clinical coding seminar 28th october 2007

Maternal conditions affecting the neonate

Issues of prematurity (<37weeks):

– Cervical incompetence – difficulties with diagnosis

management issues

outcomes ↑PNMR

midtrimester M/C

preterm delivery

Chorioamnionitis

Maternal conditions affecting the neonate

Issues of prematurity (contd):

– Preterm rupture membranes (PROM)

Maternal conditions affecting the neonate

Issues of prematurity (contd):– Preterm rupture membranes (PROM)

DefinitionDiagnosisConsequences ↑PNMR

PTLChorioamnionitishypoplastic lungslimb deformitiesPerinatal morbidity

Maternal conditions affecting the neonate

Issues of liquor volume– (physiology of liquor formation)– Oligohydramnios - association with fetal anomalies

PROM (diag)placental dysfunction (IUGR)

- outcomes ↑PNMRinfectionPTLIUFDHypoplastic lungs

limb problems

Maternal conditions affecting the neonate

Issues of liquor volume (contd)– Polyhydramnios - association with fetal anomalies

multiple pregnancies

diabetes - outcomes ↑PNMR

PTLcord presentation/prolapseunstable fetal liecompound presentationsmetabolic issues (DM)

Maternal conditions affecting the neonate

Placental issues– Position - pl.previa → APH, IUGR, prematurity– Morphology - pl.accreta/increta/percreta → IUGR– Function - Insufficiency → IUGR

Transfusion syndromeSeparation

Cord issues– Cord (funic) presentation/ Cord prolapse

polyhydramnios, unstable lie/high PPmalpresentations

– Vellamentous insertion

Haemolytic disease of the newborn

Definition - breakdown RBCs → anaemia → reduced O2 capacity

Causes: Rhesus incompatibilityABO incompatibilityOther (anti Kell, Duffy etc)ie, isoimmunisation

Outcomes: in utero – hydrops fetalisex utero - anaemia

kernicterus

Birth Injuries

Operative vaginal delivery– Large baby– Maternal exhaustion– poor application/technique/choice

Macrosomia → shoulder dystocia– May not be associated with excessive force– (demonstration)

Birth Injuries

Head - intracerebral – extra/subdural haemscalp – lacerations, haematomafacial nerve

Neck/spine – brachial plexus (Erb’s Palsy)

Other skeletal - # clavicle# humerus# femur