PERINATAL MEDICINE

Perinatal Medicine: refers to infant, particularly those with

during and after birth, acknowledging and neonatal life
This can be achievwd by modern MRI and DNA analysis, detailed
Close cooperation is important caring for pregnant mother, fetus
medical care of the fetus and complex problems, before, the
continuity of fetal technology, such as US, information about the
fetus.
between professionals and newborn infant.

SOME DEFINITIONS USED IN PERINATAL MEDICINE

Stillbirth: Fetus born with no signs of life ≥24 weeks of
pregnancy
The perinatal period: the period from the 28th week of
gestation through the 7th day a er birth.
The neonatal period: is the 1st 28 days a er birth
Very early neonatal period: birth to <24 hr
Early neonatal period: birth to <7 days
Late neonatal periods: 7 days to <28 days.

Preterm: Gestation <37 weeks of pregnancy

Term: 37–41 6/7 Weeks Of Pregnancy
Post-term: Gestation ≥ 42 Weeks Of Pregnancy

Low Birth-Weight: <2500-g

Very Low Birth-Weight: 1000 - 1500-g
Extremely Low Birth-Weight: <1000-g

Appropriate For Gestational Age: Birth-Weight from 10th Centile

to 90th Centile For GA
Small For Gestational Age: Birth-Weight <10th Centile For GA
Large For Gestational Age: Birth-Weight >90th Centile For GA

FEATURES OF PERINATAL MEDICINE

● Good Pregnancy And Neonatal Outcomes Depend On Good
Maternal Health And Care
 ●Non-invasive Antenatal Diagnosis Is Reducing The Risk Of Fetal Loss
From Invasive Tests
●Maternal Viral Infection During Pregnancy Can Seriously Affect The
Fetus
●Worldwide, Prematurity Is The Leading Cause Of Mortality In
Children < 5 Years Old
●When Required, Newborn Resuscitation Can Be Achieved With
Simple Measures In Most Instances
●Newborn Infants Have A Number Of Assessments Shortly After
Birth:
●Routine Examination
●Hearing And Biochemical Screening
●Oxygen Saturation Screening For Critical Congenital Heart Disease.

PRE-PREGNANCY CARE
●Smoking reduces birth-weight especially if born preterm.
●It associated with an increased risk of miscarriage, stillbirth and
sudden infant death syndrome.
●pre-pregnancy folic acid supplements reduce the risk of neural tube
defects in the fetus.
●Low-dose folic acid supplementation is recommended for all women
planning a pregnancy.
●A higher dose is recommended for women at increased risk of neural
tube defects.
●Pre-existing Medical Conditions As Diabetes, Epilepsy Or
Hypertension, Must Be Reviewed And Monitored.
●Certain Medications Such As Retinoids, Warfarin, And Sodium
Valproate Should Be Avoided Because Of Teratogenic Effects.
●Alcohol Ingestion And Drug Abuse (Opiates, Cocaine) May Damage
The Fetus.
●Congenital Rubella Is Preventable By Maternal Immunization Before
Pregnancy.
●Exposure To Toxoplasmosis should be minimized by avoiding eating
undercooked meat and by wearing gloves when handling cat litter.
●Listeria infection acquired from eating unpasteurized dairy products
and ready-to-eat poultry, unless reheated.
 ●Eating liver during pregnancy is best avoided as it contains a high
concentration of vitamin A.
●Avoid eating swordfish and limit tuna because of high levels of
mercury.

Pregnancies at increased risk of fetal abnormality include

those in which:
1. The Mother Is Older
2. There Is Previous Congenital Abnormality
3. There Is A Family History Of An Inherited Disorder
4. The Parents Are Identified As Carriers Of An Autosomal Recessive
Disorder, E.G. Thalassaemia
5. A Parent Carries A Chromosomal Rearrangement
6. Parents Are Close Blood Relatives (Consanguinity).

Screening Tests for Antenatal Diagnosis

Maternal blood:
1. Blood group and antibodies: for RH and other red cell
incompatibilities
2. Hepatitis B
3. Syphilis
4. Rubella
5. HIV infection
Maternal and Feto-placental hormones :
1. Neural tube defects (Raised maternal serum alpha fetoprotein)
2. Down syndrome (trisomy 21)
3. Edwards syndrome (trisomy 18)
4. Patau syndrome (trisomy 13)
Ultrasound screening:
1. Gestational age
2. Multiple pregnancies
3. Structural malformation
4. Fetal growth
5. Amniotic fluid volume: oligohydramnios , Polyhydramnios
Amniocentesis
 1. Chromosome and DNA analysis
2. Fetal infection – PCR
Fetal blood sampling
1. Fetal haemoglobin for anaemia
2. Fetal infection serology
3. Fetal blood transfusion
Chorionic villus sampling
1. Chromosome/microarray and DNA analysis
2. Fetal infection – PCR
3. Enzyme analysis of inborn error of metabolism
Preimplantation genetic diagnosis (PGD)
Fetoscopy
Non-invasive prenatal testing from maternal blood.

OBSTETRIC CONDITIONS AFFECTING THE FETUS

1- PRE-ECLAMPSIA
A. Gestational hypertension: Hypertension without
proteinuria, without symptoms or abnormal laboratory
tests after 20 weeks' gestation.
B. Preeclampsia: Blood pressures >140 mmHg systolic or
90 mmHg diastolic with proteinuria after 20 weeks‘
gestation.
C. Eclampsia: Generalized tonic-clonic seizure activity in a
pregnant woman with no prior history of a seizure
disorder.
EFFECT OF PRE-ECLAMPSIA
A. Fetal mortality markedly increases with increase severity
of disease process.
B. Fetal morbidity
1. Intrauterine fetal growth restriction
2. Fetal acidemia,
3. Complications from prematurity

2- Diabetes mellitus
Fetal problems associated with maternal diabetes are:
1- Congenital Malformations As Cardiac Malformations,
Sacral Agenesis And Hypoplastic Left Colon.
 2- IUGR
3- Macrosomia: Maternal Hyperglycaemia causes fetal
hyperglycaemia as glucose crosses the placenta and
insulin does not cross the placenta, the fetus responds
with increased secretion of insulin, which promotes
growth by increasing both cell number and size.
Neonatal problems include:
1. Hypoglycaemia
2. Respiratory distress syndrome
3. Hypertrophic cardiomyopathy: it regresses over several
weeks but may cause heart failure
4. Polycythaemia: makes the infant look plethoric.
5. birth asphyxia and birth trauma from obstructed labour
or delivery due to macrosomia.
3- Multiple births
The main problems are:
1. Preterm Labour: The Median gesta on for twins is 37
weeks, for triplets 34 weeks and for quads 32 weeks.
2. IUGR: fetal growth in one or more fetuses may
deteriorate.
3. Congenital Abnormalities: The risk is increased four-fold
in monochorionic twins (shared placenta).
4. Twin–twin Transfusion Syndrome In Monochorionic
Twins
5. Complicated Deliveries: Due to malpresentation of the
second twin at vaginal delivery.

The families of Multiple need additional assistance and

support in:
1. Feeding
2. Practical: with their care and housework
3. Emotional and physical exhaustion
4. Loss of privacy as a couple ; increased rate of separation
and divorce
5. Additional financial costs
 6. Increased behavioral problems in the infants and their
siblings.

4- Maternal drugs affecting the fetus

1. Anticonvulsant therapy with carbamazepine, valproic
acid (sodium valproate) or hydantoins (phenytoin):
midfacial hypoplasia,CNS, limb and cardiac malformations,
and developmental delay
2. Cytotoxic agents: Congenital malformations
3. Iodides/propylthiouracil: Goitre, hypothyroidism
4. Lithium: Congenital heart disease
5. Selective serotonin reuptake inhibitors (SSRIs): PPHN
6. Tetracycline: Enamel hypoplasia of the teeth
7. Thalidomide: Limb shortening(phocomelia)
8. Vitamin A and retinoids: Increased spontaneous
abortions, abnormal face
9. Warfarin: Interferes with cartilage formation; cerebral
haemorrhages and microcephaly.

5- Drugs given during labour

1. Opioid analgesics/anaesthetic agents: may suppres
respiration at birth
2. Epidural anaesthesia: cause maternal pyrexia during
labour.
3. Sedatives, e.g. diazepam: may cause sedation,
hypothermia and hypotension in the newborn
4. Oxytocin and Prostaglandin F2: cause hyper s mula on of
uterus leading to fetal hypoxia, increase bilirubin in
neonate
5. Intravenous fluids: may cause neonatal hyponatraemia
6- Congenital infections
Rubella
Growth restriction
Intracerebral calcification
Hydrocephalus
Deafness
Eye defects: cataracts, microphthalmia
Pneumonitis
Heart defects: cardiomegaly, PDA
Hepatomegaly, Jaundice, Hepatitis, Splenomegaly
Bone abnormalities
Anaemia, Neutropenia, Thrombocytopenia
Virus in urine
Rash: blueberry muffin or petechia

Toxoplasmosis
Acute infection with T. gondii, a protozoan parasite, may result
from the consumption of raw or undercooked meat
and from contact with the faeces of recently infected cats.
Clinical manifestations are:
1. Retinopathy which interferes with vision
2. Cerebral calcification
3. Hydrocephalus with long-term neurological disabilities.