Podcast
Questions and Answers
Which method is not used by the obstetrician to assess gestational age during a visit?
Which method is not used by the obstetrician to assess gestational age during a visit?
Which of the following is traditionally not considered a reliable method for estimating gestational age?
Which of the following is traditionally not considered a reliable method for estimating gestational age?
What is usually not a primary tool for assessing gestational age during prenatal visits?
What is usually not a primary tool for assessing gestational age during prenatal visits?
In the context of gestational age assessment, which information is least relevant?
In the context of gestational age assessment, which information is least relevant?
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Which of the following methods is not a standard practice for obstetricians assessing gestational age?
Which of the following methods is not a standard practice for obstetricians assessing gestational age?
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What is the most likely reason for the respiratory distress in the 750-g female after preterm delivery at 27 weeks’ gestation?
What is the most likely reason for the respiratory distress in the 750-g female after preterm delivery at 27 weeks’ gestation?
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Which of the following factors is most likely related to the infant being classified as 750-g at 27 weeks’ gestation?
Which of the following factors is most likely related to the infant being classified as 750-g at 27 weeks’ gestation?
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During an abdominal ultrasound for this infant, which finding would most likely be expected due to her prematurity?
During an abdominal ultrasound for this infant, which finding would most likely be expected due to her prematurity?
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What is the most critical immediate management step for an infant experiencing respiratory distress after preterm delivery?
What is the most critical immediate management step for an infant experiencing respiratory distress after preterm delivery?
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In the context of this infant's condition, which long-term complication is most likely associated with her low birth weight and gestational age?
In the context of this infant's condition, which long-term complication is most likely associated with her low birth weight and gestational age?
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Study Notes
Newborn Babies
- Newborn babies (NB) are assessed by obstetric professionals during the first trimester antenatal visit, using factors such as the date of the last menstrual period (LMP), the expected delivery date (EDD), quickening (first fetal movement), and fetal heart sounds.
- A 750-gram female infant born at 27 weeks gestation with respiratory distress may have different potential causes, excluding spontaneous pneumothorax.
- The neonatal period is the first four weeks of human life, divided into early (first week) and late (weeks 7-28).
- Perinatal mortality rate (PMR) is the number of stillborn babies after 20 weeks' gestation plus deaths in the first week of life per 1000 total births.
- Neonatal mortality rate (NMR) is the number of infant deaths in the first 28 days of life per 1000 live births.
- Preterm NB is born before 37 completed weeks (<259 days).
- Full-term NB is born between 37-42 weeks (260-294 days).
- Post-term NB is born after 42 weeks (>295 days).
Low Birth Weight Neonates (LBWN)
- LBWN are neonates whose birth weight is less than 2500 grams (representing 6-7% of all births, but accounting for 2/3 of neonatal deaths).
- LBWN could be preterm, small for gestational age (SGA), or both.
Causes of Prematurity
- Maternal causes include maternal age less than 16 or older than 35, grand parity, smoking, poor housing, short stature, alcohol consumption, chronic maternal diseases (like chronic hypertension), and drug abuse (such as cocaine use).
- Placental causes include placenta previa and placental abruption.
- Uterine causes include abnormalities like bicornuate uterus and cervical incompetence.
- Fetal causes include fetal distress, multiple gestations, erythroblastosis fetalis, congenital anomalies, and non-immune hydrops fetalis.
- Other causes include premature rupture of membranes, polyhydramnios, and iatrogenic interventions such as poorly timed Cesarean sections.
Problems of Prematurity
- Birth asphyxia and resuscitation needs. Respiratory center immaturity, thin chest wall, and surfactant deficiency.
- Thermal instability (hypothermia or hyperthermia) due to large surface area relative to body weight, with limited subcutaneous fat.
- Poor muscle tone, weak suction reflex, and coordination.
- Respiratory problems such as respiratory distress syndrome, pneumothorax, apnea and bradycardia, and congenital pneumonia.
- Jaundice and liver immaturity.
- Metabolic irregularities like hyper- or hypoglycemia and electrolyte imbalances.
- Cardiovascular (CVS) hypotension and cardiac dysfunction.
- Central Nervous System (CNS) depression, increased risk of intraventricular hemorrhage, leukomalacia, seizures, deafness, and hypotonia.
- Gastrointestinal (GIT) intolerance to feeding, hyperbilirubinemia, necrotizing enterocolitis (NEC).
- Infection susceptibility due to low immunoglobulin levels.
- Hematologic anemia.
- Ophthalmologic retinopathy of prematurity (ROP).
- Surgical issues like inguinal hernia.
- Renal problems and fluid/electrolyte management.
- Nutritional deficiencies, needing specific supplementation of calcium, phosphate, vitamin D, iron, and folic acid.
Clinical Features of Preterm Neonates
- Larger head size relative to body size.
- Pink or dark red thin skin.
- Hypotonia with extended limbs (frog-like posture).
- No palpable breast tissue, shapeless soft ears; Undescended testes in males, widely separated labia in females.
- Weak cry, weak sucking, poor swallowing function, and coordination.
- Cough reflexes are weak.
-
Subcutaneous tissue is minimal - Body is covered with black soft brittle hair all over the back and shoulder (lanugo hair).
Management of Preterm Neonates
- Immediate postnatal care: appropriately equipped hospital, resuscitation, and stabilization using qualified personnel and equipment with oxygen supply, temperature management, and control.
- Neonatal management: thermal regulation, respiratory support, circulatory support (blood, plasma), monitoring HR, PR, RR, TEMP, and O2.
- Metabolic disturbances: regular glucose monitoring and fluid management. Handling minimized.
- Nutrition: parenteral, partial TPN, and enteral.
- Infection prevention.
- Immunizations (DTaP, Hib, IPV, PCV), vaccine doses (no reduction), use of appropriate needles, and immunization schedule.
- RSV policy
- Complications.
Diagnosis of RDS
- Clinical course (transient tachypnea, short and mild course typically, low or no need for supplemental oxygen)
- Chest X-ray shows increased reticulogranular pattern (ground-glass appearance or white lung).
- Air bronchogram can be seen.
- Blood gases show increased carbon dioxide (paCO2), decreased oxygen (paO2), and decreased pH.
Prevention of RDS
- Preventing premature delivery through appropriate management of high-risk pregnancies and avoiding unnecessary or poorly timed Cesarean sections (CS).
- Using antenatal steroids (betamethasone) to enhance lung maturity, for example, 12mg intramuscular (IM) twice at 24-hour intervals, starting 48 hours prior to anticipated delivery.
- Prophylactic surfactant therapy (human or bovine) after delivery, typically within the first 15 minutes.
Treatment of RDS
- Supportive care (fluids, nutrition, temperature control).
- Gentle handling.
- Continuous positive airway pressure (CPAP).
- Assisted mechanical ventilation (if needed).
- Exogenous surfactant.
Complications from RDS intensive care
- Endotracheal tube complications (perforation, trauma).
- Esophageal perforation, laryngeal edema.
- Tube obstruction.
- Infection.
- Subglottic stenosis.
- Umbilical artery/vein catheterization complications.
- Extra pulmonary air (pneumothorax, pulmonary interstitial emphysema, pneumomediastinum)
-
PDA,
Apnea and bradycardia
Chronic lung disease (BPD).
Prognosis of RDS
- Generally good prognosis (with improvements in neonatal intensive care and antenatal interventions).
- Survival likelihood is inversely related to gestational age.
- Postnatal management is crucial for those with birth weight <1500 grams; some may develop significant long-term complications (e.g., cerebral palsy, developmental delays).
Early Complications of Prematurity
- Respiratory distress syndrome.
- Jaundice.
- Patent ductus arteriosus (PDA).
- Intraventricular hemorrhage (IVH).
- Early anemia.
Late Complications
- Retinopathy of prematurity (ROP).
- Bronchopulmonary dysplasia (BPD).
- Late anemia.
- Rickets
- Central Nervous System (CNS) damage.
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