40. Perinatal and Childhood Mortality Flashcards
Define the following deaths: miscarriage, stillbirth, perinatal, neonatal (early and late) and infant.
What are some modifiable factors contributing to deaths?
What are the historical trends in mortality rates and why?
What are the international differences and why?
Miscarriage: pregnancy loss <24w. Stillbirth: born >24/40 showing no life signs. Neonatal: born alive but dies in first 28d of life. P_erinatal:_ stillbirth or early neonatal (death 0-7d). Late neonatal: death 7-28d. Infant: death in 1yr.
Maternal health, access to maternity care, uteroplacental function, perinatal infection, neonatual resuscitation, effective neonatal care, postnatal infection, SIDS. These diff factors affect diff periods, can can thus affect SBR/PNMR/NNMR/IMR diff.
Decline, due to improvment in hygiene so communicable diseases reduced, then due to neonatal units and intensive care for sick, LBW and premature babies. Recent trend = steady very slow decline.
Majority of stillbirth comes from relatively underdeveloped countries e.g. Africa and Asia. Due to differences in maternal health, nutrition, services, income, family size, birthweight, prematurity. Need to make sure definitions are equivalent when comparing international data.
What are the 2 major diseases contributing to perinatal and neonatal mortality in the UK?
What is the main cause of stillbirth?
What is the A-I classification system according to relevant condition at death (ReCoDe)?
Prematurity (surfactant deficiency, periventricular haemorrhage, necrotising enterocolitis, infection) and congenital abnormalities (congenital heart disease, chromosomal, neural tube, diaphragmatic hernia). Also less so: asphyxia, infections (congenital, intrapartum, acquired), unexpained, SIDS.
Unexplained. Followed by congenital abnormality and antepartum haemorrhage.
Makes % of unexplained deaths smaller. Groups: A = foetus, B = umbilical cord, C = placenta, D = amniotic fluid, E = uterus, F = mother, G = intrapartum, H = trauma, I = unclassified.
What group A (foetal) conditions could result in death?
What group B (umbilical cord) conditions could result in death?
Congenital anomaly, infection (chronic e.g. CMV or acute), non-immune hydrops (excessive accumulation of fetal fluid within extravascular compartments and body cavities), isoimmunisation (Rh), fetal-maternal haemorrhage (loss of fetal blood cells into the maternal circulation), twin to twin transfusion, IUGR (<10th customised weight for gestational age centile).
Prolapse (baby gets asphyxiated), constricting loop/knot, velamentous insertion (umbilical cord inserts into the fetal membranes (choriamniotic membranes), then travels within the membranes to the placenta, rather than inserting into placenta. Exposed vessels are not protected by Wharton’s jelly and are vulnerable to rupture).
What is this condition?
Meckel-Gruber syndrome (autosomal recessive) at 42w. Characterised by triad of occipital encephalocele, large polycystic kidneys, and postaxial polydactyly
What group C (placenta) conditions could result in death?
What group D (amniotic fluid) conditions could result in death?
What group E (uterus) conditions could result in death?
Abruption, praevia, vasa praevia (babies’ blood vessels cross or run near the internal opening of the uterus).
Chorioamnionitis, oligohydramnios (fluid presence important for lung development to if this is lacking = hypolastic lung -> respiratory failure), polyhydramnios (develops if foetus can’t swallow amniotic fluid - marker for abnormalities).
Rupture (sudden asphyxia), uterine anomalies.
What are these 2 conditions?
L: hypercoiling. R: stricture in cord. Both compromis blood flow to foetus. Group B.
What is this condition?
Placental abruption. Group C.
What are these 2 conditions? (L is chorion/amnion and R is the umbilical cord).
L: acute chorioamnionitis: membranes inflamed, lots of inflammatory cells present. R: funisitis: cord vessels inflamed, clot within cord vessels -> hypoxic insult to foetus.
What group F (mother) conditions could result in death?
What group G (intrapartum) conditions could result in death?
What group H (trauma) conditions could result in death?
What group I (unclassified) conditions could result in death?
Diabetes, thyroid diseases, essential hypertension, hypertensive diseases in pregnancy, lupus/antiphospholipid syndrome, cholestasis, drug misuse.
Asphyxia, birth trauma.
External, iatrogenic.
No relevent condition identified, no information available.
What condition does this baby have and what could have caused it?
Macrosomia and all visceral organs quite big, maternal diabetes/gestational diabetes.
What is stillbirth with an acute mode of death (causes, baby and placenta state)?
What is stillbirth with a chronic mode of death (causes, baby and placenta state)?
What are the 2 top causes of neonatal mortality?
Occurs within hours. Causes: placental abruption, cord accidents -> acute hypoxia. Baby: well grown, absence of maceration <12h, traces of meconium, petechiae on serosal surfaces, liquid blood. Placenta: normal feto:placental ratio, findings depend on cause.
Days to several weeks. Causes: maternal disease: DM, hypertension, placental problems: massive perivillus fibrin deposition -> chronic intrauterine hypoxia. Baby: moderate-severe/advanced maceration, IRGR (symmetric/asymmetric). Placenta: small, normal or increased feto:placental ratio.
Immaturity related conditions (55%), congenital anomalies (28.8%). CA becomes top of postneonatal (after 1m) infant mortality.
What are some major associations with perinatal death?
What measures contribute to perinatal mortality?
Low birthweight, social class, maternal origin (ethnicity and environment), maternal age (higher if 40 or over) and parity.
Specific diseases/conditions, birth weight and gestation, utero-placental dysfunction, country of birth/mum’s COB, social class, maternal age and parity, healthcare access. Need to reduce perinatal and infant mortality by a partnership between maternity services, neonatology, public health and government.
