الفهرس Only 14 pages are availabe for public view
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Abstract
Infants delivered by vacuum extraction or other operative techniques may be more likely to sustain major injuries than those delivered spontaneously, but the extent of the risk is unknown. Therefore, assessment of the neonate immediately after birth is a critical function of the nurse. The assessment of physical and neurological findings to determine gestational age is important because prenatal morbidity and mortality are related to gestational age and birth weight. Ballard scale is commonly used to determine and assess gestational age of the baby.The purpose of this study was to examine the effect of the mode of delivery on the neurological adaptation of the newborn infants. The study was conducted at two settings in Menoufyia governorate, namely Shebin El-Kom teaching hospital, and Quisna hospital.The total sample was 160 women who were in labor. The women’ sample was divided into four main groups. The inclusion criteria were full-term deliveries, at least 37 weeks of gestation, with no suspicion of fetal disease. Both primipara and multipara were included, as well as malpresentations. The methods of data collection included an interview and a physical assessment sheets for the women, Apgar scoring sheet used to assess the physical condition of the neonate, and Ballad scale used to assess the neonates physically and neurologically.The study revealed that the mean age of the women ranged from 23.3 to years. About half of the sample has secondary education, while one quarter of the women were illiterate, and only has university education.The study has indicated that the complications among women during labor were highest in the ventouse group (followed by the breech group , but the percentages were small in the normal vaginal delivery and cesarean section groups, and , respectively. These differences were statistically significant. Meanwhile, the complications among women after delivery were in the ventouse group, in both breech and normal vaginal delivery groups, and only in the cesarean section group.According to the study findings, the lowest Apgar scoring during the first minute was among infants delivered by ventouse, and 5.3 in infants delivered by cesarean section. At the fifth minute, the lowest Apgar scoring was still among infants delivered by ventouse , and increased to 8.0 in infants delivered by breech presentation. These differences were statistically significant. As regards Ballard scale, the study findings indicated that the lowest total neurological score was 15.4 in infants delivered by ventouse and 15.5 in infants delivered by breech. These were statistically significantly lower than the score of infants delivered by normal vaginal delivery, whose mean score was 20.5. Similar findings were noticed in the physical and total Ballard scores.
Based on the study findings, the following is recommended:
The use of operative instruments during labor should be minimized, as possible, and preference to be given to cesarean section Further research is needed to assess nurses’ knowledge about how to receive the newborn immediately after labor, and how to apply Ballard scaleThe necessary facilities and equipment needed for making good diagnosis for the newborn, such as X-ray and ultrasonography, should be made available Follow up of the newborn infants who were delivered by instruments along the first year of their life, with repeated observation of the neurological behavior to get more valid data on the neurological adaptation is highly recommended Similar research should be carried out on a larger number of cases in each mode of delivery, with emphasis on neurological adaptation between cesarean and instrumental deliveries.