- Delayed fetal newborn
circulatory adjustment
STEPS EINC
1. DRY AND PROVIDE WARMTH
- Within the first 30 seconds
- Use a clean, dry cloth to
thoroughly dry the baby by
wiping the face, eyes, head,
front and back of the trunk,
arms and legs.
- Do a quick check of
newborn’s breathing while
drying.
- Remove the wet cloth.
2. SKIN TO SKIN CONTACT
- If newborn is breathing and
crying after 30 seconds of
drying.
- Place the newborn prone on
the mother’s abdomen or
chest skin-to-skin.
- Cover newborn’s back with a
blanket and head with a
bonnet.
- Place identification band on
ankle
RISK OF HYPOTERMIA
- Infection
- Coagulation defects
- Acidosis
- Hyaline membrane disease
- Brain hemorrhage
IF THE BABY IS NOT BREAHTING:
- Clamp the cord and cut
immediately
- Cal for HELP
- Transfer to a warm surface
- Start resuscitation protocol
3. BREASTFEEDING INITIATION
- Remain skin to skin
- Within 90 mins
- uninterrupted for at least 90
minutes after birth and until
the first thorough breastfeed
is complete
- monitor the mother and
baby during the first hour
after complete delivery of the
placenta
- never leave the woman and
baby alone
- monitor baby’s breathing and
temperature every 15 mins
FEEDING CUES:
 - Only once the newborn
shows feeding cues (opening
of mouth, tonguing, licking,
rooting)
- make verbal suggestions to
the mother to encourage her
newborn to move toward the
FIRST 90 MINS OF LIFE
breast (nudging).
4. IMMUNIZATION AND
OINTMENT
- Erythromycin ointment
- Within one hour of birth
- Vitamin K, Hepa B, BCG
5. CORD CARE
- Wash hand before and after
cord care
- Fold diaper below stump.
Keep cord stump loosely
covered with clean clothes
- If stump is soiled, wash it
with clean water and soap.
- Dry thoroughly with clean
cloth.
UNNECESSARY PROCEDURE
- Routine suctioning
- Early bathing/washing
- Foot printing
- Giving sugar water, formula
or other prelacteals and use
of bottles and pacifiers.
- Application of alcohol,
medicines and oils on the
cord stump
- Call out time of birth.
- Deliver the baby prone on
the mother’s abdomen
- Dry the newborn thoroughly.
Check breathing while
drying.
- Remove wet cloth.
- Position the newborn on the
mother’s abdomen in skin-
to-skin contact. Cover the
back with a dry blanket.
- Remove first set of gloves.
- Clamp and cut the cord
when pulsations have
stopped ( 1-3 minutes)
- Place the newborn on the
mother’s chest in skin-to-
skin contact
- Cover the baby’s head with a
hat. Cover the mother and
baby with a warm cloth.
- Initiate breastfeeding while
maintaining skin-to-skin
contact.
 - Place identification band on
ankle.
- Do eye care
- Immunization
- Monitor vitals of mother and
baby.
1. PREECLAMPSIA
- Formerly called Toxemia
- S&Sx: increase BP, sudden
weight gain, protein in urine,
severe headache, pitting
edema, facial puffiness.
- Fetal growth restriction
- Antihypertensive
- Anticonvulsant
- Corticosteroids
- HELLP syndrome
(Hemolysis, Elevated liver
enzymes, Low platelet
counts)
2. ECTOPIC PREGNANCY
- Extrauterine pregnancy
- Implants in the fallopian
tube at the ampullar portion
- S&Sx: pelvic and abdominal
pain, amenorrhea/spotting,
oliguria.
- TRIAD: amenorrhea, vaginal
bleeding, abdominal pain.
- Cullen’s sign a bluish
discoloration of the
umbilicus
- SHOCK: decrease BP,
tachycardia, tachypnea.
- Methotrexate
- Mifepristone
- IV therapy
- Nifedepine
- Laparoscopy
3. ABORTION
- A known termination of
pregnancy.
- Spontaneous
abortion/miscarriage
- S&Sx: pain, bleeding,
expulsion of tissue.
- Hemorrhage is at large
- Risk factors: age, previous
miscarriage, smoking/drug
use.
- Nifedipine; control bleeding.