PP7PerinatalNeonatal09.ppt -...

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Unformatted text preview: http://www.youtube.com/watch?v=juWNiR6uV4Y&feature=related Perinatal and Neonatal Mortality Perinatal mortality = infant/fetal deaths after 28 weeks gestation up to 1 week after birth t t t Neonatal mortality = infant deaths during first 28 days Definitions overlap and vary from country to country Worldwide, over 9 million perinatal /neonatal deaths occur each year (World Health Organization) In US perinatal/neonatal mortality has been declining but is still higher than other similar countries (i.e. Australia, Canada, United Kingdom) t Compared to other countries, U.S. Overspends on neonatal intensive care ,and t Under-spends on prenatal and preventive care High quality prenatal and preventive care in an impoverished community http://www.youtube.com/watch?v=KR6u8drEU5k Primary Delivery­Related Causes of Perinatal Mortality t t Intrapartum asphyxia – oxygen deprivation Birth trauma Premature birth Primary Pregnancy­Related Causes of Perinatal Mortality Placenta previa (placenta attaches too low , can cause bleeding) t Abruptio placenta (separation of placenta after 20 weeks but before birth) Other Causes t t Congenital anomalies Intrauterine infections Accidents/injuries to mother Perinatal Issues for Women Pregnancy and childbirth are among the leading causes of morbidity and mortality in women of reproductive age UNICEF , Maternal mortality http://www.youtube.com/watch?v=-2z7NH0yxCw Causes of Maternal Mortality Globally t t t t t Hemorrhage (most frequently, post-partum) –25% Puerperal infections – 15% Hypertensive disorders of pregnancy (particularly eclampsia) – 13% Prolonged or obstructed labor -- 7% Unsafe abortion (may account for up to 30% in some parts of the world. Pre-existing conditions that are worsened by pregnancy or its management (contraindications to pregnancy) Anemia Malaria Hepatitis Heart disease HIV/AIDS Born in the USA Wagner, Born in the USA t t 41 countries have lower infant mortality rates than the U.S. 28 countries have lower maternal mortality rates than the US In every country that has lower mortality rates than the US, normal pregnancies and births are managed by midwives, not doctors Cesarean Sections t Surgical procedures that can save lives in high risk situations Benefit physicians because: They are convenient, can be scheduled The reduce the risk of malpractice suits They help maintain the medical monopoly on childbirth Elective C­Section (not necessary to save mother or baby’s life) t t t t 2-6% risk of cutting baby Baby twice as likely to end up in intensive care Three times as likely to have serious pulmonary disorder as a neonate (less if labor is allowed to begin) Increased risk of prematurity (also less with labor) Likelihood that future births will be Cesarean Drug­Induced Labor t t t t In about 10% of all births there is a medical reason to induce labor In US, approximately 40% of labor is induced Current favored drug is Cytotec which has not been FDA-approved for this purpose Can cause ruptured uterus in women with previous C-sections Can cause brain damage in infants by shrinking the uterus too fast Midwives vs. Doctors Midwives i t t t t t t Doctors t t t t t t t Attend only low-risk births Continuously present Facilitation of natural processes Mother has control Pregnancy is not an illness Little if any intervention needed in childbirth Emphasis on quality of birth experience Also attend high-risk births Periodically present Medicalization of natural processes Doctor has control Focus on what can go wrong Intervention needed for childbirth Emphasis on procedures (most without evidence) Barriers to Midwife Practice t t t t State and local laws and licensing regulations Physician attempts to maintain monopoly on hospital childbirths Physician disapproval of home births Freestanding alternative birth centers threaten physicians Cost of malpractice insurance Fear of Litigation and Defensive Obstetrical Practice t t t C-Section Electronic fetal monitor (immobilizes woman can slow or stop labor) Labor induction Counter to ethical guidelines which stress the patient’s well-being Coalition for Improving Maternity Services (CIMS) Bill of Rights http://www.motherfriendly.org/ t t t t Normalcy—treat birth as a normal process Empowerment—supportive, sensitive, respectful care Autonomy—decisions made with accurate information from a full range of options Avoid routine use of tests, drugs, procedures, and restrictions Responsibility—Evidence-based care in the interests of mothers and infants The Two-Thirds Rule S O U R C E : J. Lawn et al., The Healthy Newborn: A Reference Manual for Program Managers (2001). Newborn tests and screenings vary by state but commonly include: APGAR (1 minute and 5 minutes) appearance, respiration t Muscle tone, heart rate, reflex response, Blood testing PKU (phenylketonuria) and other metabolic or hormonal disorders Sickle cell disease Cystic fibrosis t Hearing screening Leading Causes of Neonatal Mortality (in order of frequency) t t t t t t Prematurity (including low birth weight) Developmental and genetic defects Effects of maternal pregnancy complications Complications of placenta, cord, and membranes Respiratory distress Bacterial sepsis Intrauterine hypoxia and birth asphyxia Postpartum Depression t t t Experienced by 13% of women who have given birth (CDC) Affects mother’s relationship to child and to partner CDC recommends routine screenings by primary care physicians Treatment of depression is different for pregnant or lactating women than for other women ...
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This note was uploaded on 01/24/2011 for the course FMSC498A 498A taught by Professor Professorwallen during the Fall '09 term at Maryland.

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