outline the purpose of the Newborn assessment (NIPE)
To screen for congenital abnormalities that will benefit from early intervention
To make referrals for further tests or treatment as appropriate
To provide reassurance to the parents
Outline a NIPE exam:
General Inspection: Pallor/Cyanosis/Jaundice/Posture
Tone: Hypotonia
Head: Measure head circumference and record. Shape of the head, inspect sutures. Inspect fontanelles
Skin: Colour, Bruising/lacerations/vernix
Face: Dysmorphic features, asymmetry, trauma, nose
Eyes: Erythema, discharge, sclera, position & shape of eyes, red reflex
Ears: Inspect pinna, asymmetry, skin tags, accessory auricles
Mouth + Palate: Clefts in hard or soft palate, inspect tongue and gums
Neck and clavicles: Length of neck, neck lumps
Upper limbs: symmetry, fingers (count), palms, pulses
Chest: RR, work of breathing, RR, inspect chest. Auscultate both sides to compare for sounds. Listen to heart with bell and diaphragm. Pulse oximetry
Abdomen: Distension, umbilicus, hernias, palpation for organs
Genitalia: note any ambiguity. Males: position of urethral meatus, testicular swelling. Females: inspect labia, clitoris, vaginal discharge
Lower Limbs: Symmetry, oedema, ankle deformities, count digits. assess tone and movement in joints. pulses
Hips: Barlow’s and Ortolani’s tests for hip joint instability
Back/Spine: inspect for scoliosis, hair tufts, birth marks, sacral pits
Anus: patency. meconium should be passed within 24hrs
Reflexes: Palmar grasp, sucking, rooting, stepping, moro - MRS SP
What is an ectopic pregnancy? where are the most common sites?
When a fertilised ovum is implanted outside of the uterus.
Most common sites = fallopian tube, most in ampulla. More danger in isthmus.
Risk factors for ectopic pregnancy
- Previous ectopic pregnancy
- Pelvic inflammatory disease
- Prev surgery to fallopian tubes
- Endometriosis
- IUDs
- Older age
- Smoking
Presentation of an ectopic pregnancy
Ultrasound Findings:
- typically around 6-8wks gestation
- amenorrhoea, lower abdo pain (IF) + some bleeding (may be dark), cervical motion tenderness
On Ultrasound:
- gestational sac containing a yolk sac or foetal pole may be seen in a fallopian tube.
- non-specific mass in tube
- mass representing a tubal ectopic pregnancy moves separately to the ovary, may look similar to a corpus luteum but CL will move with the ovary.
Management of an ectopic pregnancy
3 ways to manage: Expectant, medical, surgical
Expectant: <35mm, unruptured, asymptomatic, no fetal HB, hCG <1,000IU/L
Involves closely monitoring pt over 48hrs and if b-hCG levels rise or symptoms manifest –> Intervention
Surgical: >35mm, can be ruptured, pain, visible fetal HB, hCG >5,000IU/L, Mx can involve salpingectmoy or salpingotomy.
Medical: <35mm, unruptured, no significant pain, no fetal HB, hCG <1,500IU/L, Mx involves methotrexate, only done if pt is willing to attend follow up.
