ABO Incompatibility
*significant problems arise when mothers have O blood type and where the baby is either A or B
*premature babies are much more likely to experience sever problems from ABO incompatibility, while healthy full term babies are generally only mildly affected
*Type A has the A antigen, B has the B antigen AB has both antigens and O has no antigen
*if different blood types mix, an immune response occurs and the person will produce antibodies to attack the foreign blood antigen
*antigens can cross placenta during miscarriage, trauma, birth and other reasons unknown and destruct the RBCs of the baby resulting in too much bilirubin
*anemia may then become an issue
*testing: after birth cord is tested for mothers with O blood and fathers with A or B blood
*theory is that if baby is type A or B and the test is positive then the baby can be followed closely for jaundice
* Hemolytic disease of the newborn―continued
◦ ABO incompatibility: most common cause of hemolytic disease
Fetal blood type is A or B and the maternal type is O
Naturally occurring anti-A and anti-B antibodies are transferred across the placenta to the fetus
Exchange transfusions required occasionally
Advantages of breastfeeding
why do women chose not to breastfeed? Women working(interferes with breastfeeding)
*higher socioeconomic status/more education the higher she is to breastfeed
*exclusive breastfeeding for first 6 months
*human milk sole milk supply for first 12 months
*appropriate complementary foods added during second 6months
*if weaned from breast milk before 12 months, use iron fortified infant formula
*nurtients in breast milk (like iron) more easily absorbed than those in formula (vit D supplementation for breast fed babies?)
*contains antimicrobial factors (antibodies)
*immunoglobulin A (IgA) major antibody
*colostrum: more concentrated than mature milk and extremely rich in immunoglobulins
*higher concentrations of protein and minerals but less fat than mature milk
* Composition of mature milk changes during each feeding
• More fat in milk after about 10 – 20 minutes into feeding
• Decreased incidence and severity of infectious diseases
• Reduced post neonatal infant mortality
• Decreased rates of SIDS, obesity and hypercholesterolemia
• Decreased incidence of diabetes, some cancers, asthma, allergies
• Possible enhanced cognitive development, enhanced jaw development, analgesic effect
• Decreased postpartum bleeding and improved uterine involution
• Reduced risk of ovarian cancer and premenopausal breast cancer
• Lower risk of hypertension, hypercholesterolemia, and CVD
• Earlier return to prepregnancy weight
• Decreased risk of postmenopausal osteoporosis
• Bonding experience
• Increased maternal role attainment
• Convenient, ready to feed
• No bottles or other equipment
• Less expensive
• Reduced annual health care costs
• Less parental absence from work due to infant illness
• Reduced environmental burden (waste)
Disadvantages of breastfeeding
- Disadvantages:
- Commitment to be with baby or pumping for feedings
- Pain
- Leaking Milk
- Embarrassment
- Stress
- Unequal feeding responsibilities
- Diet restriction
- Limited hormonal birth control options (can decrease milk supply)
- Vaginal dryness
- Medications
- Contraindications
- HIV, AIDS – In US
- Drug use/abuse
- Maternal smoking-encourage to quit but not a contraindication
- Medications- chemotherapy or radioactive isotopes, bromocriptine, reserpine, high-dose corticosteroids, cyclosporine
- Active tuberculosis, maternal human T-cell lymphotropic virus
- Infant with galactosemia
- Mothers with Herpes lesions on breasts
- Carbodydrate is lactose
- Alveoli are milk producing cells within lobes
- Myoeptihlial: contract to send milk to ductules
- Growth spurts: 10 days, 3 and 6 weeks and 3 and 6 months
- Oxytocin is milk ejection reflex
- Prolactin is the milk producing horomone
- Engorgement happens first 2-3 days
- Take warm shower or put warm washcloth on breasts and massage for milk letdown
- Engorge is hard swollen breasts
Bilirubin
*breakdown of hemoglobin
*too much causes jaundice
*physiologic jaundice occurs in about half of healthy newborns
*80% of preterm infants
*hyperbilirubinemia can result in kernicterus
* Hemolytic disease of the newborn
◦ Rh incompatibility (isoimmunization)
Rh-positive offspring of an Rh-negative mother is at risk
Mother forms antibodies against the fetal blood cells
Hydrops fetalis – rare - edema, anemia, cardiac decompensation, cardiomegaly, hepatosplenomegaly
Do rhogam at 28 wks and within 72 hours after birth
Acute Bilirubin Encephalopathy
◦ Caused by deposition of bilirubin in brain
◦ Can develop in newborns who show no apparent signs of clinical jaundice
◦ Associated with acute and long-term symptoms of neurologic damage
◦ Never present at birth
◦ Kernicterus-brain damage due to bilirubin toxicity
◦ Treatment:
Rh0(D) immune globulin given to Rh-negative and Coombs’ test–negative women minimizes the possibility of isoimmunization
During pregnancy
postpartum
Phototherapy to breakdown bilirubin so it can be excreted in the urine
Neonatal exchange transfusion with type O,
Rh-negative RBCs may be used at high levels of hyperbilirubinemia
TORCH
- T-toxoplasmosis
- O-other-gonorrhea, syphilis, varicella, hepatitis b, HIV
- R-rubella
- C-cytomegalovirus
- H-herpes simplex virus
- all are common infections
- can cross placenta
- varicella: for mom who hasn’t had chicken pox it is important she is not exposed to virus early in pregnancy
- if mom is hep B positive then baby needs to be immunized and given hep B immunoglobulin
Large Baby (Macrosomia)/Fractured clavicle
- over 4,000grams (8lbs 12 oz)
- round and chubby body
- enlarged internal orgnas and increased body fat esp around shoulders
- accelerated protein synthesis, together with a deposition of excessive glycogen and fat stores is responsible for the typical macrosomic infant
- most at risk for hypoglycemia, hypocalcemia, hyperviscosity, and hyperbilirubinemia
- excessive shoulder size can lead to dystocia
- birth trauma such as clavicle fracture or Erb-Duchenne palsy
- fractured clavicle: splint so its immobile
- herbs palsy is nerve damage due to trauma-resolves in 6-12 months (do ROM)
- diff between clavicle fractureand erbs palys is that pain and crepitus with clavicle
Naegles Rule
- LMP - 3 months + 7 days + 1year
* February 14, 2013 -à feb 14, 2014 – 3 Months =Nov 14, 2013………..+ 7 days = nov 21, 2013
Developmental age based on prematurity
growth and development corrected for gestational age until 2 ½ years of age
* born at 30wks, at 6 wks of life act like 36 wk gestation * catch up growth: head first, then weight and height
Oral Contraceptives (2 questions)
combined estrogen-progestin contraceptive
- regular ingestion of combine oral contraceptive pills suppresses the action of the hypothalamus and anterior pituitary, leading to insufficient secreation of FSH and LH; therefore, follicles do not mature and ovulation is inhibited
- inhibit release of ovum
- atrophic endometrium
- thick cervical mucus
- back up for 7 dyas if not initiated during menses
- miss 1 pill
- take as soon as possible-no backup needed
- miss two pills
- week 1 or 2
- take 2 pills a day for 2 days and finish package-use backup method
- week 3
- Sunday starter: take 1 pill every Sunday until Sunday-start a new pack Sunday-use backup method
- day 1 starter: throw away rest of pakc and start new pack on same day-use back up method
- week 1 or 2
- miss 3 or more pills
- Sunday starter: take 1 pill every day until Sunday. Start new pack on Sunday-use back up method
- day 1 starter: throw away rest of pack. Start new pack-use back up method
- anticonvulsatns, antifungals, antituberculosis and anti-HIV protease inhibitors decrease effectiveness, also irregular use does
Depo-vera (implant)
- progestin-only contraception
- thickens cervical mucus, suppresses ovulation, atrophic endometrium
- has lots of breakthrough bleeding
- injectable progestins
- doesn’t affect breastfeeding
Vasectomy
sealing, tying or cutting of mansvas deferens so that sperm cant travel from testes to penis
- easiest and most common used operation for male sterilization
- ice packs for swelling and discomfort
- sterility is not immediate
- tubal reconstruction (reanastomosis): in 90% of cases ducts can be hooked back together
Barrier Method (what method most effective?)
also popular a a protective measure against spread of STIs
- spermicides: do not prevent STIs or HIV and may increase risk with frequent use
- male and female condoms provide a mechanical barrier to STIs and HIV
- spermicides
- nonoxynol-9
- cream, jelly, foam
- vaginal film
- suppository
- male/female condom
- diaphragm: (slight risk for toxic shock syndrome)
- cervical cap and contraceptive sponge
- remove after intercourse
Intrauterine Devices
- offer constant contraception
- small t-shaped device inserted into the uterine cavity
- medicated iuds loaded with either copper or progestational (progesterone-type) agent
- offer no protection against STIs or HIV
- copper IUD can be considered an emergency contraceptive if inserted 5 days after unprotected sex
Amenorrhea
temporary method of birth control
- when infant suckles at mothers breast a surge of prolactin hormone is released which inhibits estrogen production and suppresses ovulation and the return of menses
- works best if mother is exclusively or almost exclusively breastfeeding, if woman has not had menstrual flow and if infant is younger than 6 months
Abortion
- induced abortion
- purposeful interruption of pregnancy before 20 wks of gestation
- elective: performed at mothers request
- therapeutic: due to health of mother or fetus
- purposeful interruption of pregnancy before 20 wks of gestation
- abortion permissible in 1st trimester
- aspiration: vacuum or suction curettage
- medical abortion
- methotrexate and misoprostol
- mifepristone and misoprostol
- in second trimester abortion is left to the discretion of the individual states
- dilation and evacuation
- may be limited or prohibited in 3rd trimester
STDs
chlamydia: preterm labor and low birth weight
* gonorrhea
* miscarriage, preterm, amniotic infection, endometritis, sepsis, IUGR etc
* herpes: intrauterine infection, congenital infection
* syphilis: miscarriage, preterm, IUGR, stillbirth (IM penicillin)
* varicella for mom who hasn’t had chicken pox –imp that shes not exposed to virus early in pregnancy
* c-section if herpes outbreak
* if mom hp B pos then baby needs to be immunized and give it hep B immunoglobulin
* If mom being treate for HIV then only 1-2% of baby getting it
Teratogens
- greatest vulnerability is day 15-8wks (also during periods of rapid growth anddifferentiation-embryonic period)
- drugs, viruses and chemicals
- can cause congenital malformations
- certain drugs and chemicals, infections, exposure to readiation and certain maternal conditions such as diabetes and PKU
PICA
*practice of consuming nonfood substances or excessive amounts of foodstuffs low in nutritional value
HIV
- if being treated only 1-2% chance of passing on to baby
- heroin use increase risk of HIV and hep
- spermicides do not protect against HIV and may increase with frequent use
- highest in aftcan American women
Alfa-fetoprotein
maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for NTDs in pregnancy
*Alpah-fetoprotein (AFP) is produced by the fetal liver and increasing levels are
detectable in the serum of pregnant women from 14-34 wks of gestation
*MSAFP is a screening tool only and identifies candidates for the more definitve procedures of amniocentesis and US
*screening recommended for all pregnant women
*with this 80-85% of all open NTDs and open abdominal wall defects can be detected early in pregnancy
Biophysical profile
noninvasive dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease
- includes AFV, FBMs, fetal movememts, and fetal tone and FHR
- score of 0-10 with 10 being normal infant, low risk for chronic asphyxia
- 8-10 with a normal AFV is considered normal
Labor positions
all fours is therapeutic for moms having back pain
- upright speeds up labor
- lithotomy: least effective
- semirecumebnt
- lateral
- upright, squatting, lateral recumbent is best for mom
Late Decels
what does a late decal mean? Uteroplacenta insufficiency
