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29 Cards in this Set
- Front
- Back
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22 yo G3P2 at 40 weeks gestation presents c/o strong uterine contractions
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denies LOF
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Cervix is dilated at 5 cm and the vertex is at -3
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Fetal bradycardia is noted upon artificial rupture of membranes
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So what is the main point of this case?
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you SHOULD NOT RUPTURE THE MEMBRANES WHEN A FETUS IS ADEQUATELY ENGAGED. THIS GIVES A CORD PROLAPSE
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So how is this case different from a case of vasa previa and ruptured umbilical vessels?
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you don't see the sinusoidal pattern FHT that you might expect with fetal anemia
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What are some other risk factors for cord prolapse?
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transverse fetal lie
footling breech presentation multiparity |
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what is the next step for suspected fetal bradycardia?
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you do a digital vaginal exam and look for the prolapse
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What is the tx regimen for a confirmed prolapse?
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you put them in Trendelenburg to relieve pressure on the cord and reduce the # of decels
Then you do emergent C/s |
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So what is the most likley cause of fetal bradycardia?
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cord prolapse
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What is the definition of engagement?
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the extent that the fetus is presenting relative to the ischial spines
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it goes from negative 3 to positive 3
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ok
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What is the definition of fetal brady?
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less than 110 for at least 10 minutes
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So what is the problem with cord prolapse?
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as the umbilical cord pushes through the cervical os, then it cuts off sufficient blood supply to the fetus
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What is the first step in evaluating fetal bradycardia?
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should attach a scalp electrode to confirm that is indeed occurring.
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This partly helps to
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separate the fetal HR from mom's HR
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What are the initial steps to help manage fetal bradycardia>
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place the mother in left decubitus to relieve pressure on the great vessels
give 100% O2 by mask IVF bolus if volume depleted |
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What are some reasons the fetus may be bradycardic?
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cord prolapse: place the mom in Trend
maternal hypoTN: IVF bolus Maternal hypoxia: Give O2 Uterine tetany- give a Beta agonist |
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The first step is fluid resuscitation because you basically assume that the fetus is hypotensive
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yep
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For cord prolapse specifically, what do you do again?
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TRend + C/s
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What do accels tell you?
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that the fetus is adequately oxygenated
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How does a uterine rupture generally present?
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as a change in the fetal HR
also they'll have severe abdominal pain and possible peritoneal signs |
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Do IUPC's help in evaluating uterine rupture?
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no not really
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why would misoprostol give prolonged decels?
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because it can give uterine tetany
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What does a woman get when the uterus starts to compress the IVC more and more?
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they get supine hypoTN
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Why would an epidural give placental insufficiency?
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because it decreases SNS outflow and gives hypotension
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Again, what is always the first step in dx of fetal bradycardia?
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distinguish it from mom- do a scalp electrode
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again, what is the basic treatment for fetal brady?
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IVF bolus
lateral decub O2 by mask stop oxytocin |
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understand, that the membranes have to already be ruptured to use a fetal scalp electrode
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yep
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What presentation gives a much higher risk of cord prolapse?
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footling breech
transverse lie |
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what is the best tx once a cord prolapse has occurred?
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emergent C/S
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