Normal childbearing notes

1. What are the different ways to calculate EDB?

• LMP, CRL, and T1 ultrasound 

When do we use LMP EDD

• Certain menstrual dating criteria assume regular cycles, ovulation at the midpoint of the cycle, fertilization on the middle day of the cycle, correct recall of the onset of the LMP

• Unfortunately, without timed ovulation and fertilization as in ART and other timed methods, clinical history is often not reliable

Gestational Age Estimation Based on Ultrasound Findings

• Ultrasound estimation of gestational age in the first trimester is therefore more accurate than later in pregnancy.1

• uses the mean gestational sac diameter and/or the crown− rump length (CRL). During the first 3 to 5 menstrual weeks an intrauterine pregnancy is first signaled by the presence of a gestational sac.

CRL

•  7 to 12 weeks is when it is the most accurate 

•  it will predict the expected date of birth to within 5 days 

CRL margin of error

• Margin of error is 5 days

CRL measurement

• first-trimester scan with a mean sac diameter or crown−rump length measurement,

• The crown−rump length is the longest straight line length of the embryo from the outer margin of the cephalic end to the rump. The neck position should be neutral

what mm for CRL is the best time for measurement

• 10 to 84 right in terms of the crown rump length That's the the best time to get the dating, because at that specific time there is limited  variability

Second and Third Trimester measurement

• In the second and third trimesters, estimation of gestational age is accomplished by measuring the biparietal diameter, head circumference, abdominal circumference, and femur length.

• Biparietal Diameter:Axial plane through a symmetrical calvarium that includes the third ventricle, thalami, falx cerebrum, and cavum septi pellicidi anteriorly and the tentorial hiatus posteriorly.

• Head circumference:The trace/ellipse should follow the outer perimeter of the bony skull, not the overlying skin, as that will falsely increase the head circumference

• Abdominal Circumference; True axial plane at the level of the bifurcation of
  the portal vein (into right and left branches) and the stomach

• Femur length; the femoral head or greater trochanter and the femoral condyle are simultaneously visualized.

When would we use LMP vs US?

• We use US 1 for more accurate results. LMP is not as accurate due to factors such as irregular cycle, tracking, ovulate earlier, they could ovulate later. there's no way. There's almost no way of them knowing when they ovulate.

Assisted reproduction has  the exact date of fertilization, like the ovulation date

What are the calculations for LMP

LMP+7 days-3 months

When do we change EDD

• When the LMP and day 1 us are more than 5 days of each other 

1. What is beta HCG when do we test

• hCG is made in early pregnancy and forms the basis for pregnancy testing, using either maternal urine or serum.

• We can do this in the first 3 month

• Corpus luteum releasing HCG until placenta is formed

What are the probable signs of pregnancy

Probable Signs

Sign	Time of occurence	Differential Diagnosis
Prescence hCG in: Blood Urine	Blood:9-10 days Urine: 14 days	Hydatidiform mole(blood) Choriocarcinoma(urine)
Softened isthmus (hegar’s sign)	6-12 wks
Blueing of Vagina (Chadwick Sign)	8 weeks+
Pulsation of fornices(osiander’s sign)	8 weeks+	Pelvic congestion Tumor
Chnages in skin pignemtation	8 weeks+
Uterine souffle	12-16 weeks	Increase blood flow to the uterus as in large Uterine myomas or ovarian tumor
Braxton Hicks	16 wks
Ballottement of fetus	16-28 weeks

Possible signs of pregnancy

Sign	Time of occurence	Differential diagnosis
Early breast changes (unreiliable in multip)	3-4wks+	Contraceptive pills
Amenorrhoea	4wks+	Hormonal imbalance Emotional stress illness
Nausea/vomiting	4-14wks	Gastrointestinal disorders Pyrexial illness Cerebral irritation
Bladder irritability	6-12wks	UTI Pelvic tumor
Quickening	16-20wks	Intestinal movement, wind

Positive signs of pregnancy

Sign	Time of occurence
Visulation of gestational sac by: Transvaginal u/s Transabdominal u/s	Transvaginal u/s:4.5wks Transabdominal u/s:5.5wks
Visulation of heart pulastion by: Transvaginal u/s Transabdominal u/s	Transvaginal u/s:5wks Transabdominal u/s:6wks
Fetal heart sound Doppler Fetal stethoscope	Doppler:11-12wks Fetal stethoscope:20wks
Fetal movement Palpable Visible	Palpable:22 wks+late Visible:22 wks+late
Fetal parts palpated	24wks+
Visualization of fetus by X-ray (superseded by u/s)	16wks+

1. What are different types of testing that midwives can offer for genteic testing?

eFTS(Nuchal translucency) and Anatomy

1. What does eFTS test and what are the result

• This testing can tell you the chance for having a baby with trisomy 21 (Down syndrome) or trisomy 18 

• What it means to screen negative means you have a lower chance of having a baby with trisomy 21,18 than some one screened positive, this is a screening and not a diagnostic test

What does eFTS include

• 11-14 wk ultrasound and blood work

What are we visualizing in 18-22 ultrasound

• how the baby's internal organs and structures are developing (like the heart, brain, kidneys, spine, arms, and legs)

• whether the baby is the right size for its age

• the position of the baby

• how active the baby is

• the amount of fluid around the baby

• the location of the placenta and the umbilical cord

• your own cervix, uterus, ovaries and bladder

• the sex of the baby, depending on the position of the baby. Checking for the sex of the baby is not one of the goals of this ultrasound. 

• Abdominal measurement 

• Nasal bone

• Ductus Venosus

• Tricuspid Regurgitation

What are the invasive testing and what do these options refer to

• chorionic villus sampling and the Amniocentesis.

What is NIPT

• During a pregnancy, your baby's placenta releases small pieces of genetic material (known as DNA) into your blood stream. NIPT looks at this placental DNA and can tell you the chance for the baby to have one of the chromosome differences that are tested.

• Non-invasive Prenatal Testing (NIPT) is the most accurate prenatal genetic screening test and may be OHIP-funded or private-pay depending on your situation.

• There is no risk to the pregnancy because it is done through blood work. NIPT can tell you the chance for having a baby with trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome) and trisomy 13 and other sex chromosome differences and other chromosome differences.

When would you use NIPT

You can have NIPT from the time you are 9 or 10 weeks pregnant until the end of the pregnancy. 

Who should not have NIPT?

You should not have NIPT if you:

• had a "vanishing" twin / co-twin demise. This is a pregnancy that started as twins, but one of the twins was lost. 

• are expecting more than two babies (triplets, quadruplets etc).

If you decide to have NIPT from the start, you do not need another screening test (such as eFTS). You should still be offered a 11-14 week (nuchal translucency) ultrasound on its own to get more information about the health of the baby.

What will the NIPT results mean?

• When you get your NIPT report, it will most likely  say that you have a “low risk” result. 

• This means there is a very low chance that the baby has one of the screened conditions.

• Some people will get a “high risk” result. 

  • This means there is a high chance that the baby has one of the screened conditions. 

  • More testing would be offered to you, including diagnostic testing.

There are three main benefits of NIPT:

• Higher accuracy

• Earlier timing

• Safe

• Limitations

NIPT has some of the following limitations:

• Not diagnostic

• Does not screen for "everything"

• Can fail to give you a result

• Can give you an unexpected result or a result that is not typical

1. What should pregnant people be avoiding an early pregnancy to prevent perinatal infection or other exposure concerns?

• Limit high-mercury fish to no more than 150g (5.3 oz) a month. 

•  long periods of standing, repeated lifting, or activities, occupational hazards

• Don't do heavy lifting,

• prepare food with care: maintain a clean kitchen space, sanitize, wash fruits and vegetables, cook meat 

• Avoid contact with cat feces, including changing cat litter, and rodents and rodent feces.

• No alcohol, vaping or cigarette use

• Listeria;foods such as meats and unpasteurized dairy, raw food, deli meats, raw eggs 

What are guidelines surrounding exercise

• SOGC guideline recommends that pregnant people should try to do physical activity at least three days a week, and they should incorporate a variety of exercises, including aerobic exercise, resistance training, gentle stretching and pelvic floor training.

• Pelvic floor muscle training (e.g., Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction in proper technique is recommended to obtain optimal benefits

• should incorporate a variety of aerobic exercise and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial 

What are abnormal lung sounds

• •abnormal wheezes, rhonchi, stridor, rubs, crackles,crunches auscultate rate and breath sounds 

What is the range of lungs sound

• [8-24 breaths per minute]

What are the heart rate for an adult

• [60-100 beats per minute]

1. What are the different points to listen to the heart

1. Aortic Pulmonary Erb's Point Tricuspid Mitral

What is expected to be a normal BP

[100-140 / 60-90 mmHg]

1. What are some of the things we are looking for in reflexes

• Assess for hyperreflexia(hyperactive or repeating reflexes), 

• areflexia(Absence of neurologic reflexes such as the knee-jerk reaction), clonus, and symmetry and muscle strength of left versus right

1. What are some routine labs and what do the test for 

CBC; ferritin levels, 

• total number of red blood cells (the RBC count)

• total amount of hemoglobin  in the blood

• percentage of blood made up of red blood cells (the hematocrit)

• average red blood cell size (the mean corpuscular volume)

• average weight of hemoglobin per red blood cell (the mean corpuscular hemoglobin)

• average amount of hemoglobin per red blood cell (the mean corpuscular hemoglobin concentration)

• total number of white blood cells

• number of each type of white blood cell (the WBC differential), including neutrophils

•  (the absolute neutrophil count, or ANC)

• number of platelets (the platelet count)

ABO;

•  this is to determine your blood type and  Rh factors 

• Urinalysis

• red blood cells, a possible sign of a urinary tract disease

• white blood cells, a possible sign of a urinary tract infection (UTI)

• glucose, because high levels of blood sugar can be a sign of diabetes

• urine culture

• STI; chlamydia and gonorrhea, HIV, Hep B

Why is testing for Rh status important

Rh immune globulin (WinRho) is a blood product that is given when you’re at risk of forming antibodies.

When is Rhogam given

• Anti-D lg 300 g IM or IV should be given within 72 hours of delivery to a postpartum non sensitized Rh-negative woman delivering an Rh-positive infant.

When do you test for Rh factors

All pregnant women (D-negative or D-positive) should be typed and screened for alloantibodies with an indirect antiglobulin test at the first prenatal visit and again at 28 weeks

Why is Rh factors dangerous

• During pregnancy or birth, fetomaternal haemorrhage (FMH) can occur, when small amounts of fetal Rh-positive blood can cross the placenta and enter the Rh-negative mother’s blood

What test is required for to determine Rh factor

• During pregnancy or birth, fetomaternal haemorrhage (FMH) can occur, when small amounts of fetal Rh-positive blood can cross the placenta and enter the Rh-negative mother’s blood

What is the drug card for Rhogam

• Indication: After 12wks GA Dose: 300 mcg Route: IM Frequency: x1 at 28wk GA (routine). Within 72h of sensitizing events (miscarriage, abortion, ectopic, amniocentesis, CVS, motor vehicle accident) x1 postpartum PRN within 72h of birth.

• RX Notes: A dose of 300 mcg IM is recommended after each sensitizing event. Fetomaternal hemorrhage >15 mL of fetal red blood cells (>30 mL of fetal blood) may require higher dose.

Indication: Prior to 12wks GA Dose: 120 mcg Route: IM Frequency: Within 72 hours of miscarriage, abortion, ectopic pregnancy.

How do we test the babies RH factors

• This would be through cord blood 

DAT/ Rosette test

• determine if there is mixing of maternal and baby blood

• To test hemolytic disease in the newborn 

• DAT also looks at jaundice risk (test is for O parents)

• a qualitative screening test performed on a maternal blood sample to determine if FMH has occurred between an Rh-positive fetus and an Rh-negative mother

Does a history of UTI increase the chances of ASB

• Yes 

• be screened for Asb in each trimester, just because of the complications that are associated with utis and pregnancy, and that it, like utis, are more common in pregnancy, 

• The raiders are holding more urine so urinary stasis is more possible 

• Also a history of kidney injection would do more MSU

Asymptomatic bacteriuria risk factor

pregnancy, frequent sexual activity , hx of UTI, poor bladder hygiene

Asymptomatic bacteriuria positive diagnosis and labs

>100×10^6 CFU/L (>10^5 CFU/mL), lab midstream urine for culture and sensitivity

Clinical management of Asymptomatic bacteriuria

increase fluid, revirew bladder hygiene, cranberry extract

How much folic acid do we give in normal pregnancy

• 0.4mg

• 1.0mg (moderate risk)

• 4.0mg (high risk)

How much vitamin D should a client take

or take a supplement with 400 IU (10 µg)

How much iron should be taken

iron intake to 27mg daily during the final six+ months of pregnancy

What is the fibre intake

• Fibre;You’ll need 2-3g more of fibre in your diet daily for a total of 28g

What does the pap test screen for

Cervical cancer is almost always caused by human papillomavirus (HPV). There are more than 100 types of HPV and they can cause changes to the cells of the cervix. With some types of HPV, these cell changes can turn into cervical cancer over time if they are not treated.

People are eligible for cervical screening

• are at least 25 years old

• are a woman, Two-Spirit person, transmasculine person or nonbinary person with a cervix

• have ever had sexual contact with another person

• do not have symptoms, like different bleeding or discharge (clear or yellow fluid) from the vagina (genital opening)

• are due for cervical screening according to the Ontario Cervical Screening Program’s recommendations

There are 2 main types of cervical cancer:

• Squamous cell carcinoma of the cervix, which starts in the cells that line the outside of the cervix. This is the most common type of cervical cancer.

• Adenocarcinoma of the cervix, which starts in the glandular cells that line the inside of the cervix. Glandular cells make mucus and other fluids.

It is recommended that you have a cervical screening test every:

• 5 years if normal

• 3 years if you have a weakened immune system, for example, if you are living with HIV/AIDS or have had an organ transplant

• 2 years, for those with a history of positive cervical screening results

What are the benefits of Vaginal exam

make a positive identification of the presentation

• determine whether the head is engaged in case of doubt

• ascertain whether the forewaters have ruptured, or to rupture them artificially

• exclude cord prolapse after rupture of the forewaters, especially if there is an ill-fitting presenting part or there are fetal heart rate changes

• assess progress or slow labour

• confirm full dilatation of the cervix (see Fig. 16.12)

• confirm the axis of the fetus and presentation of the second twin in a multiple pregnancy in order to rupture the second amniotic sac, if necessary.

-VEs are conducted every two or four hours.

Routine bladder care in first stage labour

• Constantly emptying the bladder should be emptied at least 4-hourly or more frequently if it is palpable abdominally. 

• full bladder may increase pain, reduce efficiency of uterine contractions and delay descent of the presenting part

• Bladder and uterus compete for space and a full bladder takes up space

How do you define the onset of labour?

• Regular, painful uterine contractions that cause dilation and effacement

What rate of dilation is most successful?

• Dilation that progresses @ greater than or equal to 1cm/hr after 5cm dilation. Studies suggest that if her cervix is not rapidly dilating after 5cm that labour is abnormal and needs to be re-evaluated.

• Successful labour and SVD depend on the relationship between fetus, maternal pelvis, uterine and maternal power. 

• Dystocia can be result of difficulty with one of the 4 P’s: power, passenger, passage, psyche

  • Power: Contractions and expulsion efforts

    • Accurately try to determine strength of contractions though it is subjective. IUPC can be used.

  • Passage: pelvic boney structure, soft tissues (pelvic tumours, full bladder/rectum, 

    • Vaginal septum, obesity.

    • Examine the passage to identify possible issues

  • Psyche: pain, anxiety

    • Hormones released in response to stress can cause dystocia. Pain and absence of a support person can inhibit labour. Anxiety can inhibit normal dilation and increase pain perception. Stress hormones act on smooth muscle of uterus and leads to dystocia by reducing contractions.

  • Passenger: position, attitude, size, abnormalities

    • Assess fetus for size and position

    • Adequate uterine power should correct malposition but inadequate power will result in persistant malposition

    • Normal sized infant may present an increased diameter to the pelvis because the head is not properly flexed or is asynclitic. Adequate maternal power should fix this

Dystocia can be result of difficulty labour

• Power:

• Passage:

• Psyche:

  • Passenger:

What are the comfort measures and pain relief options?

Non-pharmacological pain relief

• Self hypnosis

• Acupuncture

• Acupressure

• Aromatherapy

• Audio analgesia

• Massage

• TENS

• Water immersion

  • Found to significantly reduce use of epidural/spinal/paracervical analgesia

  • Result in shorter first stage

• Sterile water injections

  • Significantly reduces pain for up to 2 hours

  • Reduces c-section

What is power and hoe does it impact delivery

• Power: Contractions and expulsion efforts

  • Accurately try to determine strength of contractions though it is subjective. IUPC can be used.

What is passage and hoe does it impact delivery

• Passage: pelvic boney structure, soft tissues (pelvic tumours, full bladder/rectum, 

  • Vaginal septum, obesity.

  • Examine the passage to identify possible issues

What is psyche and hoe does it impact delivery

• Psyche: pain, anxiety

  • Hormones released in response to stress can cause dystocia. Pain and absence of a support person can inhibit labour. Anxiety can inhibit normal dilation and increase pain perception. Stress hormones act on smooth muscle of uterus and leads to dystocia by reducing contractions.

What is passenger and hoe does it impact delivery

• position, attitude, size, abnormalities

  • Assess fetus for size and position

  • Adequate uterine power should correct malposition but inadequate power will result in persistant malposition

  • Normal sized infant may present an increased diameter to the pelvis because the head is not properly flexed or is asynclitic. Adequate maternal power should fix this

Sedative and hypnotic drugs

• do not provide pain relief and can cause respiratory depression especially when given with opiods

  • Sedative drugs can however help women with high levels of anxiety

  • Sedative drugs reduce episodes of nausea and vomiting and enhance analgesia obtained with opiods

  • Anticholinergic side effects are common with antiemetics and sedatives and you should be careful when addressing discomforts

  • All drugs have some effects on the parent and/or fetus

  • Although opioids are great for pain, some have active metabolites that can have a long half-life in a newborn- eg meperidine

  • Women can be medicated with opioids or nitrous oxide before birth without causing significant respiratory depression in infants

Nitrous Oxide

• 50% nitrous oxide and 50% oxygen

• Provides mild to moderate analgesia

• Self administered

• Deep inhalation as soon as aware of the contraction for max benefit

• Useful for woman who coped well until transition

• Use when getting a spinal

Opioids

• IV, subq, IV bolus

• IV equals rapid effect

• Useful when combined with antiemetic 

• Side effects : nausea, vomiting, drowsiness

• Opioids with longer half-life have more intense effects on neonates- includes respiratory depression and neurobehavioural outcomes affecting regulation of states of consciousness and reflexes

• Morphine and fentanyl are preferred

Peripheral nerve block

• Local anesthetic used are lidocaine and bupivicaine

• Need to know safe doses, how top calculate dose, s/s of toxicity

• Pudendal nerve block

  • Used for pain relief of perineum in second stage of labour

• Perineal infiltration

•  

  • Used in repair of episiotomy and lacerations

Epidural block

• Provides effective pain relief through all stages of labour

• Effective relief of pain via epidural reduces endogenous catecholamines which improves labour progress and placental perfusion.

• Very beneficial for people with labour dystocia who require oxy to augment labour

• Compared to other pain relief methods an epidural is considered superior

Epidural block Associated with increased risk of 

• assisted vaginal birth, 

• maternal hypotension, 

• motor blockade which interferes with mobility and pushing efforts 

• maternal fever, 

• urinary retention, 

• longer second stage of labour, 

• oxy administration- needed if ctx ineffective or infrequent

• Relaxation of maternal pelvic floor may result in persistent fetal head malposition

• increased risk of CS

Prophylactic Uterotonics

• Prophylactic oxytocin at any dose decreases PPH greater than 500ml and the need for therapeutic uterotonics compared with placebo and ergot alkaloids

• Prophylactic oxytocin is preferred over ergot alkaloids for prevention of PPH bc it has minimal side-effects

Controlled cord traction

• Uterus continues to contract after the birth

• Once there is evidence of placental separation, traction is applied to the umbilical cord with counter pressure to the suprapubic area on the uterus until the placenta is delivered

• CCT is shown to reduce blood loss of 500ml or more, less manual removal of the placenta

• CCT should be offered in the third stage and only by people that know what they are doing

Timing of Cord clamping

• Delaying cord clamping by 60-180sec is associated with less need for transfusion for anemia, less intraventricular hemorrhage and less risk of necrotizing enterocolitis in non-resuscitated premature infants under 37 weeks gestation compared to immediate clamping

• Late cord clamping is associated with increased hemoglobin levels and iron stores in infant for up to 6  months compared with early maternal outcomes in terms of severe PPH or blood loss of greater than 500ml

What is Dystocia?

• Dilatation of less than 0.5 cm/ hour over 4 hours or no cervical change over 2 hours in the active first stage or greater than 1 hour of active pushing and no descent of the presenting part in the second stage

What is the dystocia active first stage of labour?

• Greater than 4 hours of < 0.5 cm/hour dilatation or no dilatation over 2 hours.1

What is dystocia in 2nd stage of labour

• Greater than 1 hour of active pushing without descent of the presenting part.

What is obstructed labour?

• No cervical dilatation or descent over 2 hours despite evidence of strong contractions (caput, molding, or measured using an IUPC).

Vitals for baby

• FHR should be assessed regularly throughout the labour, typically every 15-30 minutes during the first stage of labour

• Active first stage is every 15 mins

• Active second stage is every 5 min

Mom/Parent  vitals

•  It is common practice to assess vital signs every 2 hours if the waters are broken and every four hours if waters are intact. 

Blood pressure

•  should be assessed between contractions. Persistently high blood pressure readings of ≥140/90 mm Hg necessitate more frequent assessments 

Heart rate/pulse

• persistent tachycardia of ≥100 bpm is a cause for concern and consultation. 

Temperature 

•  ≥37.5oC is an indication to check the temperature again soon and address any possible causes. A reading of ≥38oC is a cause for concern

Respiration

Postpartum vitals

• Checking bleeding, fundus, (vitals)BP, temp, HR in the first 1hr its q15

• Bleeding (colour/amount), clots sizes, fundus firm or boggy/central, midline or deviated, where is the fundus, voiding 

• In the 2hrs your doing it q30

What is Active management?

•administration of uterotonic agents

• Uterotonics may be administered at different times after the delivery of the anterior shoulder, within 60 seconds of birth, or after delivery of the placenta or after clamping of the cord

• Given after anterior is born 

•controlled cord traction

• Controlled cord traction may be initiated before or after signs of placental separation are apparent

•uterine massage after delivery of the placenta, as appropriate.

• Current WHO guidelines recommend against uterine massage for prevention of PPH in women who have received prophylactic oxytocin

What is a PPH?

• Primary PPH is defined as excessive bleeding that occurs in the first 24 hours after delivery.

• It’s normal to lose some blood during and after a birth. During pregnancy, the amount of blood you have in your body almost doubles

• 500 ml of blood (about two cups) after a vaginal birth, or more than 1000 ml (about four cups)

• Secondary PPH occurs ≥ 24 hours postpartum and is estimated to occur in 1% to 3% of all births, but actual incidence is less certain. 

What Causes a PPH?

• Abnormalities of uterine contraction

• Retained placental tissue or clots prevent occlusion of uterine blood vessels

• Blood loss due to genital tract trauma

• Coagulation abnormalities prevent effective clot formation

What are the risk factors of PPH?

• Augmentation in labour, 

• previous PPH,

• macrosomia, 

• polyhydramnios, 

• epidural, 

• long/fast labour, 

• multiple baby in pregnancy, 

• Over-distended uterus

what are the 4 t’s

Why Do we do eye prophylaxis on NBs?

Erythromycin is the only ophthalmic eye ointment approved for use in NB. Does not prevent Chlamydial conjunctivitis.

What is neonatal ophthalmia?

• neonatal conjunctivitis is caused by viral infections (herpes simplex, adenovirus, enteroviruses)

What happens to infants exposed to gonococcal ophthalmia?

may progress quickly to corneal ulceration, perforation of the globe and permanent visual impairment

What causes VKDB?

•  vitamin K deficiency bleeding (VKDB) caused by inadequate prenatal storage and deficiency of vitamin K in breast milk

What is hemorrhagic disease of the newborn? (Also known as Vitamin K deficiency bleeding VKDB)

• Hemorrhagic disease of the newborn (HDNB) presents as unexpected bleeding, often with gastrointestinal hemorrhage, ecchymosis and, in many cases, intracranial hemorrhage

How is VKDB classified?

 have been classified: early onset (occurring in the first 24 hours post-birth), classic (occurring at days 2 to 7) and late onset (at 2 to 12 weeks and up to 6 months of age).

what is the recommendation to prevent VKDB?

 IM administration of a single dose of vitamin K at 0.5 mg to 1.0 mg to all newborns. Administering PO vitamin K (2.0 mg at birth, repeated at 2 to 4 and 6 to 8 weeks of age),

What is the recommendation for Vit K and preterm infants?

• Preterm infants are at higher risk for VKDB, due to hepatic immaturity, delayed gut colonization with microflora and other factors. 

•  recommendations for vitamin K prophylaxis at birth for preterm infants vary widely in terms of dosage and routes of administration

Newborn exam

What are the components of the placental exam?

1. INSERTION

• The umbilical cord inserts into the fetal side of the placenta. The location of the insertion may vary, Two arteries and one veins 

•  view Parental/FETAL SURFACEs

• Fetal surface;two placental membranes - the amnion and the chori-on - which give this side of the placenta a shiny, white appearance

3.MEMBRANES

• amnion is the top layer on the fetal side. It is thin, smooth and transparent

•  chorion is thicker, rougher and opaque

COMPLETENESS

Both layers of the membranes should be examined for completeness. The amnion is the top layer on the fetal side. It is thin, smooth and transparent (Figure 11-12). The chorion is thicker, rougher and opaque.

4. PRESENCE OF ADDITIONAL TISSUE OR VESSELS

What is the schedule for PP visits?

• provide one visit within 24 hours of birth, one visit between days two and three, one visit between days seven to fourteen, one visit between weeks three and four and one visit at approximately six weeks (discharge visit)

What are the components of the 1st PP home visit?

• Critical congenital heart defects (CCHD): ductus arteriosus should be closed by 24 hours, allowing for accurate detection

• recommendation that midwives offer pulse oximetry screening between 24 to 36 hours, and up to 48 hours post-birth.

• Newborn diseases (metabolic diseases, endocrine diseases, sickle cell diseases, cystic fibrosis and severe combined immune deficiency) approximately 20 of the diseases screened: 10% to 20% of affected infants will become symptomatic in the first week; 5% to 10% may die in the first week.

• NSO recommends blood spot specimen collection between 24 to 48 hours

• Jaundice test