Prenatal Flashcards by Robbie Rodriguez

Prenatal History

consists
-review of pregnancy
-past pregnancies
-mothers and fathers medical and genetic histories

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Pregnant History

-determine is mother used any foreign substances
-xenobiotics
-medications
-any health problems the mother experienced during pregnancy (placenta previa, abruptio placentae, gestational diabetes, HTN)

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Review of past pregnancies

-hx of congenital anomalies, still birth, genetic disorders

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Perinatal History

-newborns weight, height, and Apgar score
-duration of labor
-use of analgesia or anesthesia
-type of delivery
-complications
-prolonged labor, meconium, staining or aspiration, use of forceps or vacuum

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Apgar Score

-recored at 1 min and 5min after birth
-total of 10 points
-each test receives 0, 1, or 2
-repeat test every 5 min for 20min or until scores are above 7 in two consecutive tests

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low Birth Weight of newborn

Low birth weight (LBW): <2,500g
very low birth weight (VLBW): <1,500g
Extremely low birth weight (ELBW): <1,000g

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Average Height and Weight of newborns

length 51cm
head circumference 35cm
Males- 3.6kg
Females- 3.5kg

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best out comes for newborns. at what gestational age?

born at 37-41 weeks

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Premature and post-term gestational age?

premature before 37weeks
post-term after 42 weeks

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LGA (large for gestation age)

-genetic risk factors: Beckwith-Wiedemann syndrome, Simpson-Golabi Behmel syndrome
-Maternal risk factors include maternal diabetes, and maternal obesity.

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SGA (small for gestation age)

-intrauterine growth restrictions (IUGR)

caused by:
-maternal, placental, or neonatal factors
-maternal starvation, medical disorders, substance abuse, and intrauterine infection
-Placental injuries and structural anomalies
-Neonatal factors are inborn errors of metabolism, genetic syndromes, karyotypic abnormalities

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2 types of SGA ?

Asymmetric IUGR
-head and length WNL
-Weight below 10th percentile

Symmetric IUGR
-reducation in both body and head growth
-intrinsic factors are the cause

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Asymmetric IUGR

reductions of fetal nutrients:
-chronic HTN
-pre-eclampsia
-renal or cyanotic heart disease
-hemoglobinopathies
-abruptio placentae
-multiple gestation
-high altitude

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Symmetric IUGR

intrinsic causes:
-chromosomal abnormalities
-congenital infections

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New Born Vitals

temp: 36.1-37C
respirations: 30-60breaths per min
heart rate: 120-160bpm

check bp if cardio or renal problems suspected
below 112/74 is normal

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Newborns skin

-turns red when crying
-when cold extremities turns bluish with a mottled tint

Macular stains may be associated with extracutaneous disorders, such as spinal dysraphism or Beckwith-Wiedmann syndrome

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Hemangiomas

-strawberry marks (red/crimson macules)
-vascular neoplasm
-disappear by age 5

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Milia

-milk spots
-white papules
-disappear 3-4weeks

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erythema toxicum

-white papules w/ erythematous base
-resolve with 2 weeks

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Mongolian Spots

-African American and Asian newborns common
-blue-black macule with indefinite borders on buttocks
-disappear in 1st year

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MIliaria

-thin wall vesicles
-nonerythematous
-non-pigmented
-caused by blockage of sweat glands
-usually resolves when newborn is removed from the warm humid environment

Port Wine stains

-sometimes associated with structural anomalies (sturge-Weber syndrome)

Cafe au lait

-light brown macule with well-defines boards
-6 or more spots may indicate neurofibromatosis

How is the vestibulo cochlear nerve assessed

startle or blink response to sudden loud noises

rooting, sucking, moro reflexes disappear?

3-4 months

Microcephaly Macrocephaly

-a head circumference smaller than two standard deviations -a head circumference larger than two standard deviations

new borns hair

-should be uniform in color and distribution -white forelocks may indicate deafness - multiple hair whorls may be Down syndrome (trisomy 21)

fontanels

-should be flat and soft anterior -diamond and closes 18months posterior -triangular and closes 2-3months tense and bulging indicate intracranial pressure sunken indicate dehydration

Wide fontanels

indicate underlying condition: -IUGR -hydrocephalus -Down syndrome -Hypothyroidism

edema that crosses the midline

Caput Succedaneum -resolves w/in a few days

Abnormally wide interpuppillary distance

indicates trisomy 13 or Apert Syndrome

Blue Sclera

indicates Osteogenisis Imperfecta

Excess skin or webbing

indicates genetic disorder like Turners Syndrome

new born breast tissue may hypertrophy bc?

maternal hormones

Newborn Cardiovascular

-first few days the PMI is located on fourth intercostal space at or to the left or. the midclavicular line -120-160bpm -sleeping may be 85-90bpm -asymptomatic rhythms are relatively. common in preterm

PDA and murmurs of newborns

85% of all newborn have murmurs -usually cease once the ductus arterioles closes

diminished femoral pulses in new born

-coarctation of the aorta

Ejection clicks

-further eval required -indictes pulmonary or aortic valve stenosis

Abdomen of the newborn

-slightly protuberant -palpation of lover that is soft with a smooth edge -may also be able to locate tip of spleen

Females: -labia major may be reddened and swollen -clear white vaginal discharge, blood tinged may be normal first few days of life Males: -penis should be stretched to asses length -phimosis is common -circumcision should be postpone of hypospadias is presents -testes moth and firm and equal -blue testes -- may be torsion -testes concerned with undescended by age 6months

Sacral Dimpling

not a cause for concern unless dimples are larger than 0.5cm or located 2.5cm from the anal verge -screen for neural tube defects

lower back tufts of hair or skin tags?

-Spina Bifida

Single Palmer crease?

Trisomy 21

DDH/ developmental Dysplasia of the Hips

Barlow Maneuver/ Ortolani Maneuver Barlow: -causes posterior dislocation of an unstable hip Ortalani: -makes a click sounds with reduction of the dislocation

Mandatory Screenings of the Newborn

PKU/ Phenylketonuria galactosemia SCD congenital hypothyroidism

Newborn hearing assessment

-Startle reflex -BSAER/ brain stem auditory response test -if hearing loss indicated, tx begins by 6months

Cystic Fibrosis screened how?

dried blot spot test -confirmed with sweat test

PKU

-developmental delay -seizures -agression -autism -hyperactivity

Galactosemia

liver dysfunction and coagulopathies -may develop sepsis

Dried Blood spot screens for?

Hemoglobinopathies -sickle cell -thalassemia