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67 Cards in this Set
- Front
- Back
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kick counts |
3rd trimester, lay on left sside and count number of movement in 1 hr >10 is reassuring <10 wait one hour and repeat, still <10 call provder ****not a medical protocol!! |
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nonstress tesst |
first step in assessment of fetal well being utilizes external doppler equipment to continously monitor fetal heart rate |
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oxytocin challenge test |
combines NST with external tocometer allowing evaluation of fetal heart rate in response to contractions can determine if pregnancy can continue or if fetus should be delivered |
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when is the oxytocin challenge test used |
natural labor or prenatally with dilute infusion of oxytocin to stimulate contractions |
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biophysical profile |
ultrasound in addition to NST evaluates amniotic fluid volume, fetal tone, fetal activity, and fetal breathing movemtns score of 8-10 is reassuring top score is 10 |
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fetal scalp electrode |
used during labbor when external doppler loses it sensitivity due excessive movement of fetus or mother monitors fetal heart rate through a small electrode attached to the fetal scalp that sense depolarization of fetal heart membranes must be ruptured before placing electrode |
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intrauterine pressure catheter |
measures timing and strength of contractions threaded into uterine cavity past presenting part of fetus and requires rupture of membranes measured in montevideo units |
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purpose of NST and CST |
monitor fetal well being to ensure a positive outcome |
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questions NST and CST answer |
prenatal-can this high risk pregnancy continue or should baby be delivered delivery-should there be a c-section trauma-can this pt be safely discharged |
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When is NST and CST used |
prenatally w/ high risk pregnancies post term ( 40-41 wks) decrease in fetal movement all pts admitted for delivery not used before 32 weeks after maternal trauma |
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1st step in evaluating NST/CST |
determine fetal heart rate baseline |
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what is normal fetal heart beart |
110-160 |
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causes of fetal bradycarda |
late sign of fetal hypoxia medications such as narcotics, epidurals synthetic oxytocin maternal hypotension prolonged compression of umbilical cord |
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causes of fetal tachycardia |
early sign of fetal hypoxia medications such as terbutaline prematurity maternal anxiety maternal fever/infection fetal infection |
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2nd step of CST/NST |
determine variability absent, minimal, moderate, or marked |
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what is normal variability |
moderate heart rate varies 5-25 around baseline 12 above or 12 below |
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absent variability |
most worrisome caused by hypoxia or prematurity |
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minimal variability |
not reassuring, can occur when fetus is asleep |
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marked variability |
can occur with acute compression of cord, usually just the change of a mother's posisiton |
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rare sinusoidal pattern variabillity |
ominous |
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3rd step in CST/NST |
determine if reactive pattern in present |
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reactive pattern |
2 or more accelerations in heart rate in 20 min |
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acceleration |
heart rate must increase 15bpm or more above baseline and last 15 sec or longer |
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what do accelerations indicate |
fetal movement or fetal response to contractions |
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4th step in CST/NST |
evaluate any decelerations |
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early decelerations |
begin at the onset of the contraction and return to baseline at the end of the contraction they are a response to head compression and are considered NORMAL |
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late decelerations |
begins after contraction has started and the lowest point of deceleration occurs after peak of contraction and usually does not reutrn to baseline until after the contraction is over |
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what does late accelerations mean |
uteroplacentla insufficienncy-compromised blood flow to baby that does not deliver the amount of oxygen needed to withstand stress of labor ominous finding |
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variable decelerations |
do not follow a pattern related to contractions and have a U or V shape compression of umbilical cord not associated with poor fetal outcome if variability decreases or late decelerations occur may indicate fetal compromise |
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Documentation of NST/CST include |
date and time fetal heart baseline variability accerlerations decelerations and time overall evaluation-reassuring, non reassuring, omninous |
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intrauterine resuscitation |
1-get help 2-mother on left side 3-increase IV fluid 4-give O2 5-stop any oxycotin 6-consider tocolysis 7-apply internal monitor 8-confirm no cord prolapse 9-physician may perform amnioinfusion |
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signs of fetal distress |
fetal tachycardia, bradycardia, absent varialibity, late decels, non reactive pattern presence of meconium in amniotic fluid |
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meconium |
material that collects in intestine of fetus and forms first stools of newborn thick, black, sticky |
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what happens if meconium is passed before birth |
may pose aspiration risk and respiratory distress can lead to pneumothorax |
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Group B Strep |
non sexually transmitted bacteria found in the GI, urinary, and reproductive tract which can be transferred to fetus during labor |
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Group b strep signs and symptoms |
mother typically asymptomtic |
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Dx group B strept in mom |
must be screened between 35-37 weeks pregnancy to prevent transfer to baby |
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treatment of GBS |
IV penicillin or clindamycin |
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GBS complications |
maternal and fetal pneumonia, meningitis, bacteria |
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chorioamnionitis |
complciation of pregnancy caused by bacteriall infection of the amniotic sac and fluid commonly associated with GBS |
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Chorioamnionitits symptoms |
fever maternal and fetal tachycardia purulent or foul smelling amniotic fluid or vaginal discharge uterine tenderness |
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chorioamnionitis dx |
symptoms physical exam labs |
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chorrioamnionitis tx |
iv penicillin and clindamycin |
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Chorioamnionitis complications maternal |
endometritis thrombosis, sepsis |
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chorioamnionits complications fetal |
neurologic disease neonatal sepsis pneumonia |
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fetal alcohols syndrome |
mother drank during pregnancy increasing severity with 2-5 drinks per day |
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features of FAS |
facial features-short palpebral fissures, thin vermillion border, smooth philtrum central nervous system abnormalities growth retardation |
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how is HIV spread |
contact with bodily fluids IV drug abuse unprotected sex mother/baby transfer |
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what does HIV |
attacks and destroys T4 lymphocytes, leads to immunologic deficits and rare and difficult to treat infections |
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zidovudine |
reduces risk of HIV transmission by 70% |
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when should zidovudine be given |
during labor-IV ZDV infant-oral ZDV x 6 wks asap after birth postpartum-continue antiretroviral therapy after delivery |
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hypothroidism sx |
fatigue, cold interolerance, constipation and weiht gain, coarse skin, thin hair, brittle nails |
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tx of hypothyroidism in pregnancy |
levothyroxin 1.6 mcg/kg per day |
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hypothyroidism complications |
preeclampsia, gestational hypertension, placental abruption, nonreassuring fetal heart rate tracing preterm and very preterm delivery |
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hyperthyroidism sx |
tachycardia, heat intolerance, increased perspiration anxiety, hand tremor, weight loss |
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tx of hyperthroidism in pregnancy |
thioamide-proplythiouracil or methimazole (PTU in 1st trimester, MMI at 2nd) beta blockers, but not for more than 2-6 wks |
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what can beta blockers cause in fetus |
growth retardation and hypoglycemia |
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what tx is absolutely contraindicated in pregnancy for hyperthyroidism |
radioiodine |
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hyperthyroidism pregnancy complications |
spontaneous abortion, premature labor, low birth weight, stillbirth, preeclampsia |
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hyperthyroidism tx in baby |
PTU only for several months becauses moms antibodies diminish |
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systemic lupus erythematous early pregnancy complication |
high risk of early pregnancy loss in both the 1st and 2nd trimester |
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what is hallmark of SLE |
2nd trimester loss present as symmetric IUGR at 18-20 wks gestational age |
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SLE late pregnancy complication |
increased risk preeclampsia, placental thrombosis RF of IUGR and IUFD |
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what must you identify in SLE |
anti-RO/SSA and anti-LA/SSB positive positive-intensive heart monitoring of fetus is needed assess for fetal heart block |
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early pregnancy tx of SLE |
low dose ASA, heparin and corticosteroids |
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late pregnancy tx of SLE |
treatment SQ heparin or lovenox and low dose ASA continue vigilant monitoring of fetus, especially in antibody-positive mothers |
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neonatal tx of SLE |
complete heart block is irreversible even w/ glucocorticoid therapy second degree may be reversible may progress despite therapy |
