COMPLICATIONS OF PERINATAL CARE

1
COMPLICATIONS OF PERINATAL CARE
ENID GILBERT-BARNESS, M.D.
2
BIRTH INJURY

• INCIDENCE
• 2-7 Per 1000 LIVE BIRTHS

3
Major Forms of Traumatic Birth injury

• Subcutaneous edema and hemorrhage
• Fractures
• Injury to the spine and spinal chord
• Peripheral nerve injury and cranial nerve
  injuries
• Visceral injuries
• Injuries from surgical procedures

4
(No Transcript)
5
Types of Intracranial Hemorrhages

• Laceration of tentorium cerebelli
• Rupture of the vein of Galen
• Massive subdural hemorrhage may result in a
  subdural hygroma
• Subarachnoid hemorrhage
• Intraventricular hemorrhage
• Epidural hemorrhage

6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
Rupture of Vein of Galen (VG)

• Usually fatal
• If the anteroposterior diameter of the head is
  abnormally increased, excessive tension my cause
  rupture of the wall of the VG with blood loss
  into the space around the base of the brain
  between the cerebral hemispheres and into
  cerebellum.

Vein of Galen (VG)

• A confluence of the internal veins of both
  cerebral
• hemispheres
• Less than 1 cm long

10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
Types of Visceral Injuries

• Liver laceration rupture subcapsular hematoma
• Spleen rupture of capsule avulsion of splenic
  vein
• Kidney laceration rupture
• Subserosal hematoma of bowel obstruction of
  ileum
• Adrenal obliterative hemorrhage, unilateral or
  bilateral
• Retroperitoneal Hemorrhage diffuse spreading
  hemorrhage

15
(No Transcript)
16
Necrotizing Tracheobronchitis

• Cobblestone appearance
• Denudation of the mucosa or a pseudomembrane
• Exact etiology is unknown.
• Hypotheses include thermal burn, toxic insult,
  and drying
• More severe with high frequency jet ventilation
  than with conventional mechanical ventilation

17
(No Transcript)
18
(No Transcript)
19
Common Predisposing Factors to Pulmonary
Interstitial Emphysema (PIE)

• Immaturity of the lung
• Respiratory distress syndrome
• Aspiration syndromes (fetal hypoxia with
  excessive aspiration of amniotic fluid)
• Pulmonary infection
• Anomalies of the lung
• Overzealous resuscitation at birth
• Intubation of a mainstem bronchus followed by
  positive pressure ventilation
• Needle puncture of the lung in attempting to
  relieve pneumothorax
• Assisted ventilation

20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
Persistent Loculated Pulmonary Interstitial
Emphysema (PLPIE)

• Occurs when pseudocysts develop within
  interstitial tissue.
• These are related to either continuous positive
  airway pressure or mechanical ventilation.
• Two types localized and diffuse

25
Arterial Catheterization Complications

• Infection
• Pseudomonas
• Staphylococcus aureus
• Klebsiella pneumoniae
• Candida albicans
• Hypertension
• Minute thrombi on the catheter tips of umbilical
  artery catheters
• Blanching or small infarcts of the toes
• Infarction of the kidney and renal hypertension
• Occlusion of the ostium in superior or inferior
  mesenteric arteries
• Infarction of the small or large intestine

26
(No Transcript)
27
VENOUS CATHETERIZATION COMPLICATIONS

• Umbilical vein thrombosis
• Portal vein thrombosis
• Patchy hepatic necrosis
• Ventricular dysrthymias
• Pulmonary thromboembolism

28
(No Transcript)
29
(No Transcript)
30
COMPLICATIONS OF AMNIOCENTESIS

• Placenta may be punctured, resulting in
  hemorrhage
• Chorioamnionitis
• Perforation of umbilical vein
• Tears of the amnion may result in amniotic band
  sequence and amputations
• Fetal hemothorax
• Intestinal cutaneous fistulae
• Skin lesions
• Placental abruptions

31
CHORIONIC VILLUS SAMPLING

• Between 10 and 12 weeks gestation
• Available in 24 to 48 hours
• DNA analysis or enzymatic diagnosis amniocentesis
• Alpha-fetoprotein concentration rate of fetal
  loss 2.3 - 2.5

32
(No Transcript)
33
NASAL INTUBATION

• Over distention of the stomach
• Elevation of the diaphragm and fall in functional
  residual capacity resulting in hypoxemia and
  apnea
• Mucosal lesions
• Hemorrhage
• Stress ulcerations

34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
Complications of Cesarean Section

• Increase in intracranial fluid
• Increase in frequency of neonatal respiratory
  distress syndrome (RDS)

38
(No Transcript)
39
(No Transcript)
40
Adverse Reactions to Maternal Drug Administration

• Aspirin neonatal bleeding prolongation of
  gestation
• Phenytoin (Dilantin) bleeding diathesis
• Iodides neonatal goiter
• Mepivacaine bradycardia and death
• Temazepam (Restoril) and diphenhydramine
• (Benadryl) - stillbirth

41

• MATERNAL MEDICATIONS
• ANTACIDS
• SODIUM BICARBONATE
• MAGNESIUM TRISILICATE
• ANTHISTAMINES
• DIMENHYDRINATE
• (DRAMAMINE)
• DIPHENHYDRAMINE
• CHLORPHENIRAMINE

• FETAL EFFECTS
• METABOLIC ALKALOSIS
• CIRCULATORY OVERLOAD
• EDEMA, CONGESTIVE HEART FAILURE
• DAMAGE TO FETAL KIDNEYS
• HYPOTENSION
• LIVER TOXICITY
• RESPIRATORY DEPRESSION
• TACHYCARDIA
• RESPIRATIORY DEPRESSION

42

• MATERNAL MEDICATIONS
• BELLADONNA DERIVATIVES
• ATROPINE
• SCOPOLAMINE
• CAMPHOR
• CHLORAMPHENICOL
• DAPSONE
• DEXTROMETHORPHAN

• FETAL EFFECTS
• TACHYCARDIA
• RESPIRATORY DEPRESSION
• CONVULSIONS
• GRAY BABY SYNDROME
• HEMOLYSIS IN G6PD
• DEFICIENCY
• RESPIRATORY DEPRESSION WITHDRAWAL SYMPTOMS

43
(No Transcript)
44
(No Transcript)
45
EXTRACORPORAL MEMBRANE OXYGENTATION (ECMO)
COMPLICATION

• Hemorrhage
• Nonhemorrhagic neurologic damage
• Porencephalic cysts, infarcts, sagittal sinus,
  thrombosis, multifocal ischemic neuronal necrosis
  associated with ligation of the carotid artery
  used for arterial cannulation.
• Long term effects
• Microcephaly, seizures and neurologic impairment

46
EXTRACORPORAL MEMBRANE OXYGENATION (ECMO)
COMPLICATIONS

• Thromboemboli
• multiple pulmonary fibrin- or aluminum-
  containing thromboemboli in infants receiving
  ECMO for more than 1 week
• extrapulmonary emboli basophilic when they
  contain aluminum salts

47
(No Transcript)
48
NOSOCOMIAL INFECTIONS IN NEWBORN NURSERIES

• ORGANISM DISEASES
• BACTERIA
• Salmonella Diarrhea
• Listeria Sepsis, meningitis
• Proteus Sepsis, meningitis
• Pseudomonas Eye infections, sepsis, pneumonia
• Escherichia coli Diarrhea
• Serratia marcescens Sepsis, meningitis, abscesses
• Enterobacterioceae Sepsis, meningitis,
  conjunctivitis

49
NOSOCOMIAL INFECTIONS IN NEWBORN NURSERIES

• ORGANISM DISEASES
• BACTERIA
• Klebsiella pneumoniae Unspecified
• Staphylococcus aureus Sepsis, pneumonia,
  conjunctivitis impetigo, sepsis
• Enterococcus Bacteremia, meningitis
• Enterobacter Bacteremia, pneumonia
• Group b streptococcus Sepsis

50
NOSOCOMIAL INFECTIONS IN NEWBORN NURSERIES
DISEASES Generalized sepsis Generalized
sepsis Pneumonia Tinea capitis, tinea corpis

• ORGANISM
• FUNGI
• Candida albicans
• Aspergillus
• Malassezia furfur
• Microsporum canis

51
(No Transcript)
52
NOSOCOMIAL INFECTIONS IN NEW BORN NURSERIES

• ORGANISM DISEASES
• VIRUSES
• INFLUENZA TYPE A APNEA, LETHARGY PNEUMONIA
• RESPIRATORY SYNCYTIAL VIRUS PNEUMONIA, APNEA
• ROTAVIRUS GASTROENTERITIS
• ECHOVIRUS II SEPSIS-LIKE SYNDROME
• PARAINFLUENZA, TYPE 3 RESPIRATORY TRACT
  INFECTION
• ADENOVIRUS, TYPE 8 URI, CONJUNCTIVITIS
• HEPATITIS A ASYMPTOMATIC
• HERPES SIMPLEX DISSEMINATED INFECTION

53
(No Transcript)
54
(No Transcript)
55
(No Transcript)
56
(No Transcript)
57
(No Transcript)
58
TOTAL PARENTERAL NUTRITION (TPN)

• Lipid accumulation in the intima of pulmonary
  arteries
• Pulmonary hypertension
• Fungal sepsis with right-sided endocarditis
• Malassezia furfur- high concentrations of fatty
  acids
• Liver cholestasis ? cirrhosis

59
(No Transcript)
60

• When treating the perinate, keep your insurance
  up to date!

61
(No Transcript)