Week 6 Flashcards
What is the definition of perinatal mortality?
Consists of fetal death (including intrauterine and during birth) and neonatal death (including early- till 7 days after birth and late- 8 to 28 days after birth).
Till when can you make an end to the pregnancy by the will of the mother?
24 weeks (strafrechtelijk) 22 weken wordt door artsen gehanteerd.
What are the “Big 4” for perinatal mortality?
- Low birth weight
- Low APGAR
- Pre-term birth
- Congenital abnormalities
What percentage of perinatal mortality is caused by the Big 4?
85%
What are the two types of pre-term birth?
- Spontaneous: cervical insufficiency, infections and polyhydramnion. 2/3
- Iatrogene: Pre-eclampsia and FGR. 1/3
What monitoring can we do to prevent a Low APGAR score?
Dopotone: look at the heartrate baby, STAN: variation of CTG, Fetal scalp blood sampling: pH child.
From the cases of perinatal deaths, how many were caused by substandard care?
9%. Is care that isn’t as it should go according to protocol.
What is a perinatal audit?
A critical and systematic analysis of the quality of perinatal care.
What types of pre-term birth are there?
Extremely: <28 weken
Very: 28-32 weeks
Moderate/late: 32-37 weeks. 80%
Signs and symptoms of pre-term birth:
Hard stumaches, breaking membranes, losing amniotic fluid, blood loss
Risk factors pre-term birth
Smoking, Low or high BMI, Low SES, psychological/depression, paradontitis, curretage, chronic inflammatory disease.
Contributions to pre-term birth
Infections (broken membranes), vascular disorders (pre-eclampsia). uterus overdistantion (multiple gestation), cervical disease, decidual sentences, break down of fetal-maternal tolerance.
Investigations for pre-term birth?
History
Physical examination: uterus contracile, disclosure cervix?
Fibronectine: in women with symptoms and 15-30 mm
US
CTG: baby; rate heart and decelerations.
Lab: infection
Cultures: GBS
What can you do to manage it?
Corticosteroids (lung), magnesiumsulfate (brain) and tocolyse (inhabitory for contractions)
What is the mechanism of progestagene?
IF someone gets in labour, the number of receptors decreases. If you substitute it, it helps preventing it.
What is the normal cervix length?
40 mm. If its less than 25, its too short. If there are no labour symptoms, you can use cervical ring.
Prevalence prematurity?
7%
International difference in prevalence because of:
Obesity, smoking, environment factors, policy differences.
Short term complications pre-term birth:
IRS, infections, NEC, feeding problems
Long term complications pre-term birth:
BPD (lung damage), blindness, deafness, spacity, behaviourproblems. For parents: PTSS
Why has the minimum ammenorrhea durage changed for active support?
Due to the fact that the chance on getting a handicap is the same for 26 or 24 weeks.
What is the decision making progress?
- Explain/ inform that a decision is to be made, in which the parents opinion is very important
- Explain the options (Active support vs comfort care) and the pro’s and cons
- Determine what the wishes and concerns are ; what is important to them?
- Dicuss how the parents want to reach a decision
Medical care for neonates has become better, but there is a flip side to the coin..
Increasing number of pre-term children growing up with morbidity
Describe the brain morphometry; which 3 important steps?
- Synaptogenese
- Programmed cell death
- Myelanisation; goes on till your 30s
What is the most important risk factor for abnormal brain development?
Inflammation (30-50%)
What are the other risk factors?
- Hypoxia and hypercapnia
- Toxins; at 27 weeks the brain-blood barrier is developed
- Maternal stress; can cause inflammation
- Treatment (cortico’s)
- metabolic complications
- Intra/ periventicular bleeds.
What are the two important processes in brain damage?
- Exitoxicose: BPD –> Hypoxie –> ROS
2. Inflammatoire cascade: maternal/ fetal disease –> inflammation –> microglia –> ROS
Describe intra/ periventiculaire bleeding
Till week 34 you have the periventicular subependymal germinal matrix. Is very vasculated, lays under the lateral ventricles. Also very close to corticospinal pathways. When Germinal matrix bleeds -> motorical issues. 20% of the children with birthweight <1500.
What is Bronchopulmonary dysplasia? (BPD)
Chronic lung disease: need for supplemental oxygen to treat hypoxemia, persistent respiratory signs and symptoms.
* Incedence: 500-700 grams > 85%
What is PVL and what different types are there?
Periventicular white matter damage.
- cystic: before 26 weeks
- Non-cystic: beyond 26 weeks
How much smaller is the brain in premature children?
0.5 SD
How much down goes the IQ per pregnancy week the child misses?
1.26 points
How much down goes the IQ when you weigh 2.5 kg instead of 3.5?
20 IQ points
How much down goes the IQ when you have BPD?
15 points
How much higher is the risk of ADHD in premature children?
2-3x
How much higher is the risk on ASD in premature children?
5-9% compared to 1% in the normal population
How much higher is the chance on special educational needs in premature children?
2.5x
