apgar score lactation menopause Flashcards
Apgar score - use
assessment of newborn vital sign following labor vua a 10 point scale evaluated at 1 minute and 5 minutes
Apgar score is based on
Appearance Pulse Grimace Activity Respiration
Apgar score - score for appearance
pink –> 2
extremities blue –> 1
pale or blue –> 0
Apgar score - score for Pulse
more than 100 –> 2
less than 100 –> 1
no pulse –> 0
Apgar score - score for Grimace
cries and pulls away –> 2
Grimaces or weak cry –> 1
no response to stimulation –> 0
Apgar score - score for Activity
active movement –> 2
arms, legs flexed –> 1
no movement –> 0
Apgar score - score for Respiration
strong cry –> 2
slow irregular –> 1
no breathing –> 0
Apgar score - management/evaluation/meaning
if less than 7 –> further evaluation
if remains low at later time points –> increased risk to develop long-term neurological damage
Low birth weight definition
less than 2500 g
mechanism of low birth weight
preamaturity or intrauterine growth restriction (IUGR)
2 causes of low birth weight
- cocaine
2. smoking
Leading cause of low birth weight in developed countries
smoking
Complications of low birth weight
- high risk of sudden infant death (SIDS)
- impaired thermoregulation
- impaired immune function
- hypoglycemia
- polycythemia
- impaired neurocognitive/emotional development
- infections
- respiratory distress syndrome
- necrotizing enetrocolitis
- intraventricular haemorrhage
- persistent fetal circulation
breast/lactation during pregnancy
- Estrogens + progesterone stimulate growth and development of breasts during pregnancy
- prolactin levels increase during prengncy because estrogen stimulate anterior pituitary
- lactation does not occut because estrogne and progesterone blocks prolactin’s action on the breast
lactation after the labor
the low levels of pregnancy and estrogen disinhibit lactation
hormones of lactation - regulation of production and action
suckling is required to maintain milk production, since high nerve stimulation –> increased oxytokin+prolactin:
a. prolactin –> induce+maintains lactation and decreases reproductive function
b. oxytokin –> assists milk letdown (also uterine contraction)
prolactin inhibits reproductive function via
inhibition of GnRH
breast milk is the ideal nutrition for infants …(age)
younger than 6 months
breast milk contains
- maternal immunoglobulins conferring passive immunity, mostly IgA)
- macrophages
- lymphocytes
breast milk effects on infants
- reduce infant infections
2. associated with low risk for child develop 3. asthma, 4. allergies, 5. DM, 6. obesity
Exclusively breastfed infants require ….
vitamin D supplementation
breastfeeding effects on mother
- decreases maternal risk of breast and ovarian cancer
2. facilitates mother-child bonding
Menopause is diagnosed by (clinically)
amenorrhea for 12 months
amenorrhea
an abnormal absence of menstruation.
average age of menopause
51 (earlier in smokers)
menopause associated hirsutism - mechanism
decreased estrogen production due to age-linked decline in number of ovarian follicles
menopause usually preceded by
4-5 years of abnormal menstrual cycles
source of estrogen after menopause
peripheral conversion of androgens –> estrone
menopause - mechanism
Ovarian estrogen secretion declines rapidly, whereas ovarian androgen production continues for a few years after menopause. Androgen production after menopause is gonadotropin dependent and, when excessive, can lead to hirsutism
hormonal changes in menopause
- low estrogen
- high LH (no surge)
- VERY high FSH
- high GNRH
- high androgens
specific lab finding for menopause (and mechanism)
very high FSH (loss of negative feedback on FSH due to low estrogen)
menopause - presentation
- hot flashes 2. atrophy of vagina 3. Osteoporosis
- Coronary artery disease 5. Sleep disturbances
- Hirsuitism
Menopause before 40 suggests
1ry ovarian insuficiency (premature ovarian failure)
