Quality Education for a Healthier Scotland Multidisciplinary History as Part of Examination of Newborn Promoting multiprofessional education and development.

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Presentation transcript:

Quality Education for a Healthier Scotland Multidisciplinary History as Part of Examination of Newborn Promoting multiprofessional education and development in 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 condition to 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 Multidisciplinary Mother ’ 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 Multidisciplinary Clinical Features of FAS/FAA

Quality Education for a Healthier Scotland Multidisciplinary Congenital 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 Multidisciplinary Content family history mother ’ s medical history pregnancy history birth history picture quiz post-birth condition.

Quality Education for a Healthier Scotland Multidisciplinary Birth 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 Multidisciplinary Linking Condition to History What could be wrong with these babies?

Quality Education for a Healthier Scotland Multidisciplinary Linking Condition to History

Quality Education for a Healthier Scotland Multidisciplinary Linking Condition to History

Quality Education for a Healthier Scotland Multidisciplinary Linking 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 Multidisciplinary Cephalhaematoma 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 Multidisciplinary Birth 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 Multidisciplinary Conclusion 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.