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HD 2 > Perinatal and Childhood Mortality > Flashcards

Perinatal and Childhood Mortality Flashcards

1
Q

Define miscarriage.

A

Pregnancy loss < 24 weeks

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2
Q

Define stillbirth and stillbirth rates.

A

Baby born >24/40 showing no signs of life

Number of stillbirths for each 1000 TOTAL births.

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3
Q

Define neonatal death.

A

Baby born alive but dies in the first 28 days of life

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4
Q

Define early neonatal death.

A

Death 0-7 completed days

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5
Q

Define late neonatal death and neonatal mortality rate .

A

Death 7-28 days

Number of neonatal deaths (early and late) for each 1000 LIVE births.

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6
Q

Define infant death and infant mortality rate.

A

All deaths in the first year of life

Number of infant deaths for each 1000 LIVE births.

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7
Q

Define post-neonatal infant death.

A

Deaths 28 days-1 year

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8
Q

Define perinatal mortality rate.

A

Number of stillbirths and early neonatal deaths per 1000 TOTAL births.

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9
Q

What factors explain the international differences in these mortality rates? (7)

A 
Maternal health
Nutrition
Access to services
Income
Family size
Birthweight
Prematurity
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10
Q

What major diseases contribute to current perinatal and neonatal mortality in the UK? (6)

A 
Prematurity 
Congenital abnormalities
Asphyxia
Infections
‘Unexplained’ stillbirth
Sudden infant death
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11
Q

Why is prematurity a significant cause of mortality (i.e. what are the complications)? (4)

A

Surfactant deficiency
Periventricular haemorrhage
Necrotising enterocolitis
Infection

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12
Q

What % of perinatal mortality is caused by immaturity related conditions?

A

58.5%

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13
Q

What % of perinatal mortality is caused by congenital anomalies?

A

26.1%

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14
Q

What % of perinatal mortality is caused by antepartum infections and infections?

A

1.9% and 0.9%

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15
Q

What % of perinatal mortality is caused by asphyxia, anoxia or trauma?

A

10.2%

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16
Q

What affects stillbirth? (3)

A

Maternal health
Access to maternity care
Uteroplacental function

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17
Q

What affects early neonatal death? (4)

A

Uteroplacental function
Perinatal infection
Neonatal resuscitation
Effective neonatal care

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18
Q

What affects late neonatal death? (2)

A

Effective neonatal care

Postnatal infection

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19
Q

What affects postneonatal infant death? (2)

A

Postnatal infection

SIDS

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20
Q

What affects IMR? (3)

A

Early and late neonatal death and postneonatal infant death

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21
Q

What affects NNMR? (2)

A

Early and late neonatal death

22
Q

What affects PNMR? (2)

A

Stillbirth and early neonatal death

23
Q

Before October 1992, babies born dead before how many weeks were recorded as miscarriages? What is it now?

A

<28 weeks

<24 weeks

24
Q

List some causes of stillbirth. (6)

A 
Congenital anomaly
Infection
Death from intrapartum causes
Preeclampsia
Antepartum haemorrhage
Unexplained antepartum foetal death (most common)
25
Q

List the foetal causes of stillbirth. (7)

A 
Congenital anomaly
Infection
Non-immune hydrops
Isoimmunisation
Feto-maternal haemorrhage
Twin-twin transfusion
Fetal growth restriction
26
Q

List the causes of stillbirth due to the umbilical cord. (3)

A
  1. Prolapse
  2. Constricting loop or knot
  3. Velamentous insertion
27
Q

List the placental causes of stillbirth. (4)

A

Abruptio
Praevia
Vasa praevia
Placental insufficiency

28
Q

List the causes of stillbirth due to amniotic fluid. (3)

A

Chorioamnionitis
Oligohydramnios
Polyhydramnios

29
Q

List the causes of stillbirth due to the uterus. (2)

A

Rupture

Uterine anomalies

30
Q

List the maternal causes of stillbirth. (7)

A 
Diabetes
Thyroid diseases
Essential hypertension
Hypertensive diseases in pregnancy
Lupus or antiphospholipid syndrome
Cholestasis
Drug misuse
31
Q

List the intrapartum causes of stillbirth. (2)

A

Asphyxia

Birth trauma

32
Q

Acute mode of death occurs within hours. What are teh causes?

A 
Placental abruption
Cord accidents (causing acute hypoxia)
33
Q

Acute mode of death - how does the baby present?

A

Well grown, absence of maceration
Traces of meconium
Petechiae on serosal surfaces

34
Q

Chronic mode of death occurs days to several weeks after the cause. What are the causes?

A 
Maternal disease (e.g. diabetes, hypertension)
Placental problems

Placenta
small
normal or  feto: placental ratio

35
Q

Chronic mode of death - how does the baby present?

A

Moderate to severe maceration

IUGR

36
Q

Chronic mode of death - describe the placenta.

A

Small

Normal or increased feto-placental ratio

37
Q

What is the greatest cause of neonatal mortality?

A

Immaturity related conditions

38
Q

What is the greatest cause of post-neonatal infant mortality?

A

Congenital anomalies

39
Q

List the measures that contribute to perinatal mortality. (8)

A 
Specific diseases &amp; conditions
Birthweight &amp; Gestation
Uteroplacental dysfunction
Country of birth
Mother’s country of birth
Social class
Maternal age &amp; parity
Access to healthcare
40
Q

What is SUDI?

A

Sudden unexpected death in infancy (i.e. an unexpected death in a child under 1 year of age).
If no abnormality is found on autopsy = SIDS (sudden infant death syndrome).

41
Q

What types of sudden unexplained death are there?

A

Baby is found dead in the cot/bed
Baby dies in parents/carers arms
Rapid death due to a recognised illness (e.g. infection, CNS haemorrhage, congenital adrenal hyperplasia)

42
Q

What are the causes for a baby being found dead in the cot/bed? (8)

A 
Congenital heart disease
Respiratory infections
CNS infections
Septicaemia
Intoxication
Seizure disorders
Unexplained (SIDS)
Suffocation and non-accidental injury
43
Q

What is the current definition of SIDS?

A

The sudden unexpected death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene and review of the clinical history.

44
Q

What is the triple risk hypothesis for SIDS?

A 
Vulnerable infant (physiologic responses)
Exogenous stressor (environment)
Critical developmental period (age)
45
Q

Give some examples of ‘exogenous stressors’. (5)

A 
Minor URTI
Prone position
Bed-sharing
Overheating
Hyperthermia
46
Q

What infants are ‘vulnerable’ for SIDS? (4)

A

Males (60%)
Abnormality of the serotoninergic network
Slower responses to changes
Alterations in heart ion channels

47
Q

What are the risk factors for SIDS? (9)

A 
Social class IV or V
Unmarried mother
Young mother
High parity
High birth order
Short interpregnancy interval
City dweller
Co-sleeping
Male baby
48
Q

What are the typical external findings with SIDS? (3)

A

Body well-developed and well-nourished
Frothy fluid around nose (often blood-tinged)
Cyanosis of lips and nail-beds

49
Q

What are the typical internal findings with SIDS? (6)

A 
“Large” thymus with petechiae
Petechiae in pleura
Epicardial petechiae
Full expansion of lungs
Empty bladder
Prominent LN &amp; Peyer’s patches
50
Q

What are the typical microscopic findings with SIDS? (4)

A

Pulmonary congestion and oedema
Mild inflammation of upper respiratory tract
Focal fibrinoid necrosis of vocal cords
Persistent haemopoiesis in the liver

HD 2 (25 decks)

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