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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
What histological changes are seen in the thymus in response to asphyxia
'starry sky't
26
What histological changes are seen in a) liver and b) lungs in asphyxia
a) Extramedullary haemopoeisis | b) Squames
27
What changes are seen in the adrenals due to asphyxia
Pseudofollicular change
28
How long does chronic mode of death take in terms of stillbirth
Days-weeks
29
What can cause chronic death due to stillbirth
Maternal disease such as diabetes, hypertension | Placental problems such as MPFD
30
How does the baby appear if the stillbirth had a chronic mode of action
Moderate to severe/ advanced maceration | IUGR
31
How does placenta appear in chronic mode of death
Placenta is small | Sometimes higher feto: placental ratio
32
Describe the histological changes you would see in the thymus in chronic stress related deaths
Severe atrophy
33
What would you see in the ribs if the baby died of a chronic stillbirth
Irregular growth plate
34
What would you see in the brain if the baby died of chronic stillbirth
Widespread neuronal apoptosis | Gliosis, dystrophic calcification
35
What changes would you see in the placenta if baby died of chronic stillbirth
Nucleated RBC
36
Name some major associations with perinatal death
``` Birthweight Social class Maternal origin Maternal age Parity ```
37
What is public healths role in reducing perinatal and infant mortality
``` Maternal education Reduced teen pregnancy Reduce maternal smoking Access to antenatal care Promote breastfeeding Safe sleeping position Reduce child poverty ```
38
What does SUDI stand for
Sudden unexpected death in infancy (below 1)
39
What happens if an autopsy fails to demonstrate an abnormality in a SUDI
The diagnosis is SIDS
40
If the baby is found dead in cot, what may have caused this?
- Congenital heart disease - SIDS - CNS infection - Intoxication - Suffocation - Septicaemia
41
What would be an obvious cause of instaneous death of infants
Accident or trauma
42
What non apparent cause may result in the instantaneous death of an infant
``` Cardiac malformation Coronary arteritis or myocarditis Cardiomyopathy Arrhythmia Resp foreign body ```
43
Why are post-moterms done in SUDI
- Establish if death natural - Elucidate cause of death - Provide basis for counselling - Accurate certification of death for epidemiological and research purposes
44
Define 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 clinical history
45
What campaign have helped reduce SIDS
Back to sleep campaign
46
Between what ages is SIDS most common
4-20 weeks
47
Which season is SIDS most common in
Winter
48
What are some risk factors for SIDS
- Co-sleeping - Male - Maternal smoking - Twins - Low birth weight - High birth order - Young mother - Short inter pregnancy cycle
49
What is the critical developmental period of an infants life
2-4 months
50
Describe the 'critical developmental period' theory that aims to explain SIDS
Delayed development of arousal, CR control of CV control and thermal regulation Laryngeal spasm with GOR Failure to autoresusciate from apnoea
51
Abnormalities of what network are thought to cause SIDS
Serotonergic
52
Altercation of ion channels on what organ may relate to SIDS
Heart
53
Give 5 examples of external stressors that may lead to SIDS
``` Minor URTI Prone position Bed sharing Overheating Hyperthermia ```
54
How many a SIDS baby appear externally
Usually well developed and nourished Frothy (blood tinged) fluid around mouth Cyanosis of lips and nail beds
55
What internal findings may be seen on SIDS baby (7)
- Large thymus - Petechiae in pleura - Epicardial petechiae - Full lung expansion - Liquid heart blood - Empty bladder - Prominent LN and Peyers patches
56
What may be found on the thymus is SIDS autopsy
Petechaie- spots made from small broken capillaries
57
What microscopic findings are there in a SIDS baby
Pulmonary congestion/ oedema Mild inflammation of upper resp tract Focal fibrinoid necrosis of vocal cord Persistent haemopoiesis in liver
58
What may be seen in the lungs of a SIDS baby
Bronchiolitis Haemorrhage Oedema

HD 2 (26 decks)

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