Obs

Question 1

outline the purpose of the Newborn assessment (NIPE)

Answer 1

To screen for congenital abnormalities that will benefit from early intervention
To make referrals for further tests or treatment as appropriate
To provide reassurance to the parents

Question 2

Outline a NIPE exam:

Answer 2

General Inspection: Pallor/Cyanosis/Jaundice/Posture
Tone: Hypotonia
Head: Measure head circumference and record. Shape of the head, inspect sutures. Inspect fontanelles
Skin: Colour, Bruising/lacerations/vernix

Face: Dysmorphic features, asymmetry, trauma, nose
Eyes: Erythema, discharge, sclera, position & shape of eyes, red reflex

Ears: Inspect pinna, asymmetry, skin tags, accessory auricles

Mouth + Palate: Clefts in hard or soft palate, inspect tongue and gums

Neck and clavicles: Length of neck, neck lumps

Upper limbs: symmetry, fingers (count), palms, pulses

Chest: RR, work of breathing, RR, inspect chest. Auscultate both sides to compare for sounds. Listen to heart with bell and diaphragm. Pulse oximetry

Abdomen: Distension, umbilicus, hernias, palpation for organs

Genitalia: note any ambiguity. Males: position of urethral meatus, testicular swelling. Females: inspect labia, clitoris, vaginal discharge

Lower Limbs: Symmetry, oedema, ankle deformities, count digits. assess tone and movement in joints. pulses

Hips: Barlow’s and Ortolani’s tests for hip joint instability

Back/Spine: inspect for scoliosis, hair tufts, birth marks, sacral pits

Anus: patency. meconium should be passed within 24hrs

Reflexes: Palmar grasp, sucking, rooting, stepping, moro - MRS SP

Question 3

What is an ectopic pregnancy? where are the most common sites?

Answer 3

When a fertilised ovum is implanted outside of the uterus.

Most common sites = fallopian tube, most in ampulla. More danger in isthmus.

Question 4

Risk factors for ectopic pregnancy

Answer 4

• Previous ectopic pregnancy
• Pelvic inflammatory disease
• Prev surgery to fallopian tubes
• Endometriosis
• IUDs
• Older age
• Smoking

Question 5

Presentation of an ectopic pregnancy

Ultrasound Findings:

Answer 5

• typically around 6-8wks gestation
• amenorrhoea, lower abdo pain (IF) + some bleeding (may be dark), cervical motion tenderness

On Ultrasound:

• gestational sac containing a yolk sac or foetal pole may be seen in a fallopian tube.
• non-specific mass in tube
• mass representing a tubal ectopic pregnancy moves separately to the ovary, may look similar to a corpus luteum but CL will move with the ovary.

Question 6

Management of an ectopic pregnancy

Answer 6

3 ways to manage: Expectant, medical, surgical

Expectant: <35mm, unruptured, asymptomatic, no fetal HB, hCG <1,000IU/L
Involves closely monitoring pt over 48hrs and if b-hCG levels rise or symptoms manifest –> Intervention

Surgical: >35mm, can be ruptured, pain, visible fetal HB, hCG >5,000IU/L, Mx can involve salpingectmoy or salpingotomy.

Medical: <35mm, unruptured, no significant pain, no fetal HB, hCG <1,500IU/L, Mx involves methotrexate, only done if pt is willing to attend follow up.