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HD 2 > Perinatal neonatal and infant mortality > Flashcards

Perinatal neonatal and infant mortality Flashcards

1
Q

Define miscarriage

A

Pregnancy loss at less than 24 weeks

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2
Q

Define stillbirth

A

Baby born after 24 weeks showing no sign of life

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3
Q

What is a neonatal death

A

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

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4
Q

What is early neonatal death vs late neonatal death

A 
Early= 0-7 days
Late= 7-28 days
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5
Q

What is an infant death

A

Death in the first year of life

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6
Q

What is post neonatal infant death

A

Death 28 days- 1 year

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7
Q

Name some factors which may explain why there are differences in still birth/ neonatal death rates in different countries

A
  • Maternal health
  • Nutrition
  • Access to services
  • Income
  • Family size
  • Birth weight
  • Prematurity
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8
Q

In what ways can prematurity lead to neonatal death

A
  • Surfactant deficiency
  • Periventricular haemorrhage
  • Necrotising enterocolitis
  • Infection
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9
Q

What is the biggest cause of perinatal mortality in England/ Wales

A

Immauturity related conditions

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10
Q

What are the 3 biggest causes of stillbirth

A
  • unexplained
  • asphyxia, anoxia or trauma
  • congenital abnormalities
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11
Q

How are the causes of stillbirth classified

A 
Group a = foetus
Group B= umbilcal cord
Group C= placenta
Group D= amniotic fluid
Group E= uterus
Group F= mother
Group G= intrapartum
Group H= trauma
Group I= unclassified
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12
Q

What can cause stillbirth to be categorised at group A *foetus)

A 
Lethal congenital anomaly
Chronic or acute infection
Non-immune hydrops
Isoimmunisation
Haemorrhage
Twin- twin transfusion
Foetal growth restriction
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13
Q

What is Meckel-Gruber syndrome

A

rare, lethal genetic abnormality
Cystic kidneys, encephalopathy, CNS abnormalities
Autosomal recessive

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14
Q

Name 3 things that can go wrong with the umbilical cord

A
  1. prolapse
  2. constricting loop/ knot
  3. velamentous insertion
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15
Q

Name 3 things that can go wrong with the placenta

A
  1. abruptio
  2. praevia
  3. vasa praevia
  4. other placental insufficiency
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16
Q

Name 3 things that can go wrong with the amniotic fluid

A

1- chorioamnionitis
2- oligohydramnios
3- polyhydramnios

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17
Q

Name 2 things that can go wrong with the uterus

A

1- rupture

2- uterine abnormalities

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18
Q

Name 7 things that can go wrong with the mother

A 
1- diabetes
2- thyroid diseases
3- essential hypertension
4- hypertensive disease in pregnancy
5- lupus
6- cholestasis
7- drug abuse
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19
Q

Name 2 things that can go wrong intrapartum

A

1- asphyxia

2- birth trauma

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20
Q

4 histological signs indicative of intrapartum asphyxia

A

Capillary reduplication/ calcification
Neuronal apoptosis
Gliosis
Macrophages

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21
Q

When does acute mode of death (stillbirth) occur

A

Within hours

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22
Q

What can cause acute stillbirth

A
  • Placental abruption

- Cord accident leading to hypoxia

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23
Q

How does the baby appear in acute stillbirth

A 
Well grown
Absence of maceration
Traces of meconium
Petechiae on serosal services
Liquid blood
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24
Q

How does placenta appear in acute stillbirth

A

Normal foetal: placental ratio

25
Q

What histological changes are seen in the thymus in response to asphyxia

A

‘starry sky’t

26
Q

What histological changes are seen in

a) liver and
b) lungs in asphyxia

A

a) Extramedullary haemopoeisis

b) Squames

27
Q

What changes are seen in the adrenals due to asphyxia

A

Pseudofollicular change

28
Q

How long does chronic mode of death take in terms of stillbirth

A

Days-weeks

29
Q

What can cause chronic death due to stillbirth

A

Maternal disease such as diabetes, hypertension

Placental problems such as MPFD

30
Q

How does the baby appear if the stillbirth had a chronic mode of action

A

Moderate to severe/ advanced maceration

IUGR

31
Q

How does placenta appear in chronic mode of death

A

Placenta is small

Sometimes higher feto: placental ratio

32
Q

Describe the histological changes you would see in the thymus in chronic stress related deaths

A

Severe atrophy

33
Q

What would you see in the ribs if the baby died of a chronic stillbirth

A

Irregular growth plate

34
Q

What would you see in the brain if the baby died of chronic stillbirth

A

Widespread neuronal apoptosis

Gliosis, dystrophic calcification

35
Q

What changes would you see in the placenta if baby died of chronic stillbirth

A

Nucleated RBC

36
Q

Name some major associations with perinatal death

A 
Birthweight
Social class
Maternal origin
Maternal age
Parity
37
Q

What is public healths role in reducing perinatal and infant mortality

A 
Maternal education
Reduced teen pregnancy
Reduce maternal smoking
Access to antenatal care
Promote breastfeeding
Safe sleeping position
Reduce child poverty
38
Q

What does SUDI stand for

A

Sudden unexpected death in infancy (below 1)

39
Q

What happens if an autopsy fails to demonstrate an abnormality in a SUDI

A

The diagnosis is SIDS

40
Q

If the baby is found dead in cot, what may have caused this?

A
  • Congenital heart disease
  • SIDS
  • CNS infection
  • Intoxication
  • Suffocation
  • Septicaemia
41
Q

What would be an obvious cause of instaneous death of infants

A

Accident or trauma

42
Q

What non apparent cause may result in the instantaneous death of an infant

A 
Cardiac malformation
Coronary arteritis or myocarditis
Cardiomyopathy
Arrhythmia
Resp foreign body
43
Q

Why are post-moterms done in SUDI

A
  • Establish if death natural
  • Elucidate cause of death
  • Provide basis for counselling
  • Accurate certification of death for epidemiological and research purposes
44
Q

Define SIDS

A

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 clinical history

45
Q

What campaign have helped reduce SIDS

A

Back to sleep campaign

46
Q

Between what ages is SIDS most common

A

4-20 weeks

47
Q

Which season is SIDS most common in

A

Winter

48
Q

What are some risk factors for SIDS

A
  • Co-sleeping
  • Male
  • Maternal smoking
  • Twins
  • Low birth weight
  • High birth order
  • Young mother
  • Short inter pregnancy cycle
49
Q

What is the critical developmental period of an infants life

A

2-4 months

50
Q

Describe the ‘critical developmental period’ theory that aims to explain SIDS

A

Delayed development of arousal, CR control of CV control and thermal regulation
Laryngeal spasm with GOR
Failure to autoresusciate from apnoea

51
Q

Abnormalities of what network are thought to cause SIDS

A

Serotonergic

52
Q

Altercation of ion channels on what organ may relate to SIDS

A

Heart

53
Q

Give 5 examples of external stressors that may lead to SIDS

A 
Minor URTI
Prone position
Bed sharing
Overheating
Hyperthermia
54
Q

How many a SIDS baby appear externally

A

Usually well developed and nourished
Frothy (blood tinged) fluid around mouth
Cyanosis of lips and nail beds

55
Q

What internal findings may be seen on SIDS baby (7)

A
  • Large thymus
  • Petechiae in pleura
  • Epicardial petechiae
  • Full lung expansion
  • Liquid heart blood
  • Empty bladder
  • Prominent LN and Peyers patches
56
Q

What may be found on the thymus is SIDS autopsy

A

Petechaie- spots made from small broken capillaries

57
Q

What microscopic findings are there in a SIDS baby

A

Pulmonary congestion/ oedema
Mild inflammation of upper resp tract
Focal fibrinoid necrosis of vocal cord
Persistent haemopoiesis in liver

58
Q

What may be seen in the lungs of a SIDS baby

A

Bronchiolitis
Haemorrhage
Oedema

HD 2 (26 decks)

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