3 the impact of maternal illness on the newborn final 1
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The Impact ofMaternal Illness on
the NewbornJulniar M. Tasli
Herman BermawiAfifa Ramadanti
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Background Improvements in obstetric care can directly influence
neonatal survival
Prevention of neonatal asphyxia, sepsis, preterm birth
and low birth weight can be achieved through improvedcare during pregnancy and during delivery
In the new model of integrated perinatal care pediatricand obstetric care occur collaboratively towards thecommon goal of a safe delivery and improved neonatal
survival
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Learning Objectives
Identify maternal conditions during pregnancyand labor that can influence neonataloutcomes.
Understand the association between specificconditions and neonatal outcomes.
Suspect and recognize neonatal clinical
presentations related to such conditions.
Decide on management plan of the newbornbased on maternal presentation
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Maternal Well-being in Pregnancy:
Spacing of pregnancy
Adequacy of prenatal care including
immunizations (4 visits or more) Avoiding pregnancy at extremes of maternal
age
Avoidance of extremes of maternal pre-
pregnancy weight (under-weight and morbidobesity)
Appropriate weight gain and physical activity
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Balanced nutrition (micronutrient intake;iron, zinc, folic acid, iodine, calcium)
Avoidance of environmental exposures(nicotine, other drugs, medications,pesticides)
Mental health including stress and
depression
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Lack of compliance can be directly andindirectly associated with :
Prematurity and low birth weight and
complications associated with these
important contributors to infantmortality and morbidity
Higher incidence of specific neonatal
complications e.g. congenital anomalies
(neural tube defects) and in-utero
growth retardation
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Prenatal care and its role: Prenatal care is designed to identify maternal
complications early and give pregnant mothers guidanceto healthy behaviors during pregnancy.
Prenatal care should educate mothers and their
community on the identification of early danger signsduring pregnancy
Prenatal care should also help mothers prepare for thearrival of the newborn, and give them basic education onthe early care of the neonate.
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1. Early Identification of Pregnancy:
Accurate gestational age determination
Promotes the early adoption of healthybehaviors and avoidance of unhealthybehaviors and exposures
Early screening for infections and otherrisks
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Enhances the ability for early diagnosis andtreatment of maternal diseases affectingpregnancy: Anemia
Maternal malnutrition
Pre-existing medical conditions
(hypertension, diabetes, TB, malaria, STI &urinary tract infections)
Uterine conditions e.g. fibroids, and anatomicabnormalities (bicornuate uterus)
Maternal cardiac disease Thyroid disorders
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A. Maternal Nutrition Evaluating nutritional status
Low pre-pregnancy weight (less than 50Kg?)
Adequate weight gain (10-15 Kg)
Maternal anemia (Hgb =
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Recommendations Balanced dietary intake
Vit. D supplementation (severe deficiency may beassociated with neonatal hypocalcemia).
Adequate folic acid intake (starting before pregnancy)reduces the risk for neural tube defects.
Adequate iron supplementation especially in cases withanemia.
Avoiding Vit. A in high doses (teratogenic effects)
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B. Perinatal Infections
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Viral Infections:
Cytomegalovirus
Transmitted trans-placentally, breast milk
Associated with IUGR, hepatosplenomegaly,
microcephaly, retinopathy, and hydrops
May present in the neonate also with:
Jaundice, LBW, thrombocytopenia with skin
petechiae, and hearing loss
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Rubella:
Transplacentally transmitted
Dangerous effects on the fetus in the first
trimester Effects on the fetus include congenital heart
disease, IUGR, retinopathy, auditory nerve
hearing loss, cataract, purpura, and
hepatosplenomegaly
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Herpes simplex (HSV)
Ascending infection (intrapartum)
Effects on the fetus/neonate include: IUGR,Encephalitis/meningitis, seizures, retinitis,
mental retardation
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Varicella Zoster
Transmitted transplacentally (
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HIV
Transmitted transplacentally, during labor and
in breast milk Neonatal HIV/AIDS mostly asymptomatic in
the immediate neonatal period although some
manifest IUGR
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Hepatitis B
Transmitted mainly as an ascending
infection, and through breast feeding, rarely
transplacentally.
Associated with post-natal chronic hepatitis,
cirrhosis and hepatocellular carcinoma.
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Non-viral infections:
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Neisseria Gonorrhoea
Ascending infection intrapartum
Ophthalmia neonatorum (early)
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Treponema pallidum (syphilis)
Transmitted transplacentally, anytime during
pregnancy (worst effects with early infection)
Associated with fetal loss and still birth, andcongenital syphilis (skin and mucous
membrane lesions, hepato-splenomegaly,
anemia and thrombocytopenia, bone lesions)
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Toxoplasma gondii
Transplacentally transmitted with the worst
effects in early transmission
Associates with
Hydrocephalus/microcephaly, brain
calcifications, hepatosplenomegaly,
retintis/blindness hearing loss and mental
retardation.
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C. Thyroid Diseases
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Hypothyroidism
Suspected after thyroid surgery, and incases with goiter (thyroid swelling)
Associated with Hashimoto thyroiditis
May cause still birth, IUGR, placentalabruption, and preeclampsia.
Thyroxine replacement is indicated
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Hyperthyroidism Much more common than hypothyroidism
Should be suspected in cases with goiter
Most commonly due to Graves disease
If untreated can be dangerous to mother andfetus.
Maternal complications include severepreeclampsia and heart failure, and cardiacarrythmias
Fetal complications include preterm birth andneonatal thyrotoxicosis
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2. Identifications of IllnessesComplicating of Pregnancy:
Identification and early treatment ofhypertension in pregnancy as a continuum ofPre/eclampsia
Identification and treatment of GestationalDiabetes
Identification and treatment of infectionscomplicating pregnancy (UTI, systemic,malaria, TB, HIV)
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A. Impact of maternalhypertension
IUGR
Asphyxia
Prematurity and LBW/ SGA Congenital anomaly
Multiple gestation
Polycytemia + Hypebilirubinemia
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B. Impact of maternal diabetes
Maternal diabetes type A C :
+ LGA
+ Birth injuries+ Hyalin membran disease
+ Polycythemia
+ Hyperbilirubinemia
+ Hypoglycemia
+ Congenital anomaly
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Maternal diabetes type D F&R :
+ LBW / SGA
+ Conenital anomaly
+ Hypoglcemia
+ Polycythemia
+ Hyperbilirubinemia
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