20. the impact of maternal illness
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The Impact of Maternal
Illness on the Newborn
Julniar M. Tasli
Herman Bermawi
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Background
Improvements in obstetric care can directlyinfluence neonatal survival
Prevention of neonatal asphyxia, sepsis, preterm
birth and low birth weight can be achievedthrough improved care during pregnancy andduring delivery
In the new model of integrated perinatal care
pediatric and obstetric care occur collaborativelytowards the common goal of a safe delivery andimproved neonatal survival
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Learning Objectives
Identify maternal conditions duringpregnancy and labor that can influenceneonatal outcomes.
Understand the association betweenspecific conditions and neonatal outcomes.
Suspect and recognize neonatal clinical
presentations related to such conditions.
Decide on management plan of thenewborn based 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 andmorbid obesity) Appropriate weight gain and physical
activity
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Balanced nutrition (micronutrientintake; iron, zinc, folic acid, iodine,
calcium)Avoidance of environmental
exposures (nicotine, other drugs,medications, pesticides)
Mental health including stress anddepression
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Lack of compliance can be directly andindirectly associated with :
Prematurity and low birth weight andcomplications associated with these
important contributors to infantmortality and morbidity
Higher incidence of specific neonatal
complications e.g. congenitalanomalies (neural tube defects) andin-utero growth retardation
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Prenatal care and its role: Prenatal care is designed to identify maternal
complications early and give pregnant mothersguidance to healthy behaviors during pregnancy.
Prenatal care should educate mothers and theircommunity on the identification of early dangersigns during pregnancy
Prenatal care should also help mothers prepare
for the arrival of the newborn, and give thembasic education on the early care of the neonate.
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1. Early Identification ofPregnancy:
Accurate gestational agedetermination
Promotes the early adoption ofhealthy behaviors and avoidance ofunhealthy behaviors and exposures
Early screening for infections andother risks
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Enhances the ability for early diagnosis
and treatment of maternal diseasesaffecting pregnancy:Anemia Maternal malnutrition
Pre-existing medical conditions(hypertension, diabetes, TB, malaria,STI & urinary tract infections)
Uterine conditions e.g. fibroids, andanatomic abnormalities (bicornuate
uterus) Maternal cardiac disease Thyroid disorders
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A. Maternal Nutrition
Evaluating nutritional status
Low pre-pregnancy weight (less than50Kg?)
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 beforepregnancy) reduces the risk for neural tubedefects.
Adequate iron supplementation especially incases with anemia.
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, breastmilk
Associated with IUGR,hepatosplenomegaly, microcephaly,retinopathy, and hydrops
May present in the neonate also with:
Jaundice, LBW, thrombocytopenia withskin 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 congenitalheart 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 immediateneonatal 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 chronichepatitis, 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, anytimeduring pregnancy (worst effects with
early infection)
Associated with fetal loss and still birth,and congenital syphilis (skin and
mucous membrane lesions, hepato-splenomegaly, anemia andthrombocytopenia, bone lesions)
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Toxoplasma gondii
Transplacentally transmitted with the
worst effects in early transmissionAssociates with
Hydrocephalus/microcephaly, braincalcifications, hepatosplenomegaly,
retintis/blindness hearing loss andmental retardation.
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C. Thyroid Diseases
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Hypothyroidism
Suspected after thyroid surgery, andin cases 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 motherand fetus. Maternal complications include severe
preeclampsia and heart failure, andcardiac arrythmias
Fetal complications include preterm birthand neonatal thyrotoxicosis
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2. Identifications of IllnessesComplicating of Pregnancy:
Identification and early treatment ofhypertension in pregnancy as a continuumof Pre/eclampsia
Identification and treatment ofGestational Diabetes
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 AC :
+ LGA
+ Birth injuries+ Hyalin membran disease
+ Polycythemia
+ Hyperbilirubinemia+ Hypoglycemia
+ Congenital anomaly
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Maternal diabetes type DF&R :
+ LBW / SGA
+ Congenital anomaly+ Hypoglcemia
+ Polycythemia
+ Hyperbilirubinemia