Maternity Theory Final -> Menstural alterations to healthy newborn

Amenorrhea

____________: Complete absence of menstural flow

Primary: Absence of mensturation and secondary sex characteristics by 13 years OR absences of menses by 15 years (regardless of growth or development)

Secondary: Absense of menstration within 5 years of breast development. 6 + month cessation of menses after a period of mensturation

Hypogonadotropic Amenorrhea

_____________ __________: Cease in menstruation due to suppression of HPA axis

• Stress

• Sudden, severe wt loss (eating disorders)

• Strenous exercise

• Mental illness

Primary

_______ Dysmenorrhea: Young adult women. Caused by prostaglandin excess or increased sensitivity to prostaglandins

• No underlying pathology

• Heating pad, exercise

• Oral contraceptives supress endometrial growth

• Further investigation needed if not relieved by meds

Secondary

_________ dysmenorrhea: PATHOLOGICAL. Adenomyosis, PID, Fibroids, endometriosis. Associated with underlying pelvic pathology.

Clinical manifestations: Dull aching pain, pelvic fullness

Mgmt: Laproscopic → Hysterectomy (last resort)

Endometriosis

______________: Endometrial tissue impants outside uterus (ectopic)

• Poorly understood. Retrograde menstruation theory (back reflux flow of menstural blood through uterine tubes) most well accepted

• Painful mensturation, urination, defecation (dyschezia), painful intercourse (Dyspaneuria)

Metorrhagia

__________: Menstural bleeding occuring between periods

Leiomyomas

_________: Commonly called ‘fibroids’

• Slow growing uterine benign tumours that arise from uterine muscle tissue, rarely become malignant

• Most common female tumour → commonly occurs closer to menopause

• Related to estrogen stimulation. Enlarges with pregnancy and shrinks with menopause

Menopause

___________: Medical dx is no period for 12 months. 35-60 yo age range- median age 51.4 years

All post menopausal vaginal bleeding should be investigated for cancer

Perimenopause

_____________: Lasts 5 years. TIme where ovarian function declines

• Ova diminish

• Menstural cycle becomes anovulatory (irregular bleeding)

• Ovary stops producing estrogen → no more periods

Erb-Duchenne Palsy

_____________ ______: Damage to upper brachial plexus causing paralysis of effected extremity.

RF’s: Shoulder dystocia, difficult vertex or breech birth

Complete recovery in 3-6mos, wrist splint, dress affected arm first

Facial Nerve

_______ _____ Paralysis: Pressure on facial nerve from birth- Loss of movement on effected side. Most noticeable when crying. Resolves within hours or days

Most noticeable when crying

Hypoxic Ischemic Encephalopathy

___________ _________ ____________: Lack of o2 in blood, lack of blood flow in brain, cellular damage which happens as a result.

Tx: Passive cooling. Slows spread of damage, Brain cells able to recover, reduces severity and permanency of brain damage as decreased body temp slows brain damage.

Sepsis

_______: Neonatal infections. Presence of microorganisms or their toxins in tissues or blood. Significant cause of neonatal morbidity and mortality

Increased RF’s for neonates: Neonatal neutrophils do not function well, serum complement low, phagocytosis less efficient, mucosal barrier of newborns gut initally immature

Early onset

_______ _______ sepsis: Occuring within first 72hrs of birth

Vertical transmission from mother associated with microorganisms from vagina (GBS, HSV2, chlymidia), preterm labour, prolonged ROM +18hrs

Lower birth weight = higher risk. mortality rate +50%

Late onset

______ ______ sepsis: +72hrs of age. Acquired through environment. Enters through umbilical stump, skin, mucous membranes, resp/urinary/GI systems.

Offending organisms: Staph, e coli, candida, MRSA, VRE

Sepsis

Signs of __________:

Resp: Apnea, tachypnea, grunting, nasal flaring, retractions, decreased SPO2

Cardio: Tachycardia, hypotension, decreased perfusion

CNS: Temperature instability, lethargy, hypotonia, irritability, seizures

GI: Feeding intolerence, abdominal distenstion, vomiting/diarrhea

Integumentary: Jaundice, pallor, petechiae, mottling

Drug exposed

_______ ________ infants: Tend to have LBW releated to uteroplacental insufficiency,poor maternal nutrition, inconsistent or no prenatal care, stress from a transient lifestyle

Neonatal Abstinence Syndrome

_________ _________ _______: Most evident between 48-72hrs. Can last 6 days to 8 weeks.

Signs: Irritability, seizures, hyperactivity, high pitched cry, tachypnea

Opiods

Effects of __________: Cross placentas and cause fetal dependence.

Risk of premature birth, growth restriction/LBW, long term neuro outcomes.

Treated with methadone or Buprenorphine → Higher birth weights, lower NAS scores, shorter stays

Alcohol

____________: Most common teratogen that interferes with fetal development. Abnormalities linked to livers capacity to detoxify→ not amount ingested

Results in FAS → Difficult to diagnose in NB period. Irritability, abnormal tone, tremors, poor judgement

Nicotine

__________: Increases carbon dioxide and causes placental vasoconstriction and IUGR. Increases childhood risk of athsma, bronchitis, ear infections. Encourage smoking cessation

Cannabis

___________: Second most commonly used substance

Risks: Preterm birth, low birth weight, growth restriction. Potential negative effect on brain development, behaviour, cognitive performance.

Abstinence reccommended during pregnancy and breastfeeding

Cocaine

Fetal ___________ exposure: CNS stimulant. Fetal effects secondary to maternal effects: Increased BP, decreased uterine blood flow, increased BP, decreased IUGR. Exposure doesn’t typically cause NAS symptoms. Long term sequalae. Cocaine excreted in breastmilk

Hydrops Fetalis

________ _______: Caused by rh incompatibility/newborn hemolytic disease. Causes fetal hypoxia, cardiac failure, generalized edema, fluid effusions into pericardial, pleural, and pertoneal spaces

Erythroblastosis fetalis

_________ ______: Fetus attempts to compensate for hemolysis. Erythoblasts (RBC stem cell) appears in fetal circulation

Phenylketonuria

________________ (PKU): Inborn error in metabolism. Inhereted → autosomal recessive

Lack of enzyme to break down phenylanine leads to:

• Failure to thrive, frequent vomiting, irritability, unpredictable erratic behaviour, cognitive impairment

• Low PKU diet for life

Galactosemia

___________: Rare, autosomal recessive disorder from a hepatic enzyme deficiency.

Galactose accumulates in blood and organs too

Tx: Avoid lactose and drugs such as penicillin with lactose filler

Congenital Hypothyroidism

____________ ____________: One of most common preventable causes of cognitive impairment.

Early clinical manifestations: poor feeding, lethargy, prolonged jaundice, resp difficulty, cyanosis, being post term

Later: Depressed, nasal bridge, short forehead, puffy eyelids.

Tx: Lifelong thyroid hormone replacement therapy

Preterm

_________ births: Born before 37wks gestation

High risk: Immature organ systems, lack adequate physiologic reserves

Multifactorial RF’s: Poverty, maternal infection, previous preterm birth, multiple pregnancies, pregnancy induced hypertension, and placental problems.

Late Preterm

________ ________: Newborn born between 34-26 6/7wks

• Unique needs at birth

• Resp distress

• Hypoglycemia

• Temp instability

• Poor feeding

• Jaundice

CPAP

______: Type of o2 therapy that provides positive pressure during inhalation/exhalation with spontaneous breaths.

• Increases functional residual capacity

• Promotes diffusion of resp gases - O2 in and CO2 out

• Prevents alveolar collapse

• Decreases pulmonary vascular resistance

Respiratory Distress Syndrome

__________ ______ ___________ (RDS): Lack of surfactant → Progressive atelectasis and poor ventilation

RF’s: Lack of maternal corticosteroids, maternal diabetes, perinatal infection, c section birth without labour (no compression in birth canal)

Patent Ductus Arteriosus

________ ______ _____: DA connects left pulmonary artery to dorsal aorta

• Allowed blood to detour away from the lungs before birth

• Usually constricts after birth (hours to days)

• Delayed to preterm

• Pulmonary congestion if not closed by birth

• Medical or surgical management

Thermoregulation

_______________: Impaired for pre term infants due to smaller muscle mass, less brown fat, lack of sub q fat, poor reflex control of skin capillaries. Requires neutral thermal environment - may require external heat source.

Mechanical Ventilation

______ ________: Indicated with severe hypoxia and severe hypercapnia

Signs of readiness for weaning: Normal blood gases, acceptable SpO2, spontaneous respiratory effort

Periventricular-Intraventricular Hemmorrhage

__________ __________ __________: Bleeding in first 72hrs of life. Friable blood vessels prone to bleeding.

• PREVENTION: Position head midline, elevate HOB 30 degrees to avoid ICP fluctuations, avoid rapid infusion of parenteral fluids

Gavage

______ feeding: BM or formula through NG or orogastric tube

• Intermittent or continous

• Feedings increased gradually to prevent → Apnea, GI distention, Vomiting, Diarrhea

Necrotizing Enterocolitis

_______ _________ (NEC): Inflammation and potentially death of bowel tissue

Vascular compromise → diminshed blood supply → Damage to mucosal wall → Bacteria enter vessel wall

Bowel wall swells and breaks down

Formula RF

S&S: ABd distenstion, bilious vomiting, bloody stools, abd tenderness and redness

NEC

Treatment of ____:

• Bowel rest

• NG tube inserted for gastric decompression - set to low intermittent suction

• Parentral nutrition

• Broad spectrum abx therapy

• May need surgery if severe/perforation

Post Term

____ _____ Infant: Dry, loose peeling skin. Meconium stained, long hair and nails, and absence of vernix

• Can experience postmaturity → due to placental insufficiency: Thin, emaciated

Symmetrical IUGR

_________ ____: Conditions occuring in first trimester (Infections, teratogens) and affects all aspects of fetal growth. Small measurements, reduced brain growth.

Asymmetrical IUGR

__________ __: Third trimester. Conditions occuring in late pregnancy - maternal or placental factors. Much brain growth has already happened.

Length <10th percentile

HC > 10th percentile

LGA

__ infants: >90th percentile (4000g or more at birth)

• Fetal macrosomia

• Assess for Hypoglycemia and trauma

Respirations

First major newborn transition is establishing and maintaining ___________

Starts as a result of chemical, mechanical, thermal, and sensory stimuli

Chemical

_____ stimuli to encourage breathing: Decreased uterine blood flow and placental gas exchange. → Transient fetal hypoxia/hypercarbia → Stimulates resp centres Nega

Mechanical

______ stimuli for breathng: Chest compressed during descent/delivery → Negative intrathoracic pressure helps draw air in lungs

Thermal

______ stimuli for breathing: Cold exterior environment stimulates skins cold receptors → Stimulates respiratory center → Cold stress may help with initiation of breathing

Resp Distress

Signs of ____ ________: Nasal flaring, retractions, grunting, see-saw respirations, Apnea >20 secs, RR > 60 or <30

Acrocyanosis

___________: Bluish discolouration of hands and feet

Normal during first 7-10 days of life

Central Cyanosis

______ _______: Bluish discolouration of lips and mucus membranes

300ml

___ average newborn blood volume: Delayed clamping transfuses up to 100mL

• Increases blood volume

• Decreases preterm infants risk for intraventricular hemmorhage and NEC

Hematopoetic System

_________ _______ of newborn: RBC and Hb concentration higher than that of adult

• Leukocytosis normal in first couple of days but settles

Infeffective Thermoregulation

Infants at risk for _______ ____________: due to

• Thin layer of subcutaneous fat

• Blood vessels close to skin surface

• Larger body surface to body weight ratios

• Cold stress can cause hypoglycemia

Nonshivering Thermogenesis

_________ ____________ (NT):

Mainly happens primarily through metabolism of brown fat. Can increase heat production as much as 100%

• Brown fat stores rapidly depleted with cold stress

70%

Glucose in umbilical vein is approx ___ of maternal level

• Supply ends abruptly at birth

Physiological Jaundice

________ _______: Occurs in 60% of term infants

80% of preterm infants

• Appears > 24 hours of age - resolves spontaneously

Capcut succedaneum

_____ ________: Generalized swelling due to sustained pressure against the cervix

Crosses suture lines

Cephalohematoma

_______________: Collection of blood between skull and bone and its periosteum

• Does not cross suture lines

Subgaleal Hemorrhage

_______ ________: Not uncommon with difficult operative vaginal birth. (Vacuum, scalp pulling, bleeding into subgaleal space)

• Blood loss can be severe

• Monitor for a firm mass, boggy scalp, pallor, tachycardia, increasing head circumfrence

1st period of reactivity

__ ______ __ ________: First 30 minutes. Alert and active, shows interest in environment with open eyes and has a vigorous suck, put baby to breast

2nd period of reactivity

__ ______ _ ________: 2-8hrs after birth. Lasts 10 min to hours. Tachycardia and tachypnea in brief periods. Meconium passing