PRETERM AND POST TERM

• SGA if the birth weight is below the 10th percentile on an intrauterine growthcurve for that age
• SGA infants are small for their age because they experienced intrauterine growth restriction or retardation (IUGR) or failed to grow at the expected rate in utero.
• CAUSES of SGA  Mother’s nutrition  Placental anomaly  Women with systemic diseases  Smoking heavily and using of narcotics  Infants with intrauterine infections  Chromosomal abnormalities
• ASSESSMENT SGA  PRENATAL - fundic height - sonogram - biophysical profile - ultrasound
• APPEARANCE SGA  Below average in weight, length, and head circumference  Wasted appearance  Small liver (may cause difficulty regulating protein, glucose and bilirubin)  Wide skull sutures  Dull and lusterless hair  Sunken abdomen  Cord appears dry and stained yellow
• s LGA (macrosomia) is the birth weigh is above the 90th percentile on an intrauterine growth chart for that gestational age.  The infant could be preterm, term or post term
• Causes LGA  Infants born to diabetic mothers  Multiparous women  Other determining factors: - gestational age - fetal sex - genetic factors - congenital anomalies - taking of medications
• Assessment LGA

   Fetus is suspected of being LGA when the uterus is unusually large for thedateof pregnancy. - difficult to deliver

  shoulder dystocia and fractures of the clavicles of limbs may occur

  • CS may be necessary because of cephalopelvic disproportion
• Appearance LGA  With immature reflexes  May have extensive bruising or a birth injury; broken clavicle  Because the head is large, maybe exposed to more than usual pressure duringbirth causing prominent caput succedaneum, cephalhematoma, or molding
• Large body size — Post term fetuses have a greater chance of developing complications related to larger body size (called macrosomia), which is defined as weighing more than 4500 grams, or about 10 pounds
•  MANAGEMENT LGA: Cesarean section
• complication of LGA is Lung problems – lung development is delayed in newborns whose mothers have diabetes as well as when these newborns are delivered by cesarean
• MANAGEMENT of LGA with Lung problems : Oxygen administration
• Fetal dysmaturity — Also called "post maturity syndrome," this refers to a fetus whose growthinthe uterus after the due date has been restricted, usually due to a problem with delivery of bloodtothe fetus through the placenta
• Meconium aspiration — Beyond term, the fetus is more likely to have a bowel movement, called meconium, into the amniotic fluid. If the fetus is stressed, there is a chance it will inhale some of this meconium stained amniotic fluid; this can cause breathing problems when the baby is born.
• MANAGEMENT LGA with meconium aspiration : Antibiotics
• LGA complications Low blood sugar levels (hypoglycemia) in newborns of mothers with diabetes, the oversupply of glucose from the placenta stops abruptly at delivery when the umbilical cordis cut and continuing rapid production of insulin by the newborns pancreas leads tolowlevels of sugar in the blood
• MANAGEMENT LGA for low blood sugar: Intravenous glucose or frequent feeding by mouth or by tube
• Prematurity - A baby born before the end of 37 weeks of pregnancy is considered premature, that is, born before complete maturity.
• prematurity are preterm and "preemie." Preterm generally refers to the pregnancy (as in preterm labor), while premature is more often used to describe the baby.
• Maternal factors:  Infection (such as group B streptococcus, urinary tract infections, vaginal infections, infections of the fetal or placental tissues).  Drug use (such as cocaine).  Abnormal structure of the uterus.(bicornuate,unicornuate,didelphic)  Cervical incompetence (inability of the cervix to stay closed during pregnancy).  Previous preterm birth.
• Factors involving the pregnancy  Abnormal or decreased function of the placenta.  Placenta previa (low lying position of the placenta).  Placental abruptio (early detachment from the uterus).  Premature rupture of membranes (amniotic sac).  Polyhydramnios (too much amniotic fluid).
• Factors involving the fetus  When fetal behavior indicates the intrauterine environment is not healthy.  Multiple gestation (twins, triplets or more).  Factors involving the fetus
• Assessment:  History:  Appearance: Each baby may show different characteristics which may include: 1. Small baby, usually the weight less than 2,500 grams (5 pounds or 8 ounces) andunderdeveloped 2. Thin, shiny, pink or red skin. 3. Little body fat. 4. Covered with vernix caseosa 5. Little scalp hair, but may have lanugo (soft body hair). 6. Weak cry and body tone. 7. Genitals may be small and underdeveloped.
• Potential complications of prematurity: 1. Anemia: the bone marrow does not increase its production until approximately 32wks.  - the infant will appear pale
• Potential complications of prematurity: Kernicterus  – destruction of brain cells by invasion of indirect bilirubin
• Kangaroo Care ( method of caring for premature babies using skin-to-skincontact with the parent to provide contact and aid parent-infant attachment).
• Post maturity -refers to any baby born after 42 weeks gestation or 294 days past the first day of the mother's last menstrual period.  Less than 6 percent of all babies are born at 42 weeks or later.
• Features of post maturity syndrome  wrinkled, patchy, peeling skin  long, thin body suggesting wasting  open-eyed, unusually alert,  appears old and worried  skin wrinkling can be particularly prominent on the palms and soles  nails are typically long
• Possible Complications of Postmaturity:(www.stanfordchildrens.org)  Less amniotic fluid  This may stop the baby from gaining weight or may even cause weight loss.  Poor oxygen supply  Babies who don't get enough oxygen may have problems during labor and delivery.  Meconium aspiration  Babies who stay in the womb longer are more likely to breathe in fluid containing meconium.  Hypoglycemia or low blood sugar  This happens when the baby has already used up his or her stores of glucose.