimise transition to extra-uterine life in first hour of life.

What is the process of physiologic change in the newborn infant, that begins in utero in preperation for the change from intrauterine placental support to extrauterine self-maintenance.

Label the below fetal circulation

The Ductus Venosus is located in the [blank_start]liver[blank_end]. It connects the umbilical vein to the left [blank_start]hepatic vein[blank_end] or [blank_start]inferior vena cava[blank_end]. At birth, the sphincter close to the umbilical vein [blank_start]constricts[blank_end] and the ductus venosus [blank_start]closes[blank_end]. This becomes the [blank_start]ligamentum venosum[blank_end].

Blood continues to travel up the inferior vena cava, and enters the [blank_start]right atrium[blank_end] of the heart. Some blood goes to the [blank_start]right ventricle[blank_end], then to the pulmonary arteries. Only a small amount goes to the maturing lungs. The rest of blood is shunted away from lungs by the [blank_start]ductous ateriosus[blank_end] back to the aorta. Most of the blood in the right atrium passes to the [blank_start]left atrium[blank_end] through the [blank_start]foramen ovale[blank_end]. From the left atrium it flows to the left ventricle, and is then pumped to the [blank_start]aorta[blank_end].

The Foramen Ovale is a small opening in the septum of the heart and completely bypasses the non-functioning lungs.

Eventually the ductus arteriosus becomes the [blank_start]ligamentum arteriosum[blank_end], and the foramen ovale becomes the [blank_start]fossa ovalis[blank_end].

Factors that will initiate the first breath and lung expansion of the neonate are: 1) [blank_start]Compression[blank_end] of the chest wall during vaginal delivery AND [blank_start]recoil[blank_end] of the chest wall immediately after birth; 2) [blank_start]Chemoreceptor[blank_end] stimulation by the decrease in O2 and increase in CO2 in blood; 3) [blank_start]Sensory stimuli on the skin[blank_end] (touch, pressure and low environmental temperature); 4) Stimulation of the senses [blank_start]by light and noise[blank_end].

Which of the below are ways in which a neonate can lose heat?

At the time of birth blood effects the [blank_start]opening[blank_end] of the alveoli and clears [blank_start]lung fluid[blank_end] from the alveoli. During fetal life, the alveoli are filled with lung fluid. They are small and not expanded. At birth, capillaries fully fill with [blank_start]blood[blank_end] for the first time, expanding so they become [blank_start]erect[blank_end] and actively [blank_start]open[blank_end] the alveoli. This process is called [blank_start]recruitment[blank_end]. Lung fluid is not [blank_start]absorbed[blank_end] into ‘lung tissue’ which is an area for active gaseous exchange. The only way to clear lung fluid is through the intricate circulation established within the lung tissue immediately after birth. The higher [blank_start]colloidal osmotic pressure[blank_end] of the blood in the capillaries surrounding each alveolus [blank_start]draws[blank_end] the fluid from the lung.

Signs of normal transition are:

How many more red blood cells can newborns gain through optimal cord clamping?

What are the advantages of optimal cord clamping?

Once a baby is born [blank_start]skin-to-skin[blank_end] contact is preferable to prevent further [blank_start]heat loss[blank_end] and to regulate the [blank_start]heartbeat[blank_end]. Any part of the baby should be [blank_start]covered[blank_end] to prevent heat loss. The room should be [blank_start]warm and draught free[blank_end]. Wet towels should be replaced with [blank_start]warm, dry ones[blank_end]. The [blank_start]partner[blank_end] may provide skin to skin if the mother cannot or does not want to