large head [3 cm larger than chest] term infants chest if 1-2 cm smaller than the head,
become = at age 2
skin: ruddy, little subcutaneous fat, prominent veins high degree of acrocyanosis, little or no vernix at birth because this is formed at 24 weeks, abundant lanugo, few to no creases on soles.
eyes: small, pupillary reaction present but difficult to elicit.
ear: large in relation to the head, inspect level to assess chromosomal abnormalities.
reflexes:
deep tendon diminished, sucking, rooting, grasping,
Moro and swallowing may be weak or absent
cry: rarely cries, cry is weak and high pitched.
posture: limited flexion of arms and legs, hangs limp during ventral suspension, frog leg type position
head lag: head will lag when pulled from supine to sitting.
genitalia: testes undescended, few rugae on scrotum, labia majora separated, clitoris prominent, hymen may protrude
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6T's or PAALID
Tone - uterine atony
Turned - uterine inversion
Trauma - vaginal laceration
Tissue - placental retention [accreta, increta, percreta]
Thrombus - DIC [amniotic fluid pulmonary embolus, von willebrand disease]
Tear - placental abruption
--OR--
Post partum hemorrhage makes mom PAALID = placental retention, *a*tony,
aat partum hemorrhage makes mom *PAALID* = *p*lacental retention, *a*tony, *a*bruption, laceration, inversion, DIC
C. Uterine atony is the most common cause of postpartum hemorrhage. Risk factors for uterine atony include precipitous labor, multiparity, general anesthesia, oxytocin use in labor, prolonged labor, macrosomia, hydramnios, twins and chorioamnionitis. Patients at risk for genital tract lacerations are those who have a precipitous labor, macrosomia or who have an instrument-assisted delivery or manipulative delivery [i.e. breech extraction]. Factors that lead to an over-distended uterus are risk factors for uterine inversion. Grand multiparity, multiple gestation, polyhydramnios and macrosomia are all risk factors. The most common etiology of uterine inversion, however, is excessive [iatrogenic] traction on the umbilical cord during the third stage of delivery. Although the patient is at risk for uterine dehiscence/uterine rupture because of her history of a prior Cesarean delivery, these are infrequent occurrences so the most likely cause of postpartum hemorrhage in this patient is uterine atony.
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