CBL 10_TOLAC and Unwell newborn Flashcards
What should sugars be above?
2.6
Low sugars, what should you do?
Top up, check again, still low NICU
What sugars automatically go to the NICU?
1.8 or less
What Is CPT1A?
A gene found on chromosome 11 (1)
Provides instructions to make an enzyme called carnitine palmitoyl transferase 1A (1)
Found in the liver (1)
Helps break down fats and turn them into energy (1)
Connects carnitine to a long fatty acid chain which allows it to cross the membrane of the mitochondria (1)
When the fatty acids are in the mitochondria they are metabolized to produce energy for the liver and other tissues (1)
Incidence of CPT1A deficiency?
Rare 1/100,000
Risk of rupture w/ 1 previous low trans c/s?
.47 %
Risk of uterine rupture and risk of adverse outcomes from uterine rupture?
UR 1/200
Adverse risk UR 1/2000
What can variable, late decels or bradycardia indicate in TOLAC?
Most common indication of UR
Often present 30-60 mins before rupture
Risk of rupture for ALL people with previous c/s?
.3 %
What increases the chance of uterine rupture? (5)
- IOL with prostaglandins
- Oxytocin IOL
- 2 or more CS
- <18 mo bw deliveries
- Classical incision
Which TOLACs have the LOWEST risk?
Those w previous vaginal deliveries
Contraindications for TOLAC? (5)
Previous or suspected classical CS
Previous inverted T or low vertical uterine incision
Previous uterine rupture
Previous major uterine reconstruction
Client requests ERCS
Factors that decrease likelihood of TOLAC success? (8)
- 35 years or older
- BMI >30
- Preeclampsia
- Previous CS for dystocia
- Need of IOL that requires cervical ripening
- Need of augment of labour
- BW > 4000 g
- GA >40 wks
Factors that improve chance of VBAC? (8)
- 30 or younger
- BMI less than equal 30
- White :(
- Prev vag birth
- Dystocia not indication for prev c/s
- Spontanous labour
- Bishop score 6 or more on admission
- BW <4000 g
Ideal time between births for TOLAC?
> equal 18 mo
Strong contraindication to TOLAC?
Classical scar
Why is EFM recommended for TOLAC?
Changes in FHR key indicator of uterine rupture
What do you have to add to the NMS to add CPT1A?
ACYLCARNITINE PROFILE
What are the two first steps in the management of a well infant who can feed and is a risk of hypoglycaemia?
feed as early as possible; glucose test at 2 hours of age.
Incidence of CPT1A variant in Frist Nations/Inuit?
Inuit/First Nation along BC coast/Vancouver island 1/5
Inuit/First Nation Interior 1/25
Can result in hypoglycaemia, so support regular feeding!
Signs of hypoglycemia ? (12)
- Intermittent Tachypnea
- Episodes cyanosis
- Cardiac failure
- Sudden pallor
- Limp
- Lethargic
- Jittery/tremors
- Seizure like movements
- Difficulty feeding
- Weak/high pitched cry
- Sweating
- Hypothermia
Rate of successful VBAC?
70-75 %
Greatest maternal risk TOLAC?
TOLAC that ends up needing emergency C/S
Risk factors for hypoglocemia? (5)
- SGA/LGA
- IUGR
- Diabetic birther
- Preterm
- Required resus
What are DDX for resp distress in newborn? (7)
- TTN - ransient tachypnea of the newborn
- PPHTN - Persistent pulmonary hypertension of the newborn
- Hypoglycemia
- Infection
- RDS -respiratory distress syndrome
- MAS - Meconium aspiration syndrome
- Pneumothorax
What is TTN?
Transient tachypnea of the newborn
What is PPHTN?
Persistent pulmonary hypertension of nb
Caused by post-birth vascular resistance in the fetal lungs that remains high.(1,5) The left-to-right fetal shunts remain, instead of transitioning to the normal newborn circulation.(1) This results in impaired blood flow to the lungs.(
What is RDS?
Respiratory Distress Syndrome
- Most common cause of neonatal respiratory distress (3)
- Breathing disorder primarily affecting preterm infants since their lungs are not yet mature enough to produce sufficient surfactant (1,3)
- Secondary to surfactant deficiency. Without adequate surfactant to lower surface tension on the lungs, the alveoli collapse, hindering the baby’s ability to breathe (1,3)
What is MAS
Meconium Aspiration Syndrome
Occurs when a baby inhales meconium mixed with amniotic fluid into their lungs before, during, or immediately after birth (1,3)
What is pneumothorax?
Occurs when air leaks from the lung into the pleural space, the area between the lung and the chest wall. This air pocket can compress the lung, leading to varying degrees of respiratory distress (1,3)
What is CTP1A deficiency?
Rare genetic disorder causing DNA mutations in the CPT1A gene (2)
Unable to make the carnitine palmitoyl transferase 1A enzyme (2)
Autosomal recessive condition (needs to be inherited from both parents) (2)
