Perinatal Pathology Flashcards
what are markers of population health
- Maternal wellbeing during pregnancy
- Conditions into which babies are born
what are markers of healthcare effectiveness
- Maternity services
- Neonatal care
what is miscarriage
- Pregnancy loss less than 24 weeks
what is a still birth
- Baby born greater than 24 weeks with no signs of loss
what is a neonatal death and what is the difference between early and late neonatal death
- Baby born live but dies in the frist 28 days of life
- Early neonatal – 0-7 days
- Late – 7-28 days
what is infant death
- Death in the first year of life
How do you measure still births
- Number of still births per 1000 total births (live and still births)
how do you measure the perinatal mortality rate
number of stillbirths and early neonatal deaths per 1000 total births
how do you measure the neonatal mortality rate
number of neonatal deaths (early and late) for each 1000 live births
How do you measure the infant mortality rate
number of infant deaths for each 1000 live births
what are the international factors that contribute to differences in death of babies
Maternal health Nutrition Access to services Income Family size Birthweight Prematurity
List what can cause neonatal and perinatal mortality
- prematurity
- congenital abnormalities
Immediately after delivery
- asphyxia
- infections
- unexplained still brith
describe how prematurity can lead to neonatal death and perinatal mortality
- Surfactant deficiency
- Periventricular haemorrhage
- Infection
- Necrotising enterocolitis
what can you give to treat surfactant deficiency
antenatal corticosteroids
What can you give to treat periventricular haemorrhage
antenatal corticosteroids in order to reduce the chance of a periventricular haemorrhage
when are the luges developed enough for oxygen breathing
37 weeks
list some congenital abnormalities that can occur
- Heart disease
- Neural tube defects
- Chromosomal abnormalities
- Usually detected antenatally – usually terminated babies that are not going to survive to adulthood
when can you develop infections and when can this lead to perinatal death
- Congential
- Acquired
- Intrapartum
what is an unexplained still birth likely due to
- cord accidents
- likely placenta dysfunction
what are the most causes of perinatal mortality
- Preterm associated problems
- Intrapartum related events
- Sepsis and pneumonia
when is sudden infant death most common
- More common in the infant period and not the neonatal death
what are the causes of still birth
- Unexplained
- Umbilical cord complications
- Infection - not common in the UK
- Placental abruption
- Placental insufficiency
what are the foetal causes of still birth
- lethal congenital anomaly
- infection acute v chronic
- non-immune hydrozoan
- immunisation
- foetal/maternal haemorrhage
- twin to twin transfusion
- foetal growth restriction - probably attributed to the placenta not supplying baby with enough oxygen
what is non-immune hydrozoan
- this is when there is a material mismatch due to rhesus D
- anti D can build an antibody response to the baby and attack the baby
what type of genetic condition is mocked Gruber syndrome
autosomal recessive
What is mocked-gruber syndrome
Meckel-Gruber syndrome is a rare and lethal autosomal recessive disorder characterized by occipital encephalocele, postaxial polydactyly and bilateral dysplastic cystic kidneys
What can also cause still brith
- congenial acquired penumbra
- CMV
name some still brith causes
- umbilical cord
- placental causes
- amniotic fluid
- uterus
what are umbilical causes of death
- Prolapse – gets cold and then no longer supplies the baby
- Loop or knot – restriction of oxygen and blood supply to the baby
- Velamentous insertion - inserted on the periphery of the placenta, when the waters break the cord tears of from the placetna and this stops the babies blood supply
What is. velamentous insertion
inserted on the periphery of the placenta, when the waters break the cord tears of from the placetna and this stops the babies blood supply
What are placental causes still birth of death
- Abruption
- Praevia – placenta covering the neck of the womb, placetna will bleed out if contractions where this takes place
- Placental insufficiency
what are amniotic fluid causes of still birth death
- Chorioamnionitis - infction usually from the maternal gential tracts and infects the water around the baby
- Oligohydramnios – too little, cant develop the lungs and other organs
- Polyhydramnios
what are uterus causes of still birth death
- Rupture
- Uterine abnormalities
List the maternal causes of still birth
- diabetes
- hypertensive disorder
- lupus
- APS
- cholestasis
- drug misuse
How does diabetes, hypertensive disorder, lupus, and APS cause still birth
– poor vascular, poor implantation of the placenta and increase clot forming in the placenta, reduction oxygen supply to the baby
How can cholestasis cause still birth
- this is a genetic condition when less bile is filtered out of the maternal blood and this can kill the baby
What is drug misuse
- this is when drug can cross the placenta
what are intrapartum causes of still birth
- Birth trauma
- Asphyxia
what are the two types of stillbirth
- actue
- chronic
describe acute still brith
- acte occurs within hours
- Causes – placenta abruption, cord accident
- Baby well growth
- No maceration – not been dead for long
- Normal placenta
what causes acute still birth
- Causes – placenta abruption, cord accident
describe chronic still brith
- Days to several weeks
- Causes – diabetes, hypertension, maternal disease
- Baby; IUGR – moderate to severe maceration
- Placenta; small
what are the causes of chronic stillbirth
- Causes – diabetes, hypertension, maternal disease
what are the contributing factors to perinatal mortality
- Specific disease and conditions
- Birthweight and gestation
- Utero-placental function
- Country of birth
- Social class
- Maternal age and parity
- Access to healthcare
How can we reduce the rates of perinatal mortality
- Health care services – detecting placental problems, intrapartum care, effective treatment of neonates
- Immunisation
- Maternal education
- Reduce child poverty
- Improve housing
- Breastfeeding promotion
what does SUDI stand for
sudden unexpected death in infancy
What does SIDS stand for
sudden infant death syndrome
what is SUDI
- This is a sudden unexpected death in infancy, it is when the infant dies when they are less than 1 year of age
what situations are classed as SUDI
- Baby found death in cot
- Baby dies in parents’ arms; instantaneous
- Rapid death due to illness
what can cause SUDI
- Low birth weight and prematurity
- Birth injury and difficult labour
- Sepsis
- Congenital anomalies
- Haemolytic disease of the new-born
- Conditions of placenta and cord
what are cot causes of death
- Congenital heart disease
- Respiratory infection
- CNS infection
- Seizure disorder
- SIDS
- Suffocation
what causes rapid death due to recognised illness
- Respiratory infection
- CNS
- Fastrogtneritis
- Reyes syndrome
every infant who dies by SUDI has to ..
undergo a post mortum
what do you try to establish in a post mortar in someone who dies from SUDI
- Establish whether death was natural or not
- Provide basis of counselling
- Try to prevent reoccurance
- Epidemiology and research
what is the definition of SIDS
- Sudeen unexpencted death of an infant under 1 year of age which remains unexplained after a thorough investigation including post mortern and reiveiw of history and examination of the death scene
what are the risk factors of SIDS
- Placed on front to sleep
- Smoking
- Sleeping on softer or co sleeping
- Most common in 1st 6 months of babies life
what weeks is SIDS typically found in
- Commonest between 4 and 20 weeks
* Commoner in winter
What is the suggestion to the cause of SIDS
- Delayed developing in arousal, cardio-respiratory control and thermal regulation happens between 2 and 4 months
- Laryngeal spams – suggested that in these babies don’t have these autoregulatory functions and perhaps this is why they are dying as they failure to auto resuscitate from apnoea
What is the triple risk theory of SIDS
Idea that these 3 factors can lead to the development of SIDS
- Vulnerable infant – low brith weight twins
- Outside stressors – single mothers, smokers, city livers
- Critical developmental period
What are external stressors leading to SIDS
- Minor URTI
- Prone position
- Bed sharing
- Overheating
what are external finings of SIDS
- Body well developed and nourished
- Frothy fluid around nose
- Cyanosis of lipids and nail beds
what are internal findings of SIDS
- Large thymus
- Empty bladder
- Full expansion of lungs
- Petechiae in pleura and epicardium (haemorrhages consist with oxygen deprivation)
SIDS and suffocation have…
the same presentation
