Afected neonates undergo close observation, and pharmacotherapy is usually given. In addition to morphine and methadone, other treatment may include phenobarbital, benzodiazepines, and clonidine (Tolia, 2015). More recently, buprenorphine compared with morphine was reported to result in shorter lengths of stay (Kraft, 2017). Consensus is lacking regarding the most efective regimen. he American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine (2017f) have taken the lead in screening, intervention, and treatment of opioid use disorders in pregnant women (Chap. 12, p. 248).
here are a few neonatal disorders of erythrocytes, platelets, and coagulation with which the obstetrician should be familiar. As is the case for most other conditions manifest by the newborn shortly after birth, many of these hematological problems were manifest by the fetus and persist in the newborn.
fter 35 weeks' gestation, the mean cord hemoglobin concentration approximates 17 g/dL, and values below 14 g/dL are considered abnormal. he American College of Obstetricians and Gynecologists (20 17b) now recommends a 30-to 60-second delay in cord clamping in all healthy newborns. A review of nearly 4000 deliveries found that this delayed cord clamping was associated with a mean neonatal hemoglobin rise of 1.5 g/dL (McDonald, 2013). At the same time, this practice almost doubled the incidence of hyperbilirubinemia requiring phototherapy.
Fetal anemia results from many causes (Colombatti, 2016; Yaish, 2017). .Many of these are discussed in more detail in Chapter 15 (p. 300). Acute anemia with hypovolemia is seen with deliveries in which the placenta is cut or torn, if a fetal vessel is perforated or lacerated, if there is recent fetal-maternal hemorrhage, or if the newborn is held well above the level of the placenta for some time before cord clamping. Intracranial or extracranial injury or trauma to fetal intraabdominal organs can also cause hemorrhage with acute anemia (kin, 2011; McAdams, 2017).
Neonatal polycythemia with hyperviscosity can be associated with chronic hypoxia in utero, twin-twin transusion syndrome, placental-and fetal-growth restriction, fetal macrosomia from maternal diabetes, and transusion at delivery. When the hematocrit rises above 65, blood viscosity markedly increases and may cause neonatal plethora, cyanosis, or neurologicl aberrations. Because of the shorter life span of macrocytic fetal erythrocytes, hyperbilirubinemia commonly accompanies polycythemia. Other findings include thrombocytopenia, fragmented erythrocytes, and hypoglycemia. Cui and associates (2017) reported a case of unilateral macular hemorrhage in a newborn with polycythemia and platelets of 1 million/IlL Partial exchange transusion may be necessary in some neonates.