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Approach to women with a previous child with mental retardation
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Ashima Arora, Minakshi Rohilla
Mental retardation can be secondary to perinatal asphyxia, which is defined as a lack of blood flow or gas exchange to or from the fetus immediately before, during, or after birth. The incidence of significant perinatal asphyxia is highly variable in different parts of the world depending on the care received by pregnant women, ranging from 2 per 1000 births in the developed world to 2 per 100 in developing countries where access to maternal care is limited. This perinatal/birth asphyxia leads to profound neurological sequelae in more than 25% of the affected babies [8]. The majority of cases of birth asphyxia occur intrapartum, although around 20% of cases are antepartum, while rarely, early postnatal events may also contribute to it. Therefore, thorough history of the previous pregnancy that resulted in mental retardation is mandatory for the obstetrician managing the present pregnancy, with special focus on birthing history. History of birth trauma, difficult instrumental delivery, macrosomia, difficult breech delivery, and so on, must be elicited. Also, maternal complications, such as hypertensive disorders of pregnancy, that may lead to placental insufficiency or preterm births leading to developmental delay in the neonate must be asked about. Overall, the most likely cause of perinatal asphyxia must be ascertained. Some causes such as perinatal infections are known not to recur, while others such as untreated Rh iso-immunization may result in cognitive delays, deafness, and cerebral palsy in survivors.
Pre- and Perinatal Factors in the Etiology of Mental Retardation
Published in Michele Kiely, Reproductive and Perinatal Epidemiology, 2019
Brown, in 1974,171 thought it established that asphyxia was common, but that consequential brain damage was rare. At the same time, others suggested that the risk is substantial only if there is prior intrauterine growth impairment.172 The debate has been advanced by the discovery that fetal acidosis in growth retarded fetuses aged 21 to 36 gestational weeks, is significantly lower than in other pregnancies, and is associated with hypoxia.173 The technique of cordocentesis may offer hope of much more precise diagnosis of hypoxia in the future.174 It is possible that, in some cases, “birth asphyxia” may arise not during the birth process, but earlier in fetal life.
Children with feeding difficulties: medical and nursing perspectives
Published in Southall Angela, Feeding Problems in Children, 2017
Essex. Charles, Southall. Angela, Southall. Angela, Woolliscroft. Kim
A baby who has birth asphyxia sufficient to cause brain damage is almost always extremely ill with hypoxic ischaemic encephalopathy; he or she requires neonatal intensive care, ventilation and non-oral feeding, and has seizures. A baby whose oesophagus did not form properly (oesophageal atresia) did not have a functioning oesophagus in utero and therefore is likely to present with feeding problems.
Delayed Withholding: Disguising Withdrawal of Life Sustaining Interventions in Extremely Preterm Infants
Published in The American Journal of Bioethics, 2022
Annie Janvier, Keith J. Barrington
The extremely preterm infant, born before 28 weeks of gestational age, has been the focus of much ethical discussion. These infants have a significant risk of mortality and morbidity, and it is not rare to make life and death decisions for them, with their families. Theoretically, decision-making for these patients should be based on similar considerations as for other fragile critically ill patients facing uncertain futures. But this is not the case. For example, older children with meningococcal septicemic shock and multiple organ failure are a group with survival and long-term outcomes similar to extremely preterm infants (and often worse). In such children, the usual decision-making approach is to institute life-sustaining interventions (LSI), and repeatedly evaluate the evolving situation; in the case of major complications affecting survival or long-term outcomes, then potential withdrawal of LSI will be discussed. Full-term newborn infants presenting with shock due to infection, profound cardiac dysfunction, hypoxic ischemic encephalopathy following birth asphyxia or catastrophic metabolic conditions are also usually treated in the same way.
Maternal risk factors for birth asphyxia in low-resource communities. A systematic review of the literature
Published in Journal of Obstetrics and Gynaecology, 2020
Somkene Igboanugo, Alice Chen, John G. Mielke
Approximately 4 million neonatal deaths occur every year, and developing countries, especially those within the Asia-Pacific region and the Sub-Saharan part of Africa, are disproportionately affected (Lawn et al. 2005; Wall et al. 2009; Rajaratnam et al. 2010). Although a large number of these deaths occur following complications from infection and pre-term birth, birth asphyxia is also an important factor (Lawn et al. 2005). The World Health Organisation (2012) defines birth asphyxia (BA) as the “failure to initiate or maintain breathing at birth”, and the multi-organ dysfunction that often results is thought to be responsible for 23% of neonatal deaths (globally) and 26% of the one million intrapartum stillbirths observed annually (Lawn et al. 2005). Unfortunately, many of those who survive experience chronic neuro-developmental morbidity, such as cerebral palsy, epilepsy, and learning disabilities (World Health Organization 2005; Lawn et al. 2009; Chiabi et al. 2013). Significantly, low- and middle-income countries, particularly those with a high birth rate (e.g. India, Pakistan, and Nigeria), bear almost all of the morbidity and mortality burden attributable to BA (World Health Organization 2005; Lawn et al. 2009).
The relationship between circadian blood pressure variability and maternal/perinatal outcomes in women with preeclampsia with severe features
Published in Hypertension in Pregnancy, 2020
Liuying Zhong, Wenfeng Deng, Weihan Zheng, Shuting Yu, Xiaosi Huang, Yaohong Wen, Philip C.N. Chiu, Cheuk-Lun Lee
PE with severe features was defined by the combined presence of hypertension (systolic BP ≥160 mmHg and/or diastolic BP ≥110 mmHg) and one or more of the following new-onset conditions at or after 20 weeks’ gestation: 1) proteinuria (≥0.3 mg/24 h), 2) other maternal organ dysfunction (thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema) (1). Premature delivery was defined as the birth of a baby at the gestation of less than 37 weeks and low birth weight (<2500 g) (10). A fetus with an estimated weight that was less than the 10th percentile for its gestational age was considered to have fetal growth restriction (11). HELLP syndrome, postpartum hemorrhage, fetal distress, fetal and neonatal death, placental abruption, placenta previa, placenta implantation were diagnosed according to the criteria of ACOG Practice Bulletin (12–15). Neonatal asphyxia was diagnosed according to “Birth asphyxia: a statement. World Federation of Neurology Group” (16). Postpartum anemia was defined as a hemoglobin level of less than 110 g/L. Retinopathy was diagnosed according to the Keith–Wagener–Barker grading (17). Acute ischemic stroke was diagnosed according to “Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke” (18).