Perinatal and Childhood Mortality Flashcards by Emilia McColm

Define miscarriage.

Pregnancy loss < 24 weeks

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Define stillbirth and stillbirth rates.

Baby born >24/40 showing no signs of life

Number of stillbirths for each 1000 TOTAL births.

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Define neonatal death.

Baby born alive but dies in the first 28 days of life

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Define early neonatal death.

Death 0-7 completed days

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Define late neonatal death and neonatal mortality rate .

Death 7-28 days

Number of neonatal deaths (early and late) for each 1000 LIVE births.

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Define infant death and infant mortality rate.

All deaths in the first year of life

Number of infant deaths for each 1000 LIVE births.

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Define post-neonatal infant death.

Deaths 28 days-1 year

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Define perinatal mortality rate.

Number of stillbirths and early neonatal deaths per 1000 TOTAL births.

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What factors explain the international differences in these mortality rates? (7)

Maternal health
Nutrition
Access to services
Income
Family size
Birthweight
Prematurity

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What major diseases contribute to current perinatal and neonatal mortality in the UK? (6)

Prematurity 
Congenital abnormalities
Asphyxia
Infections
‘Unexplained’ stillbirth
Sudden infant death

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Why is prematurity a significant cause of mortality (i.e. what are the complications)? (4)

Surfactant deficiency
Periventricular haemorrhage
Necrotising enterocolitis
Infection

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What % of perinatal mortality is caused by immaturity related conditions?

58.5%

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What % of perinatal mortality is caused by congenital anomalies?

26.1%

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What % of perinatal mortality is caused by antepartum infections and infections?

1.9% and 0.9%

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What % of perinatal mortality is caused by asphyxia, anoxia or trauma?

10.2%

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What affects stillbirth? (3)

Maternal health
Access to maternity care
Uteroplacental function

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What affects early neonatal death? (4)

Uteroplacental function
Perinatal infection
Neonatal resuscitation
Effective neonatal care

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What affects late neonatal death? (2)

Effective neonatal care

Postnatal infection

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What affects postneonatal infant death? (2)

Postnatal infection

SIDS

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What affects IMR? (3)

Early and late neonatal death and postneonatal infant death

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What affects NNMR? (2)

Early and late neonatal death

What affects PNMR? (2)

Stillbirth and early neonatal death

Before October 1992, babies born dead before how many weeks were recorded as miscarriages? What is it now?

<28 weeks

<24 weeks

List some causes of stillbirth. (6)

Congenital anomaly
Infection
Death from intrapartum causes
Preeclampsia
Antepartum haemorrhage
Unexplained antepartum foetal death (most common)

List the foetal causes of stillbirth. (7)

``` Congenital anomaly Infection Non-immune hydrops Isoimmunisation Feto-maternal haemorrhage Twin-twin transfusion Fetal growth restriction ```

List the causes of stillbirth due to the umbilical cord. (3)

1. Prolapse 2. Constricting loop or knot 3. Velamentous insertion

List the placental causes of stillbirth. (4)

Abruptio Praevia Vasa praevia Placental insufficiency

List the causes of stillbirth due to amniotic fluid. (3)

Chorioamnionitis Oligohydramnios Polyhydramnios

List the causes of stillbirth due to the uterus. (2)

Rupture | Uterine anomalies

List the maternal causes of stillbirth. (7)

``` Diabetes Thyroid diseases Essential hypertension Hypertensive diseases in pregnancy Lupus or antiphospholipid syndrome Cholestasis Drug misuse ```

List the intrapartum causes of stillbirth. (2)

Asphyxia | Birth trauma

Acute mode of death occurs within hours. What are teh causes?

``` Placental abruption Cord accidents (causing acute hypoxia) ```

Acute mode of death - how does the baby present?

Well grown, absence of maceration Traces of meconium Petechiae on serosal surfaces

Chronic mode of death occurs days to several weeks after the cause. What are the causes?

``` Maternal disease (e.g. diabetes, hypertension) Placental problems ``` Placenta small normal or  feto: placental ratio

Chronic mode of death - how does the baby present?

Moderate to severe maceration | IUGR

Chronic mode of death - describe the placenta.

Small | Normal or increased feto-placental ratio

What is the greatest cause of neonatal mortality?

Immaturity related conditions

What is the greatest cause of post-neonatal infant mortality?

Congenital anomalies

List the measures that contribute to perinatal mortality. (8)

``` Specific diseases & conditions Birthweight & Gestation Uteroplacental dysfunction Country of birth Mother’s country of birth Social class Maternal age & parity Access to healthcare ```

What is SUDI?

Sudden unexpected death in infancy (i.e. an unexpected death in a child under 1 year of age). If no abnormality is found on autopsy = SIDS (sudden infant death syndrome).

What types of sudden unexplained death are there?

Baby is found dead in the cot/bed Baby dies in parents/carers arms Rapid death due to a recognised illness (e.g. infection, CNS haemorrhage, congenital adrenal hyperplasia)

What are the causes for a baby being found dead in the cot/bed? (8)

``` Congenital heart disease Respiratory infections CNS infections Septicaemia Intoxication Seizure disorders Unexplained (SIDS) Suffocation and non-accidental injury ```

What is the current definition of SIDS?

The sudden unexpected death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene and review of the clinical history.

What is the triple risk hypothesis for SIDS?

``` Vulnerable infant (physiologic responses) Exogenous stressor (environment) Critical developmental period (age) ```

Give some examples of 'exogenous stressors'. (5)

``` Minor URTI Prone position Bed-sharing Overheating Hyperthermia ```

What infants are 'vulnerable' for SIDS? (4)

Males (60%) Abnormality of the serotoninergic network Slower responses to changes Alterations in heart ion channels

What are the risk factors for SIDS? (9)

``` Social class IV or V Unmarried mother Young mother High parity High birth order Short interpregnancy interval City dweller Co-sleeping Male baby ```

What are the typical external findings with SIDS? (3)

Body well-developed and well-nourished Frothy fluid around nose (often blood-tinged) Cyanosis of lips and nail-beds

What are the typical internal findings with SIDS? (6)

``` “Large” thymus with petechiae Petechiae in pleura Epicardial petechiae Full expansion of lungs Empty bladder Prominent LN & Peyer’s patches ```

What are the typical microscopic findings with SIDS? (4)

Pulmonary congestion and oedema Mild inflammation of upper respiratory tract Focal fibrinoid necrosis of vocal cords Persistent haemopoiesis in the liver