Perinatal Asphyxia: Model Clinical Case & Viva QnA
Clinical Case of Perinatal Asphyxia
Clinical Case: Severe Perinatal Asphyxia in a Term Neonate
A 28-year-old G2P1 woman at 40 weeks gestation presents to the labor and delivery unit with spontaneous rupture of membranes and regular contractions. Her pregnancy has been uncomplicated, and she has been receiving regular prenatal care.
Labor Course:
- Initial fetal heart rate (FHR) tracing shows baseline of 140 bpm with moderate variability
- After 6 hours of labor, FHR shows recurrent late decelerations
- Maternal fever develops (38.5°C)
- Decision made for emergency cesarean section due to non-reassuring fetal status
Delivery:
- Male infant delivered via emergency cesarean section
- Thick meconium noted at delivery
- Infant is limp, cyanotic, and not breathing
- Heart rate <60 bpm
- Cord blood gas: pH 6.85, BE -18 mEq/L, pCO2 75 mmHg
Resuscitation:
- Immediate cord clamping and transfer to warmer
- Intubation performed with suctioning of thick meconium below the cords
- Positive pressure ventilation initiated
- Chest compressions started due to persistent bradycardia
- Epinephrine administered via endotracheal tube
- Apgar scores: 1 at 1 minute, 3 at 5 minutes, 5 at 10 minutes
- Infant achieves spontaneous circulation at 12 minutes of life
NICU Course:
- Admitted to NICU for post-resuscitation care
- Therapeutic hypothermia initiated within 6 hours of birth
- Mechanical ventilation continued
- Seizures noted at 8 hours of life, treated with phenobarbital
- Multiorgan dysfunction: acute kidney injury, elevated liver enzymes, coagulopathy
- MRI at 5 days of life shows bilateral thalamic and basal ganglia injury
Outcome:
The infant is extubated on day 7 and gradually weaned off respiratory support. Feeding is established via nasogastric tube due to poor suck. The infant is discharged at 3 weeks of life with close neurodevelopmental follow-up arranged.
2. Clinical Presentations of Perinatal Asphyxia
Clinical Presentations of Perinatal Asphyxia
1. Neurological Presentation
- Altered level of consciousness (ranging from lethargy to coma)
- Hypotonia or floppiness
- Absent primitive reflexes (Moro, sucking, grasping)
- Seizures (subtle, focal, or generalized)
- Abnormal posturing (decerebrate or decorticate)
- Abnormal eye movements or fixed, dilated pupils
- Apnea or irregular breathing patterns
2. Cardiovascular Presentation
- Bradycardia or tachycardia
- Hypotension or shock
- Poor peripheral perfusion
- Cardiac arrhythmias
- Tricuspid regurgitation
- Myocardial dysfunction
- Persistent pulmonary hypertension of the newborn (PPHN)
3. Respiratory Presentation
- Apnea or gasping respirations
- Meconium aspiration syndrome
- Persistent pulmonary hypertension
- Respiratory distress (tachypnea, grunting, retractions)
- Need for prolonged mechanical ventilation
- Pneumothorax or pneumomediastinum
4. Renal Presentation
- Oliguria or anuria
- Acute kidney injury
- Electrolyte imbalances (hyperkalemia, hyponatremia)
- Proteinuria
- Hematuria
- Renal vein thrombosis
5. Gastrointestinal Presentation
- Feeding intolerance
- Abdominal distension
- Necrotizing enterocolitis
- Elevated liver enzymes
- Hypoglycemia or hyperglycemia
- Gastrointestinal bleeding
6. Hematological Presentation
- Thrombocytopenia
- Disseminated intravascular coagulation (DIC)
- Prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT)
- Anemia
- Leukocytosis or leukopenia
7. Metabolic Presentation
- Metabolic acidosis
- Hypoglycemia
- Hypocalcemia
- Hypomagnesemia
- Hyponatremia or hypernatremia
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Knowledge Check: Question and Answers for Medical Students & Professionals
This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.
Disclaimer
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