Late preterm delivery
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Late preterm infants born between 34 0/7 and 36 6/7 weeks have higher rates of morbidity than full term infants. During the initial birth hospitalization, late preterm infants are more likely to experience conditions like temperature instability, hypoglycemia, respiratory distress, and jaundice. The risks are even higher for late preterm infants whose mothers have complications like hypertension, diabetes, bleeding, or infections. Readmission rates within the first year are also higher, around 15%, for late preterm infants compared to full term infants. Late preterm infants also have higher mortality rates within the first year of life and are at greater risk for long-term neurodevelopmental issues.
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![LATE PRETERM DELIVERY NEONATAL MORBIDITY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],AAP LATE PRETERM DELIVERY Pediatrics. 2007;120(6):1390-401 ACOG LATE PRETERM DELIVERY Number 404 • April 2008](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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This document summarizes different types of irreversible cell injury including autolysis, necrosis, and apoptosis. It describes the morphology and characteristics of various forms of necrosis including coagulative, liquefactive, caseous, fat, and fibrinoid necrosis. Coagulative necrosis is the most common type and results in swollen, pale tissue with intact cell outlines. Liquefactive necrosis degrades tissue through enzymatic digestion. Caseous necrosis occurs in tuberculosis and destroys tissue architecture. Fat necrosis results from lipase digestion of fat cells. Fibrinoid necrosis involves fibrin deposition in small blood vessels.
Kpsc diabetes in pregnancy pathway 8.6.2012
The document outlines guidelines for managing diabetes in pregnancy across medical centers. It discusses:
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2. Risk stratification of patients into low, medium, and high risk groups based on diabetes history and control. This determines interventions like medication management and fetal monitoring.
3. Screening all prenatal patients for GDM risk and providing diabetes education. High risk patients receive early glucose testing while low risk patients are tested at 24-28 weeks.
4. Postpartum follow-up
RESPIRATORY SYSTEM: INTRODUCTION, ATELECTASIS, ARDS
The document discusses various pulmonary diseases and abnormalities including atelectasis, acute respiratory distress syndrome (ARDS), and hyaline membrane disease. It describes the pathogenesis, clinical presentation, radiographic findings, and histopathology of these conditions. Regarding the case of the 7-year-old boy who inhaled a peanut, the document indicates that compression atelectasis is the most likely abnormality present, as a chest x-ray revealed mediastinal shift towards the side of the bronchial obstruction.
RESPIRATORY SYSTEM: EMPHYSEMA, CHRONIC BRONCHITIS
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Chronic leukemias
Chronic leukemias have an insidious onset and are usually less aggressive than acute leukemias. The two main types are chronic myeloid leukemia, characterized by the Philadelphia chromosome, and chronic lymphocytic leukemia, which mainly affects B cells. These diseases involve increased numbers of mature but dysfunctional white blood cells and are diagnosed based on blood counts, bone marrow examination, and identification of genetic abnormalities.
Hemolytic anemia extracorpuscular defects.
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Sickle cell anemia is caused by a genetic mutation that results in abnormal hemoglobin called HbS. When HbS is deoxygenated, it polymerizes inside red blood cells, causing them to take on a sickle or holly leaf shape. This leads to hemolysis, anemia, vaso-occlusive crises involving painful blockages in small blood vessels, and organ damage. The condition is most common where malaria is endemic, as the sickle cell trait provides resistance to that disease. Laboratory testing can demonstrate sickle cells on blood smears and the presence of HbS on electrophoresis.
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A prospective observational study was conducted in the Neonatal Unit of Indraprastha Apollo Hospital over a period of 10 months. A total of 86 high-risk newborns were included to study the mortality and morbidity patterns. Majority of these (68%) were outborn male babies: 65% were pre-term and 36% were low birth weight. Overall survival was 77.2% and was better in inborn babies. Survival was directly proportional to gestation and birth weight. Systemic infection was associated with higher mortality and morbidity. Klebsiella was the commonest organism cultured followed by Candida. Hyaline membrane disease was the commonest respiratory morbidity. Sixty-seven percent required ventilatory support, and mortality was directly proportional to the duration of ventilation. Only 6% of the survivors had neurodevelopmental delay at 6 months and one baby had hearing impairment requiring cochlear implant. They continue to be on long-term follow-up.
Short Term Outcome of High Risk Newborns
A prospective observational study was conducted in the Neonatal Unit of Indraprastha Apollo Hospital over a period of 10 months. A total of 86 high risk newborns were included to study the mortality and morbidity pattern. Majority of these (68%) were outborn male babies. Sixty five percent were preterm and 36% low birth weight. Overall survival was 77.2% and was better in inborn babies. Survival was directly proportional to gestation and birth weight. Systemic infection was associated with higher mortality and morbidity. Klebsiella was the commonest organism cultured followed by Candida. Hyaline membrane disease was the commonest Respiratory morbidity. Sixty Seven pecent required ventilatory support and mortality was directly proportional to the duration of ventilation. Only six percent of the survivors had Neurodevelopmental delay at 6 months and 1 baby had hearing impairment requiring Cochlear implant. They continue to be on long term follow up.
High risk infants
This document outlines the management of high risk infants. It defines high risk infants as those exposed to conditions that endanger survival, such as prematurity, low birthweight, or maternal medical conditions. The management of high risk infants requires close observation and individualized care plans. Key aspects of management include prevention of complications, treatment when problems occur, careful advancement of feeding and fluid plans, and addressing the specific needs of special populations like preterm infants and those from multiple births. The overall goal is to identify and address the unique risks faced by each high risk infant.
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This document summarizes key information about neonatal sepsis:
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2. Risk factors include prolonged hospitalization and use of central venous catheters. Immediate treatment with antibiotics is critical.
3. Blood culture remains the diagnostic standard, but neonates often show only subtle signs initially, like feeding intolerance or abnormal vital signs, making early recognition difficult. A high index of suspicion is important.
Prediccion y prevencion del parto pretermino
This document discusses screening and prevention of preterm birth, which is the leading cause of neonatal mortality in the US. It describes various risk factors for preterm birth such as a prior preterm birth, short cervical length on ultrasound, vaginal bleeding, infections, and behavioral factors like smoking. Transvaginal ultrasound is an effective way to screen for short cervical length, which is a strong predictor of preterm birth risk. The document reviews evidence for different proposed screening and treatment methods, noting that while some risk factors are associated with preterm birth, treatments have not been shown to consistently and definitively reduce that risk.
Intrauterine growth restriction Intrauterine growth restriction
This document discusses intrauterine growth restriction (IUGR), including definitions, health burden, classification, etiology, pathophysiology, screening, prevention, diagnosis, interventions, management, and long-term outcomes. IUGR is defined as a fetus that does not achieve expected in utero growth potential due to genetic or environmental factors. It affects about 10% of live births and is a leading cause of perinatal morbidity and mortality. Causes include fetal, maternal, placental, and environmental factors. Screening involves ultrasound and Doppler assessments. Management involves timing of delivery based on gestational age and severity. IUGR is associated with short and long-term complications.
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Infant mortality is defined as the death of an infant before their first birthday. The infant mortality rate is the number of infant deaths per 1,000 live births. Leading causes of infant mortality include preterm birth, low birth weight, congenital abnormalities, Sudden Infant Death Syndrome, infectious diseases, malnutrition, and lack of access to basic healthcare. Factors that contribute to higher infant mortality rates include socioeconomic challenges, environmental conditions like air pollution, and lack of policies supporting maternal health and early childhood development. Reducing infant mortality requires improved access to prenatal care, nutrition, sanitation, immunizations, and social support systems.
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Maternal immunization is an important strategy to protect both mothers and newborns from infectious diseases. The document discusses various vaccines recommended during pregnancy including influenza, tetanus, diphtheria, pertussis (Tdap), respiratory syncytial virus (RSV), and COVID-19 vaccines. It provides evidence that maternal immunization reduces morbidity and mortality in mothers and newborns by providing passive immunity through antibody transfer across the placenta. The timing and efficacy of different vaccines in reducing infections, hospitalizations, and complications in mothers and newborns is reviewed. Caution is advised for some vaccines that are contraindicated during pregnancy.
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The document discusses various risks associated with pregnancies resulting from assisted reproductive technologies (ART) like IVF. It notes that ART pregnancies have slightly higher risks of early pregnancy loss, ectopic pregnancy, multiple pregnancies, gestational diseases, birth defects, and poorer perinatal outcomes. However, it also states that some of these risks may be due to underlying infertility issues rather than the ART procedures themselves. The document advocates for close monitoring of ART pregnancies and suggests more research is needed to fully understand all risk factors.
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This document discusses fetal growth disorders including definitions, classifications, and causes. It defines fetal growth restriction (FGR) as an estimated fetal weight below the 10th percentile and classifies it as either constitutional/normal if the Doppler is normal, or abnormal/pathological if the Doppler shows alterations. Abnormal FGR can be early-severe (<28 weeks) or late-mild. Causes of abnormal FGR include genetic factors like chromosomal abnormalities, infections like TORCH, and toxins like alcohol. Risk factors for FGR include maternal age, prior FGR, maternal diseases, and placental or cord abnormalities. Macrosomia is defined as an estimated fetal weight above the 90th-95th percentile for
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Exclusive Breastfeeding Reduces Acute Respiratory Infection And Diarrhea
This study examined the relationship between breastfeeding practices and infant mortality in Dhaka, Bangladesh. The researchers followed over 1600 infants from birth to 12 months. They found that exclusive breastfeeding declined from 53% at 1 month to 5% at 6 months. Partial or no breastfeeding was associated with a 2-3 times higher risk of infant death from all causes, acute respiratory infection (ARI), and diarrhea compared to exclusive breastfeeding. The study suggests that exclusive breastfeeding in early infancy reduces infant mortality, particularly from ARI and diarrhea.
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This document summarizes guidelines for predicting and preventing spontaneous preterm birth from the American College of Obstetricians and Gynecologists (ACOG). It defines preterm birth and discusses its increasing rates and racial disparities in the United States. It reviews factors associated with spontaneous preterm birth, including a history of preterm birth, short cervical length on ultrasound, and infections. It also discusses strategies for assessing risk, including cervical length screening via ultrasound in the mid-trimester.
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Preventing preterm labour
Screening for and treatment of asymptomatic bacteriuria in high-risk pregnant women reduces the risk of preterm birth. However, routine screening of all pregnant women in the first trimester with urine culture is not currently recommended due to the low prevalence of asymptomatic bacteriuria in the general pregnant population and the costs of universal screening.
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This document discusses the classification and care of low birth weight and preterm newborns. It begins by outlining the presentation which will cover classification based on gestational age and birth weight, as well as essential newborn care. The objectives are then stated as describing newborn classification, explaining elements of early care, and outlining care principles. The document proceeds to define terms, discuss epidemiology and risk factors for low birth weight, potential health issues for low birth weight babies, and classification in more depth. Pathogenesis, prevalence, risk factors, causes, clinical manifestations, and diagnosis of preterm birth are also covered.
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This document provides guidelines for managing twin pregnancies, including determining chorionicity and amnioticity. It recommends that all twins undergo an NT ultrasound before 14 weeks to validate chorionicity/amnionicity and detect early complications. Management of monochorionic twins requires more intensive surveillance due to increased risks of complications affecting fetal growth and well-being. Dichorionic twins generally require less frequent monitoring while monochorionic twins should be monitored more closely, with delivery planned before 37 weeks.
New Progesterone Guideline for Preterm labor and incidental shortened cervix
This document summarizes recommendations for using progesterone to prevent preterm birth based on a woman's history and cervical length. It recommends 17-hydroxyprogesterone caproate injections weekly from 16-20 weeks until 36 weeks for women with a prior spontaneous preterm birth. For women without a prior preterm birth but an incidental short cervical length of 10-20mm before 24 weeks, it recommends daily vaginal progesterone until 36 weeks. Safety follow-up of children exposed to 17-hydroxyprogesterone caproate in clinical trials found no differences compared to placebo.
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The document discusses improving patient satisfaction scores related to communication about medications at Riverside Medical Center's maternity service. The goal is to increase the HCAHPS medication communication score from 66% to 75% by December 2012 and 85% by June 2013. This will be achieved through education of providers, patients, and staff. Providers will be educated on medications through meetings and flashcards. Patients will receive verbal and written information about new medications. Staff will track medication discussions on patient care boards. Progress will be measured through education documentation and eventual HCAHPS scores.
Hcahps score trends in the past 4 years
This document shows trends in patient experience scores over 4 years from 2008-2012 at KP Riverside Medical Center based on the HCAHPS survey. The line graphs depict scores for various measures related to nurse and doctor communication, responsiveness of staff, pain management, medication communication, discharge processes, cleanliness and quietness. Scores fluctuate over time but generally remain between 60-90% for most measures.
Von willebrands disease
Von Willebrand disease is the most common inherited bleeding disorder caused by mutations that decrease or impair von Willebrand factor, which promotes platelet adhesion and clotting. It ranges from mild to severe. Type I is the most common form with a quantitative deficiency, while type II has qualitative defects affecting function. Treatment involves desmopressin, which releases stored VWF, or VWF replacement for refractory or severe cases. Careful management is needed around procedures and delivery to maintain adequate VWF and factor VIII levels through replacement to prevent bleeding.
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The document summarizes key findings from a review of literature on polycystic ovary syndrome (PCOS). It finds that the most consistent predictors of PCOS are hyperandrogenemia (high levels of "male" hormones) in 60-80% of cases, hirsutism (excess hair growth) in 60% of cases, and polycystic ovaries in 75% of cases. It also discusses debates around definitions of PCOS and relationships with insulin resistance.
Induction summary
This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
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Hyperemesis Gravidarum is a condition characterized by persistent and severe nausea and vomiting during pregnancy. It can lead to weight loss of 5% or more of the woman's pre-pregnancy weight and the presence of ketones in the urine. Potential causes include multiple gestation, trophoblastic disease, or genetic conditions like trisomy 21. Treatment focuses on managing symptoms, avoiding triggers, dietary changes, medications like antihistamines, phenothiazines, and serotonin antagonists. Intravenous fluids and supplementation of vitamins and minerals may be needed to address nutritional deficiencies and prevent complications like Wernicke's encephalopathy. Enteral nutrition through nasojejunal feeding tubes is preferable to parent
Gbs 2010
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Foley bulb
The document discusses the use of Foley bulbs for cervical ripening and labor induction. It finds that:
1) A Foley bulb induction is as effective as common prostaglandin methods like misoprostol for cervical ripening and inducing labor, with fewer risks of complications.
2) Inflating the Foley bulb to 60-80ml is more effective for cervical dilation and shorter delivery times than only inflating to 30ml.
3) Using a Foley bulb alone without additional prostaglandins or oxytocin is equally effective while avoiding increased need for pain management.
Fht interpretation & management
This document provides guidelines for the management and interpretation of intrapartum fetal heart rate tracings. It discusses important factors to consider when interpreting tracings such as gestational age, maternal conditions, and fetal conditions. It describes the physiology underlying different fetal heart rate patterns. It also presents the NICHD nomenclature for standardized description of tracings, including definitions for baseline rate, variability, accelerations, and decelerations. Tracings are categorized as Category I, II, or III based on patterns that reflect fetal acid-base status. Category I tracings are normal while Category III tracings indicate abnormal fetal status and need for prompt evaluation and treatment.
Asymptomatic short cervix and vaginanal, progesterone
1. Vaginal progesterone reduces preterm birth in women with an asymptomatic sonographic short cervix in the midtrimester. The meta-analysis found vaginal progesterone once daily from identification of a short cervix <25mm until 37 weeks decreases preterm birth <33 weeks by 45% and decreases neonatal morbidity and mortality.
2. Treatment with vaginal progesterone was associated with significant reductions in preterm birth before 28 weeks, 33 weeks, and 35 weeks as well as composite neonatal morbidity and mortality.
3. There were no significant differences in adverse maternal events or congenital anomalies between the vaginal progesterone and placebo groups.
Prevention of pertussis
The document discusses pertussis (whooping cough) prevention, treatment, and epidemiology. It provides guidelines for vaccinating pregnant women and new mothers with Tdap to prevent transmission to infants. It describes the symptoms and phases of pertussis, recommends antibiotic treatment and prophylaxis, and defines close contacts for evaluation and post-exposure prophylaxis. Pertussis cases are increasing significantly in California and infants are most at risk for severe disease.
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The document discusses evidence that magnesium sulfate administered to mothers at risk of preterm birth reduces the risk of cerebral palsy in infants. Several large randomized controlled trials and meta-analyses involving over 15,000 women found magnesium sulfate decreased the risk of cerebral palsy without increasing mortality. The number needed to treat to prevent one case of cerebral palsy is estimated at 63 women. The document also describes a modified magnesium sulfate neuroprotection protocol used at Riverside Hospital for imminent preterm deliveries between 23 and 33 weeks.
Labor down
1) Studies on delayed pushing, also called "laboring down", have shown mixed results, with the main consistent benefit being a reduced need for operative vaginal deliveries in nulliparous women with epidurals.
2) Delaying pushing can prolong the second stage of labor by about an hour and may increase risks like chorioamnionitis with delays over 1 hour.
3) Delayed pushing may be considered for nulliparous women with epidurals who do not have an urge to push and the fetal head is not yet at station +2, as long as the fetal heart rate is reassuring and no other risk factors exist. The delay should not exceed 90 minutes.
Vte prophylaxis
This document provides guidelines for venous thromboembolism (VTE) prophylaxis and the use of low molecular weight heparin (LMWH) in pregnancy and postpartum. It outlines risk factors for VTE and bleeding, dosing recommendations for LMWH, and guidelines for the timing of LMWH administration and removal of epidural catheters around C-sections and other surgeries. LMWH is recommended for at least 7 days for those with a VTE risk score of 3 or higher, and dosing depends on weight. Strict timing guidelines aim to reduce the risk of spinal hematoma when combining neuraxial anesthesia and LMWH.
Von willebrands disease
Von Willebrand disease (VWD) is the most common inherited bleeding disorder, caused by mutations resulting in decreased or impaired von Willebrand factor (VWF). VWF promotes clotting by forming bridges between platelets and injured endothelium, and between platelets. It also carries and protects factor VIII. VWD is classified into three main types - type I is most common due to VWF deficiency; type II involves functional defects; type III is most severe with very low VWF. Treatment involves desmopressin, VWF replacement, or factor VIII depending on type and severity of bleeding. Careful management is needed around surgery, delivery, and circumcision.
Vbac tables
Elective repeat cesarean delivery (ERCD) and trial of labor after previous cesarean delivery (TOLAC) both carry maternal risks. ERCD has slightly higher risks of endometritis and blood transfusion compared to TOLAC. TOLAC has a higher risk of uterine rupture compared to ERCD, but both procedures carry low risks of operative injury, hysterectomy, and death.
Vbac2010a
The document summarizes guidelines from the American College of Obstetricians and Gynecologists (ACOG) on trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC). It outlines factors that may increase or decrease the likelihood of a successful VBAC, including previous delivery history, induction methods, gestational age, and maternal BMI. It also discusses maternal and neonatal risks associated with TOLAC versus elective repeat cesarean delivery.
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Uterine inversion is a life-threatening obstetric emergency that requires immediate treatment to prevent hemorrhagic shock and death. The diagnosis is based on clinical findings of bleeding and palpation of the inverted uterus. The first steps in treatment are to stop oxytocin, establish IVs, and manually replace the inverted uterus. If manual replacement fails, intravenous nitroglycerin can be used to relax the uterus and allow replacement, with doses up to 1000 micrograms. Surgery may be required if inversion persists after attempts at uterine relaxation and manual replacement.
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