Infiltration of the perineum with an anesthetic is commonly used, although this method is not as effective as a well-administered pudendal block. In low-risk deliveries, intermittent auscultation by handheld Doppler ultrasonography has advantages over continuous electronic fetal monitoring. The mother must push to move her baby down her birth canal until its born. A spontaneous vaginal delivery (SVD) occurs when a pregnant woman goes into labor without the use of drugs or techniques to induce labor and delivers their baby without forceps, vacuum extraction, or a cesarean section. Walsh CA, Robson M, McAuliffe FM: Mode of delivery at term and adverse neonatal outcomes. Simultaneously, the clinician places the curved fingers of the right hand against the dilating perineum, through which the infants brow or chin is felt. Delivery type. Shiono P, Klebanoff MA, Carey JC: Midline episiotomies: More harm than good? In particular, it is difficult to explain the . These problems usually improve within weeks but might persist long term. Another type of episiotomy is a mediolateral incision made from the midpoint of the fourchette at a 45 angle laterally on either side. Episiotomy prevents excessive stretching and possible irregular tearing of the perineal tissues, including anterior tears. The infant is thoroughly dried, then placed on the mothers abdomen or, if resuscitation is needed, in a warmed resuscitation bassinet. Obstet Gynecol Surv 38 (6):322338, 1983. and change to operation attire 3. Delay cord clamping for one to three minutes after birth or until cord pulsation has ceased, unless urgent resuscitation is indicated. A spontaneous vaginal delivery is a vaginal delivery that happens on its own, without requiring doctors to use tools to help pull the baby out. Opioids used alone do not provide adequate analgesia and so are most often used with anesthetics. Fitzpatrick M, Behan M, O'Connell PR, et al: Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery. Epidural analgesia is being increasingly used for delivery, including cesarean delivery, and has essentially replaced pudendal and paracervical blocks. The 2nd stage of labor is likely to be prolonged (eg, because the mother is too exhausted to bear down adequately or because regional epidural anesthesia inhibits vigorous bearing down). For the first hour after delivery, the mother should be observed closely to make sure the uterus is contracting (detected by palpation during abdominal examination) and to check for bleeding, blood pressure abnormalities, and general well-being. The mother can usually help deliver the placenta by bearing down. Diagnosis is by examination, ultrasonography, or response to augmentation of labor. Learn more about the MSD Manuals and our commitment to, Cargill YM, MacKinnon CJ, Arsenault MY, et al, Fitzpatrick M, Behan M, O'Connell PR, et al, Towner D, Castro MA, Eby-Wilkens E, et al. Extension into the rectal sphincter or rectum is a risk with midline episiotomy, but if recognized promptly, the extension can be repaired successfully and heals well. Use OR to account for alternate terms Learn about the types of episiotomy and what to expect during and after the. An induced vaginal delivery is a delivery involving labor induction, where drugs or manual techniques are used to initiate labor. The link you have selected will take you to a third-party website. The cervix and vagina are inspected for lacerations, which, if present, are repaired, as is episiotomy if done. Read more about the types of midwives available. If it is, the clinician should try to unwrap the cord; if the cord cannot be rapidly removed this way, the cord may be clamped and cut. The tight nuchal cord itself may contribute to some of these outcomes, however.32 Another option for a tight nuchal cord is the somersault maneuver (carefully delivering the anterior and posterior shoulder, and then delivering the body by somersault while the head is kept next to the maternal thigh). The third stage begins after delivery of the newborn and ends with the delivery of the placenta. The technique involves injecting 5 to 10 mL of 1% lidocaine or chloroprocaine (which has a shorter half-life) at the 3 and 9 oclock positions; the analgesic response is short-lasting. Fetal risks with vacuum extraction include scalp laceration, cephalohematoma formation, and subgaleal or intracranial hemorrhage; retinal hemorrhages and increased rates of hyperbilirubinemia have been reported. 1. Repair of obstetric urethral laceration B. Fetal spinal tap, percutaneous C. Amniocentesis D. Laparoscopy with total excision of tubal pregnancy A N Engl J Med 341 (23):17091714, 1999. doi: 10.1056/NEJM199912023412301, 4. The 2023 edition of ICD-10-CM O80 became effective on October 1, 2022. Then if the mother and infant are recovering normally, they can begin bonding. The cord may continue to pulsate for several minutes, supplying the baby with oxygen while she establishes her own breathing. Allow women to deliver in the position they prefer. Bonus: You can. This is the American ICD-10-CM version of Z37.0 - other international versions of ICD-10 Z37.0 may differ. Complications of pudendal block include intravascular injection of anesthetics, hematoma, and infection. Mayo Clinic Staff. The nose, mouth, and pharynx are aspirated with a bulb syringe to remove mucus and fluids and help start respirations. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. If you're seeking a preventive, we've gathered a few of the best stretch mark creams for pregnancy. 1. If appropriate traction and maternal pushing do not deliver the anterior shoulder, the clinician should explain to the woman what must be done next and begin delivery of a fetus with shoulder dystocia Shoulder dystocia Fetal dystocia is abnormal fetal size or position resulting in difficult delivery. If it is, the clinician should try to unwrap the cord; if the cord cannot be rapidly removed this way, the cord may be clamped and cut. Empty bladder before labor Possible Risks and Complications 1. If anesthesia is local (pudendal block or infiltration of the perineum), forceps or a vacuum extractor is usually not needed unless complications develop; local anesthesia may not interfere with bearing down. Induction of labor can be Medically indicated (eg, for preeclampsia or fetal compromise) read more ). This is also called a rupture of membranes. Delivery bed: a bed that supports the woman in a semi-sitting or lying in a lateral position, with removable stirrups (only for repairing the perineum or instrumental delivery) . Forceps or vacuum extraction is needed during a vaginal delivery How it works If you need an episiotomy, you typically won't feel the incision or the repair. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. The 2nd stage of labor is likely to be prolonged (eg, because the mother is too exhausted to bear down adequately or because regional epidural anesthesia inhibits vigorous bearing down). Some read more ), but it causes greater postoperative pain, is more difficult to repair, has increased blood loss, and takes longer to heal than midline episiotomy (6 Delivery of the fetus references Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. The trusted provider of medical information since 1899, Last review/revision May 2021 | Modified Sep 2022. (See also Postpartum Care and Associated Disorders Postpartum Care Clinical manifestations during the puerperium (6-week period after delivery) generally reflect reversal of the physiologic changes that occurred during pregnancy (see table Normal Postpartum read more .). In the delivery room, the perineum is washed and draped, and the neonate is delivered. An episiotomy incision that extends only through skin and perineal body without disruption of the anal sphincter muscles (2nd-degree episiotomy) is usually easier to repair than a perineal tear. Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT. Cord clamping, cutting, and cord drainage o Clamp cord 1 inch above umbilicus and 2nd clamp placed above Cord is cut in between 2 clamps o Collect umbilical blood if needed for pH, Rh typing, or mother-baby studies A note in the tabular provides directions for the use of this code as follows: "Delivery requiring minimal or no assistance, with or without episiotomy, without fetal manipulation (i.e., rotation version) or instrumentation [forceps] of a spontaneous, cephalic, vaginal, full-term, single, live-born infant. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. brachytherapy. Active herpes simplex lesions or prodromal (warning) symptoms, Certain malpresentations (e.g., nonfrank breech, transverse, face with mentum posterior) [corrected], Previous vertical uterine incision or transfundal uterine surgery, The mother does not wish to have vaginal birth after cesarean delivery, Normal baseline (110 to 160 beats per minute), moderate variability and no variable or late decelerations (accelerations may or may not be present), Anything that is not a category 1 or 3 tracing, Absent variability in the presence of recurrent variable decelerations, recurrent late decelerations or bradycardia, Third stage of labor lasting more than 18 minutes. When about 3 or 4 cm of the head is visible during a contraction in nulliparas (somewhat less in multiparas), the following maneuvers can facilitate delivery and reduce risk of perineal laceration: The clinician, if right-handed, places the left palm over the infants head during a contraction to control and, if necessary, slightly slow progress. There are two main types of delivery: vaginal and cesarean section (C-section). o [ pediatric abdominal pain ] Management of spontaneous vaginal delivery. NSVD (Normal Spontaneous Vaginal Delivery) Back to Obstetrical Services. . The cord should be double-clamped and cut between the clamps, and a plastic cord clip should be applied about 2 to 3 cm distal from the cord insertion on the infant. Vaginal delivery is the most common type of birth. Mayo Clinic Staff. the procedure described in the reproductive system procedures subsection excludes what organ. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Only one code is available for a normal spontaneous vaginal delivery. Bloody show. Ask the mother to change position (to lie on her side), and check the baby's heartbeat again. Extension into the rectal sphincter or rectum is a risk with midline episiotomy, but if recognized promptly, the extension can be repaired successfully and heals well. Remember, its always better to go to the hospital too early and be sent back home than to get to the hospital when your labor is too far along. Bex PJ, Hofmeyr GJ: Perineal management during childbirth and subsequent dyspareunia. The most common episiotomy is a midline incision made from the midpoint of the fourchette directly back toward the rectum. In such cases, an abnormally adherent placenta (placenta accreta Placenta Accreta Placenta accreta is an abnormally adherent placenta, resulting in delayed delivery of the placenta. 6. The link you have selected will take you to a third-party website. In such cases, an abnormally adherent placenta (placenta accreta Placenta Accreta Placenta accreta is an abnormally adherent placenta, resulting in delayed delivery of the placenta. Use for phrases Options include regional, local, and general anesthesia. This frittata is high in protein and rich in essential nutrients your body needs to support a growing baby. Childbirth classes can give you more confidence before it comes time to go into labor and deliver your baby. 5. The trusted provider of medical information since 1899, Last review/revision May 2021 | Modified Sep 2022. For manual removal, the clinician inserts an entire hand into the uterine cavity, separating the placenta from its attachment, then extracts the placenta. The time from delivery of the placenta to 4 hours postpartum has been called the 4th stage of labor; most complications, especially hemorrhage Postpartum Hemorrhage Postpartum hemorrhage is blood loss of > 1000 mL or blood loss accompanied by symptoms or signs of hypovolemia within 24 hours of birth. Episiotomy, An episiotomy is a surgical cut made in the perineum during childbirth. About 35% of women have dyspareunia after episiotomy (7 Delivery of the fetus references Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. Postpartum maternal and neonatal outcomes can be improved through delayed cord clamping, active management to prevent postpartum hemorrhage, careful examination for external anal sphincter injuries, and use of absorbable synthetic suture for second-degree perineal laceration repair. The woman's partner or other support person should be offered the opportunity to accompany her. Infiltration of the perineum with an anesthetic is commonly used, although this method is not as effective as a well-administered pudendal block. Second stage warm perineal compresses have been associated with a reduction in third- and fourth-degree perineal lacerations.28 Studies have not shown benefit to keeping hands on vs. hands off the fetal head and maternal perineum during delivery.29 Although not well studied, shorter pushes as the head is crowning are encouraged by many clinicians in an attempt to decrease perineal lacerations. Another type of episiotomy is a mediolateral incision made from the midpoint of the fourchette at a 45 angle laterally on either side. Consuming turmeric in pregnancy is a debated subject. Thus, the clinician controls the progress of the head to effect a slow, safe delivery. Some read more ). Author disclosure: No relevant financial affiliations. Thus, the clinician controls the progress of the head to effect a slow, safe delivery. Some units use a traditional labor room and separate delivery suite, to which the woman is transferred when delivery is imminent. Tears or extensions into the rectum can usually be prevented by keeping the infants head well flexed until the occipital prominence passes under the symphysis pubis. Emergency medical technicians, medical students, and others with limited maternity care experience may benefit from the AAFP Basic Life Support in Obstetrics course (https://www.aafp.org/blso), which offers a module on normal labor and delivery. Methods include pudendal block, perineal infiltration, and paracervical block. LeFevre ML: Fetal heart rate pattern and postparacervical fetal bradycardia. undergarment, dentures, jewellery and contact lens etc.) If the baby's heartbeat does not come back up within 1 minute, or stays slower than 100 beats a minute for more than a few minutes, the baby may be in trouble. However, traditional associative theories cannot comprehensively explain many findings. Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. False A Which procedure is coded to the Medical and Surgical section? This block anesthetizes the lower vagina, perineum, and posterior vulva; the anterior vulva, innervated by lumbar dermatomes, is not anesthetized. Allow client to take ice chips or hard candies for relief of dry mouth. It is the most common gastrointestinal emergency read more and intraventricular hemorrhage (however, slightly increased risk of needing phototherapy). Labor can be significantly longer in obese women.9 Walking, an upright position, and continuous labor support in the first stage of labor increase the likelihood of spontaneous vaginal delivery and decrease the use of regional anesthesia.10,11. Episiotomy prevents excessive stretching and possible irregular tearing of the perineal tissues, including anterior tears. The cord should be double-clamped and cut between the clamps, and a plastic cord clip should be applied about 2 to 3 cm distal from the cord insertion on the infant. Lumbar epidural injection Analgesia of a local anesthetic is the most commonly used method. Latent labor lasting many hours is normal and is not an indication for cesarean delivery.68 Active labor with more rapid dilation may not occur until 6 cm is achieved. The water might not break until well after labor is established, even right before delivery. Exposure therapy is an effective intervention for anxiety-related problems. Midwives provide emotional and physical support to mothers before, during, and even after childbirth. Local anesthetics and opioids are commonly used. Pudendal block is a safe, simple method for uncomplicated spontaneous vaginal deliveries if women wish to bear down and push or if labor is advanced and there is no time for epidural injection. Youll learn: When labor begins you should try to rest, stay hydrated, eat lightly, and start to gather friends and family members to help you with the birth process. Dresang LT, et al. Compared with interrupted sutures, continuous repair of second-degree perineal lacerations is associated with less analgesia use, less short-term pain, and less need for suture removal.45 Compared with catgut (chromic) sutures, synthetic sutures (polyglactin 910 [Vicryl], polyglycolic acid [Dexon]) are associated with less pain, less analgesia use, and less need for resuturing. The length of the labor process varies from woman to woman. Both procedures have risks. Soon after, a womans water may break. Shiono P, Klebanoff MA, Carey JC: Midline episiotomies: More harm than good? Identical twins are the same in so many ways, but does that include having the same fingerprints? Diagnosis is clinical. With thiopental, induction is rapid and recovery is prompt. After delivery, the cord can be removed from the neck.32 A video of the somersault maneuver is available at https://www.youtube.com/watch?v=WaJ6sZ4nfnQ. This occurs after a pregnant woman goes through labor. Promote walking and upright positions (kneeling, squatting, or standing) for the mother in the first stage of labor. 5. (2015). Please confirm that you are a health care professional. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. After delivery of the head, gentle downward traction should be applied with one gloved hand on each side of the fetal head to facilitate delivery of the shoulders. version of breech presentation successfully converted to cephalic presentation, with normal spontaneous delivery. After delivery, the woman may remain there or be transferred to a postpartum unit. Paracervical block is rarely appropriate for delivery because incidence of fetal bradycardia is > 10% (1 Anesthesia reference Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. A vaginal examination is done to determine position and station of the fetal head; the head is usually the presenting part (see figure Sequence of events in delivery for vertex presentations Sequence of events in delivery for vertex presentations ). Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. It is used mainly for 1st- or early 2nd-trimester abortion. Labor opens, or dilates, her cervix to at least 10 centimeters. Most women with a low transverse uterine incision are candidates for a trial of labor after cesarean delivery and should be counseled accordingly. Placental function is normal, but trophoblastic invasion extends beyond the normal boundary read more ) should be suspected. Copyright 2015 by the American Academy of Family Physicians. Complications of pudendal block include intravascular injection of anesthetics, hematoma, and infection. When the head is delivered, the clinician determines whether the umbilical cord is wrapped around the neck. Allow the client to assume a birthing position of her choice as long as it is not contraindicated. Enter search terms to find related medical topics, multimedia and more. vaginal delivery), within a reasonable time (not less than 3 hours or more than 18 hours), without complications to the mother, or the fetus. A spontaneous vaginal delivery is a vaginal delivery that happens on its own, without requiring doctors to use tools to help pull the baby out. Spinal injection (into the paraspinal subarachnoid space) may be used for cesarean delivery, but it is used less often for vaginal deliveries because it is short-lasting (preventing its use during labor) and has a small risk of spinal headache afterward. Copyright 2023 American Academy of Family Physicians. A local anesthetic can be infiltrated if epidural analgesia is inadequate. Spontaneous vaginal delivery: A vaginal delivery that happens on its own and without labor-inducing drugs. If the placenta is incomplete, the uterine cavity should be explored manually. Clin Exp Obstet Gynecol 14 (2):97100, 1987. Indications for forceps delivery read more is often used for vaginal delivery when. The position of the ears can also be helpful in determining fetal position when a large amount of caput is present and the sutures are difficult to palpate. If anesthesia is local (pudendal block or infiltration of the perineum), forceps or a vacuum extractor is usually not needed unless complications develop; local anesthesia may not interfere with bearing down. Water for injection. Thus, for episiotomy, a midline cut is often preferred. Episiotomy An episiotomy is the. Within an hour, the mother pushes out her placenta, the organ connecting the mother and the baby through the umbilical cord and providing nutrition and oxygen. Please confirm that you are a health care professional. 1. 2008 Aug . Spontaneous vaginal delivery at term has long been considered the preferred outcome for pregnancy. For spontaneous delivery, women must supplement uterine contractions by expulsively bearing down. Paracervical block is rarely appropriate for delivery because incidence of fetal bradycardia is > 10% (1 Anesthesia reference Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. Then, the infant may be taken to the nursery or left with the mother depending on her wishes. Explain the procedure and seek consent according to the . For manual removal, the clinician inserts an entire hand into the uterine cavity, separating the placenta from its attachment, then extracts the placenta. Oxytocin can be given as 10 units IM or as an infusion of 20 units/1000 mL saline at 125 mL/hour. All Rights Reserved. 00 Comments Please sign inor registerto post comments. The woman has a disorder such as a heart disorder and must avoid pushing during the 2nd stage of labor. fThe following criteria should be present to call it normal labor. How do you prepare for a spontaneous vaginal delivery? If the fetus is in the occipitotransverse or occipitoposterior position in the second stage, manual rotation to the occipitoanterior position decreases the likelihood of operative vaginal and cesarean delivery.26 Fetal position can be determined by identifying the sagittal suture with four suture lines by the anterior (larger) fontanelle and three by the posterior fontanelle. Practices that will not improve outcomes and may result in negative outcomes include discontinuation of epidurals late in labor and routine episiotomy. An alternative to delayed clamping in premature infants is umbilical cord milking, which involves pushing blood toward the infant by grasping and squeezing (milking) the cord before it is clamped. Going into labor naturally at 40 weeks of pregnancy is ideal. In the meantime, wear sanitary pads and do pelvic . It is the most common gastrointestinal emergency read more and intraventricular hemorrhage (however, slightly increased risk of needing phototherapy). Treatment depends on etiology read more , which is a leading cause of maternal morbidity and mortality. After delivery, the woman may remain there or be transferred to a postpartum unit. Encounter for full-term uncomplicated delivery. Pudendal block is a safe, simple method for uncomplicated spontaneous vaginal deliveries if women wish to bear down and push or if labor is advanced and there is no time for epidural injection. True B. Wait 1-3 minutes after delivery to clamp cord or until cord stops pulsating. If this procedure is not effective, the umbilical cord is held taut while a hand placed on the abdomen pushes upward (cephalad) on the firm uterus, away from the placenta; traction on the umbilical cord is avoided because it may invert the uterus. If she cannot and if substantial bleeding occurs, the placenta can usually be evacuated (expressed) by placing a hand on the abdomen and exerting firm downward (caudal) pressure on the uterus; this procedure is done only if the uterus feels firm because pressure on a flaccid uterus can cause it to invert Inverted Uterus Inverted uterus is a rare medical emergency in which the corpus turns inside out and protrudes into the vagina or beyond the introitus. After delivery, skin-to-skin contact with the mother is recommended. Obstet Gynecol Surv 38 (6):322338, 1983. Delayed cord clamping, defined as waiting to clamp the umbilical cord for one to three minutes after birth or until cord pulsation has ceased, is associated with benefits in term infants, including higher birth weight, higher hemoglobin concentration, improved iron stores at six months, and improved respiratory transition.35 Benefits are even greater with preterm infants.36 However, delayed cord clamping is associated with an increase in jaundice requiring phototherapy.35 Delayed cord clamping is indicated with all deliveries unless urgent resuscitation is needed. Actively manage the third stage of labor with oxytocin (Pitocin). 7. An arterial pH > 7.15 to 7.20 is considered normal. However, use of episiotomy is decreasing because extension or tearing into the sphincter or rectum is a concern. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. The normal spontaneous vaginal delivery is a fundamental skill in the intrapartum care of women. Some read more , 4 Delivery of the fetus references Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. Use to remove results with certain terms Spinal injection (into the paraspinal subarachnoid space) may be used for cesarean delivery, but it is used less often for vaginal deliveries because it is short-lasting (preventing its use during labor) and has a small risk of spinal headache afterward. Induction is recommended for a term pregnancy if the membranes rupture before labor begins.4 Intrapartum antibiotic prophylaxis is indicated if the patient is positive for group B streptococcus at the 35- to 37-week screening or within five weeks of screening if performed earlier in pregnancy, or if the patient has group B streptococcus bacteriuria in the current pregnancy or had a previous infant with group B streptococcus sepsis.5 If the group B streptococcus status is unknown at the time of labor, the patient should receive prophylaxis if she is less than 37 weeks' gestation, the membranes have been ruptured for 18 hours or more, she has a low-grade fever of at least 100.4F (38C), or an intrapartum nucleic acid amplification test result is positive.5, The first stage of labor begins with regular uterine contractions and ends with complete cervical dilation (10 cm). Some read more ) tend to be more common after forceps delivery than after vacuum extraction. Third- and 4th-degree perineal tears (1 Delivery of the fetus references Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. Its important to stay calm, relaxed, and positive. The doctor will explain the procedure and the possible complications to the mother 2. Some read more ) and anal sphincter injuries (2 Delivery of the fetus references Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) room, so that the woman, support person, and neonate remain in the same room throughout their stay. An arterial pH > 7.15 to 7.20 is considered normal. Every delivery is unique and may differ from mothers to mothers. Diagnosis is clinical. J Obstet Gynaecol Can 26 (8):747761, 2004. https://doi.org/10.1016/S1701-2163(16)30647-8, 2. The technique involves injecting 5 to 10 mL of 1% lidocaine or chloroprocaine (which has a shorter half-life) at the 3 and 9 oclock positions; the analgesic response is short-lasting. Obstet Gynecol 75 (5):765770, 1990. O80 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. These drugs pass through the placenta; thus, during the hour before delivery, such drugs should be given in small doses to avoid toxicity (eg, central nervous system [CNS] depression, bradycardia) in the neonate.

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