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Maternal Conditions Affecting Neonates: Understanding Prematurity and Birth Injuries

This seminar discusses critical maternal conditions impacting neonates, focusing on prematurity issues such as cervical incompetence, preterm rupture of membranes (PROM), oligohydramnios, and polyhydramnios, along with their associations and outcomes. We also explore placental issues and their implications for perinatal morbidity and mortality. Additionally, the seminar covers birth injuries related to operative vaginal delivery and factors like macrosomia, including various neonatal injuries. Understanding these elements is vital for improving management strategies and outcomes for both mothers and newborns.

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Maternal Conditions Affecting Neonates: Understanding Prematurity and Birth Injuries

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  1. Clinical Coding Seminar 28th October 2007

  2. Maternal conditions affecting the neonate • Issues of prematurity (<37weeks): • Cervical incompetence – difficulties with diagnosis management issues outcomes ↑PNMR midtrimester M/C preterm delivery Chorioamnionitis

  3. Maternal conditions affecting the neonate • Issues of prematurity (contd): • Preterm rupture membranes (PROM)

  4. Maternal conditions affecting the neonate • Issues of prematurity (contd): • Preterm rupture membranes (PROM) Definition Diagnosis Consequences ↑PNMR PTL Chorioamnionitis hypoplastic lungs limb deformities Perinatal morbidity

  5. Maternal conditions affecting the neonate • Issues of liquor volume • (physiology of liquor formation) • Oligohydramnios - association with fetal anomalies PROM (diag) placental dysfunction (IUGR) - outcomes ↑PNMR infection PTL IUFD Hypoplastic lungs limb problems

  6. Maternal conditions affecting the neonate • Issues of liquor volume (contd) • Polyhydramnios - association with fetal anomalies multiple pregnancies diabetes - outcomes ↑PNMR PTL cord presentation/prolapse unstable fetal lie compound presentations metabolic issues (DM)

  7. Maternal conditions affecting the neonate • Placental issues • Position - pl.previa → APH, IUGR, prematurity • Morphology - pl.accreta/increta/percreta → IUGR • Function - Insufficiency → IUGR Transfusion syndrome Separation • Cord issues • Cord (funic) presentation/ Cord prolapse polyhydramnios, unstable lie/high PP malpresentations • Vellamentousinsertion

  8. Haemolytic disease of the newborn • Definition - breakdown RBCs → anaemia → reduced O2 capacity • Causes: Rhesus incompatibility ABO incompatibility Other (anti Kell, Duffy etc) ie, isoimmunisation • Outcomes: in utero – hydrops fetalis ex utero - anaemia kernicterus

  9. Birth Injuries • Operative vaginal delivery • Large baby • Maternal exhaustion • poor application/technique/choice • Macrosomia → shoulder dystocia • May not be associated with excessive force • (demonstration)

  10. Birth Injuries • Head - intracerebral – extra/subdural haem scalp – lacerations, haematoma facial nerve • Neck/spine – brachial plexus (Erb’s Palsy) • Other skeletal - # clavicle # humerus # femur

  11. Thank you

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