Maternal, Infant, Pediatric Care and Complications

Infant

Preterm Infant

  • Definition: A baby born alive before 37 weeks of gestation, typically weighing less than 2,500 grams.

  • WHO Classifications:

    • Extremely Preterm: < 28 weeks

    • Very Preterm: 28 0/7 through 31 6/7 weeks

    • Moderate Preterm: 32 0/7 through 33 6/7 weeks

    • Late Preterm: 34 to 36 6/7 weeks

Small for Gestational Age (SGA)

  • Definition: Babies smaller than expected for their sex and gestational age.

  • Characteristics:

    • Low birth weight ( <10th percentile)

    • Proportional growth or asymmetrical growth

    • Thin body appearance

    • Loose or thin skin

    • Weaker muscle tone

    • Increased head size in asymmetrical SGA

    • Risk of hypoglycemia

    • Breathing and temperature issues

    • Higher risk of health problems (jaundice, feeding difficulties)

Appropriate for Gestational Age (AGA)

  • Definition: Babies with normal size for gestational age, weight, length, and head size within the 10th - 90th percentile.

  • Characteristics:

    • Normal weight (2,500 - 4,000 grams)

    • Proportional body size

    • Good muscle tone and movement

    • Healthy skin color and development

Large for Gestational Age (LGA)

  • Definition: Babies whose weight is >90th percentile for gestational age ( >4,000 grams).

  • Characteristics:

    • Plump or chubby appearance

    • Risk of birth injuries (shoulder dystocia)

    • Higher risk of hypoglycemia

    • Possible breathing and feeding issues

    • Increased risk of jaundice and metabolic issues later in life

Low Birth Weight (LBW) Infant

  • Definition: A baby weighing less than 2,500 grams regardless of gestational age.

  • Characteristics:

    • Small size with thin or frail body

    • Low body fat

    • Large head compared to body

    • Weak cry and low muscle tone

    • Difficulty maintaining body temperature

    • Feeding problems and respiratory issues

Very Low Birth Weight (VLBW) Infant

  • Definition: An infant weighing less than 1,500 grams at birth.

  • Characteristics:

    • Extremely small size with thin arms and legs

    • Difficulty breathing and feeding

    • Weak muscle tone

    • Increased risk of infections

Extremely Low Birth Weight (ELBW) Infant

  • Definition: A newborn weighing less than 1,000 grams at birth.

  • Characteristics:

    • Very small size, thin skin

    • Breathing difficulties requiring oxygen

    • Inability to regulate body temperature

INDUCTION VS. AUGMENTATION

Induction: Stimulating contractions before labor begins.

Augmentation: Enhancing existing contractions that are inadequate.

Active Management of Labor

  1. Amniotomy: Artificial rupturing of amniotic membranes; not done at the latent phase.

    • Risks include:

      • Cord prolapse and infection

      • No increase in cervical dilation.

  2. Oxytocin: Not given if the case has cephalopelvic disproportion (CPD); Must monitor fetal heart rate and contraction frequency.

    • Avoid in cases of:

      • Uterine overdistension

      • High parity

      • Uterine scar

    • Stop giving oxytocin if contractions are:

      • 5x in 10 minutes

      • 7x in 15 minutes

      • Longer than 60 to 90 seconds

      • Non-reassuring FHR

Indication for Labor Induction

  • PROM (Premature Rupture of Membranes)

  • Maternal hypertension

  • Non-reassuring fetal status

  • Post-term gestation

Contraindications to Induction

  • Uterine factors (scar, classical csect)

  • Fetal factors (macrosomia, congenital anomalies)

  • Maternal factors (size, pelvic anatomy, active genital herpes)

UTERINE RUPTURE

  • Definition: Tearing of the uterus, manifesting as;

    • Complete rupture: Extends through entire uterine wall and uterine contents spill into the abdominal cavity

    • Incomplete rupture: Rupture extends through the endometrium and myometrium, but the peritoneum surrounding the uterus remains intact

  • Etiology

    • Trauma caused by injury from obstetric instruments

    • Obstetric interventions such as excessive fundal pressure, forceps delivery, violent bearing down, tumultuous labor, fetal shoulder dystocia,

    • Previous uterine surgery, grand multiparity combined with the use of oxytocic agents, CPD, malpresentation, hydrocephalus

  • Pathophysiology: Pre-existing scar that results in weakening or defect in the myometrium that does not stretch; this is most frequently identified in spontaneous uterine rupture, potentially leading to maternal hypovolemic shock, subsequent peritonitis, consequent fetal anorexia, and fetal demise.

  • Assessment Findings: Varies from no signs to severe symptoms

    • Abdominal pain and tenderness, which may indicate the severity of the rupture.

    • Vaginal bleeding (may be present but is not always)

    • Non-reassuring FHR

    • Palpation of fetal parts under the skin

    • Signs of hypovolemic shock (with complete uterine rupture

  • Danger signs of Pregnancy: Uterine rupture, Assess for; loss of uterine contour and palpable fetal part

    “CRAMPS UP” 

    • C ramping, contractions (uterine)

    • R upture of membranes

    • A bsence of fetal movement

    • M uscle irritability 

    • P ain (epigastric, abdominal, uterine) 

    • S potting or vaginal bleeding

    • U rine frequency or Oliguria

    • P ersistent vomiting

  • Nursing Management:

    • Close monitoring (for hypertonicity or signs of weakening uterine muscle, recognize signs of impending rupture, immediately notify the physician)

    • Prepare for possible surgical intervention.

CESAREAN SECTION

  • Definition: Delivery through abdominal incision.

  • Types of Incisions:

    • Midline vertical or Pfannenstiel abd incision

    • Uterine incisions include low transverse, low vertical, and classic vertical.

Indications for Cesarean Birth

  • Maternal factors: CPD, herpes, previous CS by classical section, hypertension.

  • Placental factors: placenta previa, abruptio placenta.

INFERTILITY IN MALE AND FEMALE

  • Fertility: Ability to conceive.

  • Infertility: Inability to conceive after one year of unprotected sex; 6 months for women 35+.

Types

  1. Primary: Woman has never been pregnant.

  2. Secondary: Difficulty conceiving after previous pregnancy.

Evaluation History of Infertility

  • Menstrual history, sexual history, past medical/surgical history, social history with emphasis on lifestyle factors.

Causes of Infertility

  • Female Factors: Hormonal issues, tubal blockage, uterine issues, PCOS.

  • Male Factors: Testosterone levels, sperm production, varicocele, prostate issues.

Diagnostic Tests for Female Fertility Issues

  • Pelvic exam, blood tests, ultrasound, hysteroscopy.

Treatment Options for Infertility

  • Women: Medications, surgery for obstructions or fibroids.

  • Men: Hormonal therapies and surgical interventions for blockages.

  • Both: IUI, IVF, ICSI, third-party ART options.

NEWBORN PROBLEMS

  1. Sudden Infant Death Syndrome (SIDS): Unexpected death of infants, linked to apnea and infections.

  2. Febrile Seizures: Seizures triggered by fever, common in children 6 months - 5 years.

  3. Failure to Thrive: Declines below 5th percentile in growth, can be organic or non-organic.

Examples of Treatments/Management

  • For SIDS: Emergency care and monitoring.

  • For Febrile Seizures: Identifying fever causes, ensuring hydration and comfort, and potential antipyretic use.

  • For Failure to Thrive: Nutritional intervention, psychosocial evaluations.