perinatal medicine Flashcards
What is perinatal mortality rate=?
stillbirth + death within the first week per 1000 births
What is neonatal mortality rate?
deaths of live born infant within 4 weeks after birth per 1000 births
What is a neonate?
Child <28 days old
What is low birth weight?
<2500
What is very low birth weight?
<1500
What is extremely low birth weight?
<1000
What is small for gestational age?
birthweight <10th centile for gestational age
What is large for gestational age?
birthweight >90th centile for gestational age
What are symptoms of foetal hyperthyropidism?
foetal tachy on CTG trace
foetal goitre on USS
What does anti phospholipid syndrome cause?
recurrent miscarriage IUGR PET placental abruption preterm delivery
Why does maternal Graves affect the foetus?
Because the thyroid stimulating antibodies cross the placenta
They stimulate the foetal thyroid
What are symptoms of foetal alcohol syndrome?
Saddle shaped nose
Maxillary hyperplasia
absent philtrum
short upper lip
growth restriction
developmental delay
cardiac defect
What can an epidural cause to the mother during labour?
it can cause a fever
What do vitamin A/retinoids cause on the foetus?
increased spontaneous abortion
abnormal face
What does warfarin cause on the foetus?
interferes with cartilage formation (nasal hypoplasia)
cerebral haemorrhage
microcephaly
What are the risks to the foetus with drug abuse?
prematurity
growth restriction
drug withdrawal
cocaine: placental abruption, preterm delibery, cerebral infarction
IVDU: increased risk of contracting Hep B, C, HIBV
What is the effect of rubella on the newborn?
TRIAD:
- cataracts
- deafness
- congenital heart disease
How does the effect of rubella on the foetus change based on gestation time?
infection < 8 wks : cataracts, deafness, heart disease in 80%
13-16 weeks: impaired hearing in 30%
>20 weeks: no consequence
How do you manage rubella infection in pregnancy?
Notify health protection unity
Test for Parvovirus 19
NO TREATMENT - advise rest and paracetamol for sx relief
Advise to avoid contact with pregnant women for 6 days since rash onset
Refer urgently to obstetrics for risk assessment and counselling
What is the most common congenital infection ?
CMV
What occurs to each proportion of foetuses affected with CMV, and how?
90% are fine
5% have clinical features at birth (hepatosplenomeg, petechiae), neurodevelopmental disabilityes
5% develop problems in later life (sensorineural hearing loss)
What is screenign and vaccination like for CMV?
NONE
What is management of newborns with CMV?
IV ganciclovir
or IV vanganciclovir
How do mothers get infected with toxoplasma?
COntact with faeces from infected cat
OR
undercooked meat
What clinical features will a foetus develop from toxoplasma?
retinopathy
cerebral calcification
hydrocephalus
> > long term neuro disabilities
What is mx of newborns with toxo?
pyrimethamine + sulfadiazine + calcium folinate
When is risk of VZV passing from mother to foetus highest?
Around labout (five days pre to 2 days post)
How do you manage VZV in newborn?
VZIG to mother if within 10 days from exposure
acyclovir tx
How do you manage a mother with syphilis
ensure complete treatment 1 month prior to delivery
if in doubt treat foetus with penicillin
What is asphyxia?
lack of oxygen to foetus during labour / delivery
can cause brain injury / death
What is primary apnoea?
Once the foetus is deprived of oxygen in utero, it will attempt to breathe
This is unsuccessful as still in utero
Heart rate is maintained
What is secondary apnoea?
The period that follows primary apnoea and irregular gasping
HR and BP drop
What does a foetus delivered in secondary apnoea need help with?
lung expansion > positive pressure ventilation / tracheal tube
What are causes of continous apnoea?
Placental abruption, cord prolapse
Is asphyxia in utero common?
yes, during labour and delivery
but it is intermittent, due to frequent uterine contractions
What is the Apgar score used for?
To describe baby’s condition at 1 and 5 minutes after delivery
or every 5 minutes if condition is poor
What ate the 5 components of the apgar score’
HR Resp effort muscle tone reflex irritability colour
What numbering is the apgar score out of
0-2 for each section
What are patterns of growth restriction?
Asymmetrical
or
symmetrical
what are causes for LGA baby?
gestational diabetes
congenital (beckwith Wiedeman syndrome)
physiologically large
What are consequences for the baby of being LGA?
Birth asphyxia Breathing difficulty from an enlarged tongue Birth trauma (shoulder dystocia) Hypoglycaemia (due to hyperinsulinism) Polycythaemia
When is the routine examination of newborn performed?
24h after birth
What is a post-wine stain (naevus flammus)?
vascualr malformation of capillaries in the dermis
What is a strawberry naevus?
a CAVERNOSUS HAEMANGIOMA appears in 1st month of life (not at birth) may be mutliple gradually regresses no treatment
Why must midline abnormalty over spine e.g. hair tuft be checked?
may indicate abnormality of CNS
What is DDH?
Developmental dysplasia of the hip
Abnormality of hip joint where acetabulum does not fully cover the femoral head
This results in risk of hip dislocation
What are RF for DDH?
girls
breech
What are two tests for DDH?
Barlow maneuvre (dislocate hip posteriorly) Ortolani maneuvre (relocate dislocated hip back into acetabulum)
How do you manage DDH?
splint with Pavlik harness
What does Vit K deficiency cause?
haemorrhagic disease of the newborn
What is haemorrhagic disease of the newbortn?
In most infants, mild bleeding (bruising, haematemesis, melaena)
In some: intracranial haemorrhage
What are RF for haemorrhagic disease of newborn?
breast feeding (poor source of vit K compared to formula)
Anticonvulsants (impair vit K synthesis)
How must you administer sufficient vitamin K to foetus?
Give IM vit K at birth
Overall 3 doses in first 4 qeeks of life
What does Guthrie test screen for?
Phenylketonuria Hypothyroidism Sickle cell and thalassaemia Cystic fibrosis MCAD deficiency
What is the maternal mortality rate?
death in pregnancy + labour + 6 weeks postnatal
How do you rate an apgar score
0-3 very low
4-6 moderately low
7-10 good
What do mongolian blue spots look like
blue / black macular discoloration at the base of the spine and on the buttocks
Commonly in afrocaribbean / asian babies
How do you manage mongolian blue spots
None
Fade slowly over first few yeara
What are milia?
White pimples on nose and cheeks from retention of keratin and sebaceous material
What is an umbilical hernia epidemiology?
Common in children, likely found on newborn exam
Should close by the age of 5
HOw does an umbilical hernia occur
due to weakness of the umbilical ring
The umbilical ring allows passage of vessels through abdo wall muscle between the mother and the foetus
After birth, the ring remains, with spontaneous closure at 5 years old
How does an umbilical hernia present
Reducible, painless bulge at umbilicus
Prominent on strain
How do you manage infant with umbilical hernia
if <3 years old and healthy: no tx required, should resolve, safety net parents
If >3 yo: refer to surgeon for elective repair
** do not attempt to tape things over it to close the hernia
What is failure to thrive?
Weight below 5th centile on multiple occasions OR weight decelaration across 2 major percentile lines
What is oesophageal atresia?
congenital defect in which upper oesophagus ends blindly and is not connected to the lower oesophagus
Why does oesophageal atresia occur
due to abnormal debeòlopment of the tracheoesophageal septum
How do you classify oesophageal atresia
Gross Classification (A-E)
What is the most common type of oesophageal atrasia
Type C - oesophageal atresia with fistula which connects to trachea distally
How does oesophageal atresia present
Cyanotic attack
Foaming at mouth
Cough
Depending on type- aspiration pneumonia, gastric distension
How do you investigate oesophageal atresia
Feeding tube cannot pass
X ray
What do you see on x ray of oesophageal atresia
air filled pouch at T3
How does oesophageal atresia present in utero
POLYHYDRAMNIOS
How do you manage oesophageal atresia
Do NOT feed orally
Suction tube in oesophagus
Antibiotics if aspirating
SURGERY WITHIN 24h
What other things must you be aware of in baby with oesopahgeal atrasia
Likelyhood of other congenital malformations VACTERL
What does VACTERL stand for
Vertebral, Anorectal, Cardiac, Trachea-Oesophageal, Renal, Radial LImb
When will small bowel obstruction vomiting NOT be bile stained
When obstruction is BEFORE ampulla of vater
What are causes of small bowel obstruction
Duodenal / Jejunal / Ileum - atresia / stenosis (Down’s)
Malrotation with volvulus
Meconium ileus
Meconium plug
What is meconium ileus
thick insippated meconium
becomes impacted on lower ileum
What is the single biggest RF for meconium ileus
CF
What is meconium plyg
COngealed meconium causing lower intestinal obstruction
How do you manage meconium plug
passes spontaneously
How do you manage a meconium ileus
Dislodge Using Gastrograffin contrast medium
What are two key causes to laarge bowel obstruction in neonates
Hirschprung / Rectal atresi
What is another name for exomphalos
omphalocele
What is exomphalos
Abdominal contents protrude through umbilical ring
Coevred. by transparent sac (amniotic membrane + peritoneum)
What is exomphalos associarted with
Major congenital abnormalities
e.g. Down, Beckwith Wiederman
How do you manage exomphalos
ECS + staged repair
What is gastroschisis
Bowel protrudes through defect in anterior abdominal w all
NO covering sac
What is gastroscisis associated with
NOTHING
No association with congenital abnormalities
WHat is the risk in gastroscisis
dehydration.
protein loss q
How do you manage gastroscisis
vaginal delivery
immediate repair
