CFB OGPAE01-2 Perinatal Medicine, Antenatal Care And Pre-pregnant Counselling (part II)
Continuation of perinatal medicine education covering advanced aspects of antenatal care, including screening strategies, management of high-risk pregnancies, and pre-pregnancy counselling to optimize maternal and fetal outcomes.
Perinatal Medicine — Newborn Resuscitation and Normal Care of Newborn
Big idea: This lecture, delivered by Dr. Mabel SC Wong (Paediatrics, QMH/HKU), covers two main areas: (1) Neonatal Resuscitation based on NRP 8th edition (AAP/AHA 2020 guidelines) and (2) Normal Newborn Care including thermoregulation, cord care, screening, prophylaxis, feeding, sleeping, and parental counselling. It is the paediatric counterpart to the obstetric Part I lecture — together they form the "Perinatal Medicine, Antenatal Care and Pre-pregnant Counselling" CFB series. [1]
How it fits in: At delivery, the obstetrician hands over to the paediatrician/midwife. You must know the resuscitation algorithm cold — it is the single most common acute scenario tested across paediatrics and O&G exams. Normal newborn care feeds into breastfeeding (OGPAE02), neonatal screening, and immunisation topics.
Learning objectives (inferred from slides):
- Anticipate which newborns will need resuscitation (risk factors).
- Perform structured neonatal resuscitation: initial steps → PPV → intubation → chest compressions → medications.
- Know targeted SpO₂ values, MR SOPA corrective steps, indications for each escalation.
- Understand special considerations for preterm resuscitation.
- Describe routine normal newborn care: thermoregulation, cord care, screening, prophylaxis, feeding, sleeping position, counselling.
Part A — Neonatal Resuscitation
"Approximately 10% of newborns require some assistance to begin breathing at birth; ~1% require extensive resuscitative measures." [1]
The earlier CPR starts, the better the outcome and the shorter the time to revival. The transition from intrauterine to extrauterine life requires the lungs to take over gas exchange within seconds. If this fails → progressive asphyxia → organ damage → death.
High Yield — First Sign of Compromise
"Cessation of respiratory efforts is the first sign that a newborn is deprived of oxygen." [1] This is different from adults, where cardiac arrest is more common as the primary event. In neonates, the problem is almost always respiratory first.
When a fetus/neonate becomes hypoxic:
| Phase | Breathing | HR | BP | Response to Stimulation |
|---|---|---|---|---|
| Primary apnoea | Stops (apnoea) | Falls | Maintained initially | YES — tactile stimulation works |
| Secondary (terminal) apnoea | None (after brief gasping) | Falls further | Falls | NO — requires PPV |
Why this matters for exams: You cannot distinguish primary from secondary apnoea clinically at the bedside. Therefore, if a baby is apnoeic and does not respond to brief tactile stimulation, you must assume secondary apnoea and begin PPV immediately. [1]
"Gasping respiration is ineffective and should be considered the same as apnoea." [1]
Every birth should be attended by at least 1 qualified individual who can initiate resuscitation and whose only responsibility is the management of the newly born baby. [1]
4 Pre-birth questions: [1]
- Expected gestational age?
- Amniotic fluid clear?
- Additional risk factors?
- Umbilical cord management plan?
| Antepartum Risk Factors | Intrapartum Risk Factors |
|---|---|
| GA < 36+0 weeks | Emergency caesarean delivery |
| GA ≥ 41+0 weeks | Forceps or vacuum-assisted delivery |
| Pre-eclampsia / eclampsia | Breech or abnormal presentation |
| Maternal hypertension | Category II or III fetal heart rate pattern |
| Multiple gestation | Maternal general anaesthesia |
| Fetal anaemia | Maternal magnesium therapy |
| Polyhydramnios | Placental abruption |
| Oligohydramnios | Intrapartum bleeding |
| Fetal hydrops | Chorioamnionitis |
| Fetal macrosomia | Opioids given to mother within 4 hrs of delivery |
| IUGR | Shoulder dystocia |
| Significant fetal malformations | Meconium-stained amniotic fluid |
| No prenatal care | Prolapsed umbilical cord |
Why certain risk factors matter:
- Opioids within 4 hrs → cross placenta, depress neonatal respiratory drive
- Maternal magnesium → neonatal neuromuscular depression
- Meconium-stained fluid → risk of meconium aspiration syndrome
- Chorioamnionitis → neonatal sepsis risk
- Preterm → immature lungs, surfactant deficiency, fragile germinal matrix vessels
| Step | Equipment | Key Details |
|---|---|---|
| Warm | Pre-heated warmer, warm towels, hat; plastic bag/wrap + thermal mattress if < 32 weeks | Temp target 36.5–37.5°C |
| Clear airway | Bulb syringe, 10F/12F suction catheter, suction 80–100 mmHg, meconium aspirator | Mouth before nose |
| Auscultate | Stethoscope | HR is key vital sign |
| Ventilate | Flow-inflating/self-inflating bag, T-piece; flowmeter 10 L/min; O₂ blender at 21% (or 21–30% if < 35 wks); term + preterm masks; 8Fr feeding tube | PPV is single most effective step |
| Oxygenate | Free-flow O₂ equipment; pulse oximeter + sensor on right hand/wrist (preductal) | Target SpO₂ table |
| Intubate | Laryngoscope blades 0 and 1 (00 for extreme preterm); ETT 2.5, 3.0, 3.5; stylet; CO₂ detector; LMA size 1; securing device | CO₂ detector confirms placement |
| Medicate | Adrenaline 1:10,000 (0.1 mg/mL); normal saline; UVC supplies; ECG monitor | IV/UVC preferred route |
Provide warmth aiming baby's temp 36.5–37.5°C → Dry → Stimulate → Position head/neck in neutral or "sniffing" position → If needed, clear secretions (mouth before nose). [1]
Tactile stimulation: [1]
- Two methods: (1) Gently rub back/trunk/extremities, (2) Slap/flick sole
- Do not perform one after the other — try one, and if no response after several seconds, move to PPV
- Vigorous/deep suctioning is harmful → tissue injury + vagal bradycardia
Umbilical cord clamping:
High Yield — Delayed Cord Clamping
The two key vital signs in neonatal resuscitation are: (1) Respiration and (2) Heart rate. [1]
- HR is assessed by auscultation (stethoscope over precordium) — fastest bedside method
- If HR cannot be determined and baby is not vigorous → use pulse oximeter or ECG monitor [1]
- Pulse oximeter placed on right hand/wrist (preductal — reflects O₂ going to brain/coronaries)
Targeted Preductal SpO₂ After Birth: [1]
| Time after birth | Target SpO₂ |
|---|---|
| 1 min | 60–65% |
| 2 min | 65–70% |
| 3 min | 70–75% |
| 4 min | 75–80% |
| 5 min | 80–85% |
| 10 min | 85–95% |
Why SpO₂ Is Low Initially
At birth, SpO₂ is normally ~60% because the transition from fetal to adult circulation takes minutes. Fetal PaO₂ is only ~25–30 mmHg. Immediately supplementing to 100% O₂ causes oxygen free radical damage (especially in preterms → retinopathy of prematurity, BPD). Hence we start at 21% (room air) for term babies and titrate up.
Avoid oxygen saturation > 95% [1] — hyperoxia is harmful.
Indications for PPV: [1]
- Apnoea / gasping
- HR < 100 bpm
- O₂ saturation below target despite free-flow O₂ or CPAP
PPV Parameters: [1]
| Parameter | Value |
|---|---|
| Initial O₂ concentration (≥ 35 wks) | 21% |
| Initial O₂ concentration (< 35 wks) | 21–30% |
| Ventilation rate | 40–60 breaths/min |
| Initial ventilation pressure | 20–25 cmH₂O |
Most important indicator of successful PPV: Rising heart rate [1]
After 15 seconds of PPV: Check HR
- HR rising + chest movement → continue
- HR not rising, no chest movement → MR SOPA corrective steps [1]
"MR. SOPA!!" [1] — This mnemonic is for when PPV is not working (no chest rise, HR not improving):
| Letter | Step | Explanation |
|---|---|---|
| M | Mask adjustment | Ensure proper seal — most common problem |
| R | Reposition airway | Neutral/"sniffing" position |
| S | Suction mouth and nose | Clear secretions |
| O | Open mouth | Open baby's mouth slightly, lift jaw |
| P | Pressure increase | Increase PIP gradually (up to 30–40 cmH₂O) |
| A | Alternative airway | ETT or LMA |
| HR | Action |
|---|---|
| > 100 bpm | Gradually reduce rate/pressure, then discontinue PPV |
| 60–100 bpm | Reassess ventilation, corrective steps, adjust O₂, insert alternative airway if not done |
| < 60 bpm | Alternative airway strongly recommended; call for help; increase O₂ to 100%; begin chest compressions |
Indications: [1]
- HR < 100 bpm and not increasing after PPV with face mask or LMA
- Before starting chest compressions (if intubation unsuccessful and weight > 2 kg → LMA)
- Special circumstances:
- Direct tracheal suction for thick secretions/airway obstruction
- Surfactant administration
- Suspected diaphragmatic hernia
- Prolonged PPV — ETT improves efficacy
Confirming correct ETT position: [1]
- Rapidly rising HR
- Exhaled CO₂ detected by CO₂ detector (colorimetric: purple → yellow = CO₂ present)
- Equal breath sounds in both axillae
- Symmetrical chest movement
- Little/no air leak from mouth during PPV
- Decreased/absent air entry over stomach
DOPE Mnemonic — if baby deteriorates after intubation: [1]
- D = Displacement (of ETT)
- O = Obstruction (of ETT)
- P = Pneumothorax
- E = Equipment failure
"A misplaced tube is worse than having no tube at all!!!" [1]
Indications: [1]
- PPV with face mask ineffective AND intubation not possible AND baby weight > 2 kg
- Congenital anomalies involving mouth/lip/tongue/palate/neck making mask seal difficult
- Very small mandible or relatively large tongue (e.g., Pierre Robin syndrome, trisomy 21)
High Yield — Updated Meconium Management
"Routine laryngoscopy with or without intubation for tracheal suction is NOT suggested" for meconium-stained fluid. [1] This changed from previous editions. "Intubation and tracheal suction may be necessary if airway obstruction is suspected." [1]
- If vigorous (good tone + respiratory effort) → stay with mother, routine initial steps
- If not vigorous → bring to radiant warmer for initial steps
Indications: [1]
"HR < 60 bpm despite at least 30 seconds of PPV that inflates the lungs."
Technique — Thumb Technique (preferred): [1]
- Thumbs on sternum, side by side (or one over the other in small babies), just below imaginary line connecting nipples
- Encircle torso with both hands, support back with fingers
- Thumbs flexed at first joint
- Depress sternum approximately 1/3 of AP diameter of chest
- Pressure vertical, maintained on sternum
Coordination with ventilation: [1]
- 3 compressions : 1 breath = 4 events in 2 seconds
- ~120 events/min (90 compressions + 30 breaths)
- When compressions begin → ventilate with 100% O₂ until HR ≥ 60 and pulse oximeter reliable
After 60 seconds of compressions + PPV: [1]
- HR ≥ 60 bpm → discontinue compressions, resume PPV at 40–60/min
- A cardiac monitor is the preferred method for assessing HR during compressions (pulse ox unreliable with poor perfusion)
Exam Trap — Compression:Ventilation Ratio
Neonatal ratio is 3:1, NOT the 15:2 (children) or 30:2 (adults). This is because neonatal arrest is almost always respiratory in origin → ventilation takes priority. The 3:1 ratio provides relatively more breaths.
When: HR < 60 bpm despite 30s effective PPV + 60s coordinated compressions with 100% O₂ [1]
| Medication | Details |
|---|---|
| Adrenaline (Epinephrine) | 1:10,000 (0.1 mg/mL); via UVC (preferred) or intraosseous |
| Volume expander | Normal saline; if not responding to resuscitation AND signs of shock or history of acute blood loss |
Route: Prepare umbilical vein catheter (UVC) or intraosseous (IO) access [1]
When to stop: [1]
"If confirmed no HR after all appropriate steps, cessation of resuscitation should be discussed with the team and family. A reasonable timeframe is around 20 minutes after birth." Decision should be individualized.
Why preterms are at higher risk: [1]
- Rapid heat loss (high surface area:volume ratio, thin skin, less subcutaneous fat)
- Immature organ systems (lungs: surfactant deficiency; brain: germinal matrix fragility)
- Small blood volume (total ~80 mL/kg)
- Vulnerability to hypoglycaemia (limited glycogen stores)
Additional resources needed: [1]
- Polyethylene plastic wrap/bag (< 32 weeks), hat, thermal mattress
- Preterm-sized mask, size-0 laryngoscope blade, ETT 2.5 & 3.0 mm
- Device providing PEEP and CPAP
- Surfactant
- Pre-warmed transport incubator
To decrease risk of neurologic injury (esp. IVH): [1]
- Handle baby gently
- Avoid positioning legs higher than head (avoids rapid changes in cerebral blood flow)
- Avoid high PPV or CPAP (barotrauma, pneumothorax)
- Use pulse oximeter and blood gases to adjust ventilation/O₂
- Avoid rapid IV fluid infusions (rapid volume shifts → IVH)
- Routine care: vigorous term babies with no risk factors
- Post-resuscitation care for babies with depressed breathing/activity or requiring supplemental O₂:
- Close monitoring: respiratory effort, oxygenation, BP, blood glucose, electrolytes, urine output, neurologic status, temperature
- Avoid overheating during or after resuscitation
- If indicated, therapeutic hypothermia must be initiated promptly (for moderate-severe HIE: cooling to 33.5°C for 72h, started within 6h of birth) [2]
Documentation: [1]
"Thorough documentation is essential for good clinical care, communication and medicolegal concern." Must include narrative description of interventions, their timing, and personnel responsible.
Multidisciplinary team: [1]
"Obstetrician, Midwife and Paediatrician should work as close partnership for better mother and infant care."
Part B — Normal Newborn Care
| Measure | Why |
|---|---|
| Room temperature ≥ 24°C | Reduces convective heat loss |
| Dry baby immediately after birth | Evaporative heat loss is the biggest contributor |
| Radiant heat warmer | Radiative warming |
| Wrap/clothe baby, hat | Reduces convective + radiative loss; head is ~20% BSA in neonate |
| Incubator care (if indicated) | Servo-controlled neutral thermal environment |
| Early feeding | Generates metabolic heat, prevents hypoglycaemia |
"Postnatal weight loss of up to 7% of birth weight due to fluid loss. Start gaining weight from day 5–7."
This is normal physiological contraction of extracellular fluid volume. Weight loss > 10% is concerning.
Problematic fluid management: [1]
| Fluid Overload | Dehydration |
|---|---|
| Respiratory distress | Poor perfusion / shock |
| Heart failure | Hypernatraemia |
| Hyponatraemia (dilutional) | Hyperviscosity |
| Inadequate nutrition |
- Keep dry and clean
- Clean with cotton ball soaked in cold boiled water/alcohol, then dry
- Usually sloughs off by day 14
Abnormal conditions: [1]
- Omphalitis — periumbilical erythema, purulent discharge; may need systemic antibiotics (risk of portal vein septicemia)
- Granuloma — pink/red tissue at stump base after cord separates; treat with silver nitrate application
- Malformation — persistent urachal cyst (bladder connection), vitelline duct (bowel connection)
High Yield — HK Newborn Screening Programme
| Screening Type | Tests | Details |
|---|---|---|
| Biochemical (cord blood) | G6PD deficiency | Incidence: 4.4% males; 0.5% females |
| TSH (congenital hypothyroidism) | Incidence: 1:2000–2500 | |
| Expanded newborn screening | Inborn Errors of Metabolism | 26 disorders (heel-prick dried blood spot) |
| Severe Combined Immunodeficiency (SCID) | Since October 2021 (TREC assay) | |
| Hearing screening | OAE / ABR | Universal newborn hearing screening |
| Physical screening | Congenital heart disease, developmental dysplasia of hip | Clinical examination |
Why G6PD screening matters in HK: Very high carrier rate in Chinese. G6PD-deficient neonates are at risk of severe neonatal jaundice → kernicterus if certain oxidant triggers (e.g., naphthalene, fava beans, certain drugs) are not avoided. Parents must be counselled.
Why congenital hypothyroidism screening: Untreated → cretinism (severe intellectual disability). Treatment with levothyroxine is simple and completely prevents disability if started early.
| Prophylaxis | Purpose | Details |
|---|---|---|
| IM Vitamin K1 at birth | Prophylaxis against haemorrhagic disease of newborn (VKDB) | Neonates have low vitamin K stores + sterile gut (no bacterial vitamin K production) |
| HBV vaccine at birth | Prevent vertical transmission of Hepatitis B | + HBIG if mother is HBsAg carrier |
| BCG before hospital discharge | Prevent disseminated TB / TB meningitis | Intradermal injection, left deltoid |
Continue routine immunisation programme at MCHC / private sector. [1]
Past Paper Alert — HBV Prophylaxis for Newborn
2023 SAQ Q5 tested this directly: "Name two measures to be implemented for the infant within 24 hours of birth [if mother HBsAg+]." [3] Answer: (1) HBV vaccine AND (2) HBIG — both within 24 hours. This is from the lecture slides and is frequently examined.
"Breast milk is the best. Nutritionally adequate for the first 6 months for term infants."
- Consider supplement — vitamin D (breast milk is relatively low in vitamin D; 400 IU/day recommended)
- Promotion of breastfeeding: starts from antenatal preparation → early maternal contact after birth → room-in → feeding on demand
"Supine preferable; prone position associated with a higher chance of sudden infant death; lateral position also slightly higher risk."
- No pillow required
- Tight bed sheet and no loose blanket
Why supine: Prone sleeping is the single most modifiable risk factor for SIDS. Prone → impaired arousal, CO₂ rebreathing, overheating. The "Back to Sleep" campaign dramatically reduced SIDS incidence worldwide.
- Establish good rapport with parents
- Open, sensitive and informative communication
- Advise on infant care: cleaning of umbilical cord, newborn sleeping pattern/position, sneezing and hiccup (physiological — reassurance), bathing, diaper care
- Reassurance and positive reinforcement
Integration With Related Material
While not on Part II slides, the Apgar score complements the resuscitation algorithm. It is assessed at 1 and 5 minutes but should never delay resuscitation — it is a retrospective descriptor.
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| Appearance (colour) | Blue/pale all over | Acrocyanosis | Completely pink |
| Pulse (HR) | Absent | < 100 | ≥ 100 |
| Grimace (reflex) | None | Grimace | Cry/cough |
| Activity (tone) | Limp | Some flexion | Active |
| Respiration | Absent | Slow/irregular | Good cry |
A low Apgar (0–3) at 5 min correlates with neonatal morbidity but is NOT a reliable predictor of long-term neurodevelopmental outcome by itself. [4]
Exam Intelligence
| Stem Type | Focus |
|---|---|
| "A newborn is apnoeic at birth. Describe the steps of resuscitation." | NRP algorithm |
| "What is the most important step in neonatal resuscitation?" | PPV / Lung ventilation |
| "A baby has HR 50 bpm after 30s of PPV with chest movement. What is your next step?" | 100% O₂ + Chest compressions |
| "Name the corrective steps if PPV is not producing chest rise." | MR SOPA |
| "List the targeted SpO₂ at 1, 2, 5, and 10 minutes after birth." | Table values |
| "What investigations are performed on cord blood in HK?" | G6PD, TSH |
| "What newborn screening tests are available in HK?" | G6PD, TSH, IEM (26 disorders), SCID, hearing |
| "What prophylaxis is given at birth?" | Vitamin K IM, HBV ± HBIG, BCG |
| "Describe measures to prevent SIDS." | Supine sleep, no pillow, firm mattress, no loose blankets |
| "Compression:ventilation ratio in neonatal resuscitation?" | 3:1 |
Common Exam Mistakes
- Using 100% O₂ from the start — No! Start at 21% for term, 21–30% for preterms < 35 wks. Only increase to 100% when starting chest compressions.
- Forgetting mouth before nose for suctioning — mouth first prevents aspiration of oral secretions when baby gasps during nasal stimulation.
- Routine tracheal suctioning for meconium — No longer recommended. Only if airway obstruction suspected.
- Using adult compression:ventilation ratio (30:2) — Neonatal is 3:1.
- Pulse oximeter on left hand — Must be right hand/wrist (preductal). Left hand is postductal.
- Thinking Apgar score guides resuscitation — It does NOT. Resuscitation begins based on breathing, tone, and HR, not Apgar.
- Confusing "physiological weight loss" threshold — Up to 7% is normal; > 10% is concerning.
| Scenario | Answer A | Answer B | Discriminator |
|---|---|---|---|
| HR 50 after initial steps only | Start PPV | Start compressions | PPV first — compressions only if HR < 60 after ≥30s of PPV that inflates lungs |
| HR 80 during PPV | Continue PPV | Start compressions | 80 > 60, so continue PPV, reassess |
| Baby not improving after intubation | Re-intubate immediately | Think DOPE | DOPE first — systematically check Displacement, Obstruction, Pneumothorax, Equipment |
| Preterm < 32 wks, thermoregulation | Dry and wrap | Plastic bag without drying | Plastic bag/wrap directly (do NOT dry first — drying wastes time and increases heat loss in very preterms) |
Q1 (SAQ style): A term baby is born apnoeic with poor tone. Describe your management in a stepwise fashion. (10 marks)
Markscheme:
- Initial steps: warmth (radiant warmer), dry, stimulate (rub back/flick sole), position (sniffing), suction if needed (mouth then nose) [2 marks]
- Evaluate: breathing + HR within 30s [1 mark]
- If apnoeic/HR < 100: PPV at 40–60/min with 21% O₂, initial pressure 20–25 cmH₂O [2 marks]
- After 15s: check HR — if no chest rise → MR SOPA [1 mark]
- After 30s effective PPV: HR < 60 → intubate/alternative airway, 100% O₂, chest compressions 3:1 [2 marks]
- After 60s compressions: HR still < 60 → adrenaline 1:10,000 via UVC [1 mark]
- Consider cessation if no HR after ~20 min [1 mark]
Q2 (MCQ style): During neonatal resuscitation, the initial oxygen concentration for a term baby should be: A. 21% ✓ B. 30% C. 60% D. 100%
Q3 (SAQ): List the newborn screening tests performed in Hong Kong. (5 marks)
- Cord blood: G6PD deficiency, TSH for congenital hypothyroidism [2 marks]
- Heel prick dried blood spot: 26 IEM + SCID [2 marks]
- Hearing screening [1 mark]
- (Physical examination for CHD, DDH — may get additional credit)
Active Recall - Lecture Notes
High Yield Summary
Neonatal Resuscitation: ~10% of newborns need help breathing; ~1% need extensive resuscitation. The key vital sign is HR. The single most effective action is PPV (ventilation). Start O₂ at 21% for term (21–30% for preterms < 35 wks). Use the NRP 8th edition algorithm: Initial steps → PPV (40–60/min) → MR SOPA if no chest rise → HR < 60 after 30s effective PPV → 100% O₂ + chest compressions (3:1) → HR < 60 after 60s → adrenaline via UVC. Target preductal SpO₂ (right hand): 60–65% at 1 min to 85–95% at 10 min. Avoid SpO₂ > 95%. Meconium: NO routine tracheal suctioning. Cessation discussion at ~20 min if no HR detected. For preterms: plastic wrap without drying (< 32 wks), surfactant, CPAP/PEEP, handle gently.
Normal Newborn Care: Prevent hypothermia (dry, warm, hat). Cord care: dry and clean, sloughs by day 14 (watch for omphalitis). Screening: cord blood G6PD + TSH; heel-prick for 26 IEM + SCID; hearing; physical exam. Prophylaxis: IM Vitamin K1, HBV ± HBIG, BCG. Breastfeeding: best for first 6 months + vitamin D supplement. Sleep supine (prevent SIDS), no pillow, no loose blankets. Physiological weight loss up to 7%, regain from day 5–7.
[1] Lecture slides: CFB (OGPAE01-2) Perinatal Medicine, Antenatal Care and Pre-pregnant Counselling (Part II).pdf [2] Senior notes: Adrian Lui Pediatrics Notes.pdf (Section 2.3.2 — HIE) [3] Past papers: 2023 Fourth Summative SAQ.pdf (Question 5) [4] Senior notes: Adrian Lui Pediatrics Notes.pdf (Section 2.1 — Overview on Neonatology) [5] Past papers: 2025 Fourth Summative SAQ.pdf (Question 7) [6] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Section on thalassaemia screening) [7] Senior notes: Block A - Leg swelling and chest pain_ deep vein thrombosis; pulmonary embolism; Thrombophilia.pdf [8] Past papers: 2022 Fourth Summative MCQ.pdf (Question 13)
CFB OGPAE01-1 Perinatal Medicine, Antenatal Care And Pre-pregnant Counselling (part I)
Perinatal medicine and antenatal care encompass the systematic medical supervision of pregnancy from preconception counseling through the prenatal period, including risk assessment, health optimization, and screening to ensure optimal maternal and fetal outcomes.
CFB OGPAE02-1 Physiology Of Lactation, Breast Feeding And Infant Feeding (part I)
Lactation physiology encompasses the hormonal mechanisms of mammogenesis, lactogenesis, and galactopoiesis, along with the principles of breastfeeding initiation and infant nutritional requirements in the early postnatal period.