quality education for a healthier scotland multidisciplinary history as part of examination of...

Quality Education for a Healthier Scotland

Multidisciplinary

History as Part of Examination of Newborn

Promoting multiprofessional education and developmentin Scottish maternity care

Quality Education for a Healthier Scotland

Multidisciplinary

Objective:To increase knowledge

on the importance of:

• family history• mother’s medical

history• pregnancy history• birth history• post-birth conditionto the routine examination of the newborn.

Quality Education for a Healthier Scotland

Multidisciplinary

Family History

• Cardiac• Hip problems• Congenital cataract• Renal conditions• Haemoglobinopathies• Cleft lip and/or palate• Hearing problems.

Quality Education for a Healthier Scotland

Multidisciplinary

Content

• family history• mother’s medical history• pregnancy history• birth history• picture quiz• post-birth condition.

Quality Education for a Healthier Scotland

MultidisciplinaryMother’s Health

Medical conditions:• Endocrine• Hypertension• Haematological• Psychiatric• Connective tissue disorders, e.g. SLE• Medication• Social circumstances – child protection.

Quality Education for a Healthier Scotland

Multidisciplinary

Content

• family history• mother’s medical history• pregnancy history• birth history• picture quiz• post-birth condition.

Quality Education for a Healthier Scotland

Multidisciplinary

Mother’s Pregnancy

• Past obstetric history and children’s health• Relate antenatal history to stage of fetal

development to predict outcome in baby• Results of antenatal screening• Gestation accuracy.

Use case notes and direct questioning.

Quality Education for a Healthier Scotland

Multidisciplinary

Additional sources of Fetal Compromise

• Smoking• Alcohol• Drugs - Prescribed medication

- Recreational misuse• Infection.

Quality Education for a Healthier Scotland

Multidisciplinary

Smoking in Pregnancy

• Chronic fetal hypoxia • Carbon monoxide reduces the oxygen

carrying capacity of both the mother and fetus

• IUGR, approx 188g lighter than non- smokers (Bardy et al 1993)

• Fetal, perinatal and neonatal morbidity and mortality.

Quality Education for a Healthier Scotland

Multidisciplinary

Alcohol in Pregnancy

• Fetal Alcohol Syndrome:believed by some to be the third most common cause of mental retardation (Seidel et al 1997).

• Variable fetal effects depending on quantities of alcohol.

Quality Education for a Healthier Scotland

MultidisciplinaryClinical Features of FAS/FAA

Quality Education for a Healthier Scotland

MultidisciplinaryCongenital Infections• Group B Streptococcus• Cytomegalovirus (CMV)• Rubella• Toxoplasmosis• Varicella Zoster (Chickenpox)• Listeria• Hepatitis B, C• HIV• Herpes – genital warts.

Quality Education for a Healthier Scotland

MultidisciplinaryContent

• family history• mother’s medical history• pregnancy history• birth history• picture quiz• post-birth condition.

Quality Education for a Healthier Scotland

MultidisciplinaryBirth History

• Fetal condition• Duration of labour • Rupture – delivery interval• Maternal analgesics• Maternal response – pyrexia• Mode of delivery.

Quality Education for a Healthier Scotland

Multidisciplinary

Neonatal Delivery Effects

• Posture and compression effects

• Birth injuries

• Effects of hypoxia

• Effects of maternal medication

• Postnatal issues.

Quality Education for a Healthier Scotland

MultidisciplinaryLinking Condition to History

What could be wrong with these babies?

Quality Education for a Healthier Scotland

MultidisciplinaryLinking Condition to History

Quality Education for a Healthier Scotland

MultidisciplinaryLinking Condition to History

Quality Education for a Healthier Scotland

MultidisciplinaryLinking History to Condition

What would you be looking for in the history to explain this picture?

Quality Education for a Healthier Scotland

Multidisciplinary

Caput Succedaneum

• distribution is across suture lines• oedema• pits on pressure• swelling largest at birth• disappears within a few days.

Quality Education for a Healthier Scotland

MultidisciplinaryCephalhaematoma

• DOES NOT cross suture lines• Can be bilateral• NOT apparent immediately after birth.

Quality Education for a Healthier Scotland

Multidisciplinary

Other answers you may find in the notes!

• Reduced fetal movements, abruption, fetal distress and or meconium staining

• Late maternal “sedation” with opiates• Required active resuscitation.

Quality Education for a Healthier Scotland

MultidisciplinaryBirth and Beyond• Condition at birth – APGAR• Vitamin K• Baby’s behaviour• Temperature• Feeding• Mothering.

Importance of mother’s opinion of baby’s health and progress.

Quality Education for a Healthier Scotland

Multidisciplinary

Any Questions?

Quality Education for a Healthier Scotland

MultidisciplinaryConclusion

• Careful review of case notes is essential.

• Thorough knowledge of family/maternal health, pregnancy, labour, delivery and subsequent condition of baby is essential prior to newborn examination.