Ob

Front 1

O2 is tranferred from uterine circulation to umbilical circulation by?

Back 1

Passive Diffusion

Front 2

Indicators of Normoxemic state include:

Back 2

"Net lactate uptake by the fetus,Small amounts of hydrogen ion are transferred from fetus to mother, No increase in oxygen consumption occurs when maternal oxygen levels increase,Healthy fetus has a normal basal pH

Front 3

Fetal Oxidative Metabolism: Uterine Uptake is what 2 components

Back 3

1)Placental Comsumption (40% of utake at term, higher mid-term due to high carb and A.Acid metabolism 2) Umbilical O2 consumption is uptake by fetus

Front 4

Five factors Fetal O2 consumption

Back 4

Substrate Availability. Fetal: Growth, Activity, Hormone Status, Organ Metabolism.

Front 5

Is O2 fetal O2 consumption for growth necessary?

Back 5

No…not required to survive. Can be eliminated during high stress times. May lead to IUGR if prolonged

Front 6

Factors increasing Fetal Demand for O2

Back 6

Increased: Fetal Activity, Glucose Uptake (mom's high BG) and increase Hormone secretion

Front 7

Factors decreasing Fetal Demand for O2

Back 7

Mom's Hypoxemia, Low uterine or placental blood flow, placenta abnormal, fetal disorder

Front 8

Normal fetal growth is from

Back 8

Adequate metabolic substrates and fetus able to use it

Front 9

AGA

Back 9

Appropriate for Gestational Age. Wt b/w (10-90%) "for age"

Front 10

LGA

Back 10

Large for Gestational Age. Wt. >90% for age.

Front 11

SGA

Back 11

Small for Gestational Age. Wt. <10% for age

Front 12

What terms descibe birth wt. "Independent of Gest-Age

Back 12

LBW,VLBW,ELBW (low, verylow, Extrm low…birth wt.) 2500, 1500,1000 gms

Front 13

LBW

Back 13

<2500 gm

Front 14

VLBW

Back 14

<1500 gm

Front 15

ELBW

Back 15

<1000 gm

Front 16

Factors of Fetal Circulation

Back 16

"Fetal Oxygen Transport,Regulation of Fetal Blood Volume,Unique Fetal Circulatory Pattern, Various Factors that Control the Distribution of Blood Flow

Front 17

Oxygen content of fetal blood is determined by what formula?

Back 17

[Hgb] * HGB02 (bound) + constant 1.39 ml O₂/g Hgb Hgb (oxygen-carrying capacity of hemoglobin)

Front 18

Amount of oxygen dissolved in fetal plasma is?

Back 18

insignificant

Front 19

Normal fetal Hgb is __g/dl?

Back 19

18 g/dl

Front 20

Oxygen-carrying capacity of fetal blood should be

Back 20

25 ml O₂/dL – this is theoretical as fetal Hgb never approaches complete saturation @ low PO2

Front 21

P:50 for Fetus v. Mom ___mm Hg v. ___ mm HP

Back 21

Fetal Po2 is 19-21mm and mom's 27 mm Hg

Front 22

Per Rich. How does ocyhemoglob curve differ b/w mom and fetus?

Back 22

Fetus stays "locked and loaded" can drop to po2"19-21) and stays 50% saturated (@P:50)

Front 23

Fetal Hemoglobin does not interact as well with

Back 23

with DPG to stabilize the deoxygenated hemoglobin as maternal Hemoglobin does

Front 24

fetal hemoglobin has less DPG, less deoxy:hgb affinity and more…

Back 24

affinity for O2, so it takes it from mom *With emphasis*

Front 25

Fetal cardiac output is

Back 25

biventricular (also called combined ventricular output) "BV-CVO" due to ductus arteriosus

Front 26

Fetal Systemic and Pulmonary Circulations are

Back 26

PARALLEL, whereas postnatal circulations are in series

Front 27

The reason for parallel circulation is obvious

Back 27

fetal lungs do not participate in blood oxygenation

Front 28

almost complete right-to-left shunt is due to

Back 28

ductus arteriosus

Front 29

Can fetus increase their CVO in utero

Back 29

They cannot! …even during periods of stress (damn patent ductus arteriosus)

Front 30

Does fetal PNS or SNS develop first and which is more developed

Back 30

The PNS is developed first, thus the baseline FHR at 40 weeks gestation is < the baseline at 26 weeks gestation

Front 31

As the head decends into the pelvis, the ICP___?

Back 31

Increases…Ouch! "Hello there mom...stress me out with a head squish"

Front 32

Redistribution of circulation includes?

Back 32

"Decreases perfusion of the splanchnic organs, kidneys, and skin-Preservation of blood flow to skeletal muscle & bone-Augmented blood flow to the heart, brain, placenta, & adrenal glands-Cardiac output does not change-Fetal pH decreases as a result of these compensatory mechanisms

Front 33

FHRM: External (Indirect)

Back 33

Detected through maternal abdominal wall, no membrane rupture, doesn't quantify uterine pressure

Front 34

FHRM: Internal (Direct)

Back 34

"Wire electrode to the scalp of the fetus, requires rupture of membrane & partially dilated cervix

Front 35

Average FHR __bpm

Back 35

110-160

Front 36

"Tachy" FHR ___bpm

Back 36

>160

Front 37

"Tachy" FHR problems

Back 37

Prolonged hypoxemia (result of catecholamine secretion and SNS activity),Maternal Fever,Intrauterine infection,Medications (Terbutaline (β-adrenergic agonist), Atropine)

Front 38

"Brady" FHR ___ bpm

Back 38

<110 for 2 min.

Front 39

Why "Brady" FHR?

Back 39

Fetal initial response to acute hypoxemia, or maternal HoTN

Front 40

What is Variability?

Back 40

The irregularity of the FHR baseline from the competing effects of the PSNS and SNS

Front 41

Variability Describes?

Back 41

small HR changes in the FHR

Front 42

"What is the single, best non-invasive clinical indicator of fetal well-being?"

Back 42

Variability

Front 43

Short-term variability (beat-to-beat variability) results from the influence of ?

Back 43

the PSNS

Front 44

Long-term variability is?

Back 44

Rhythmic fluctuations in the FHR basline that are seen over a 5-10” tracing

Front 45

Normal (LT variability) frequency of such waves is

Back 45

3-5 cycles/min

Front 46

Lack of variability results from

Back 46

hypoxemia and the decompensation of cerebral blood flow & O₂ delivery

Front 47

How should you manage mom's BP?

Back 47

Keep it up…SBP >95

Front 48

A Periodic Changes in FHR called an acceleration is

Back 48

An abrupt increase in FHR (<30 Seconds)

Front 49

What is the mechanism for an accelaration?

Back 49

"Fetal Movement,Uterine Contractions,Umbilical Cord Occlusion,

Front 50

Periodic Changes in FHR precludes the presence of significant

Back 50

fetal metabolic acidosis (reassuring)

Front 51

"Early Decelerations are from what three factors?"

Back 51

"1) Occur simultaneously with uterine contractions and usually are <20 bpm below baseline-2) Onset and offset of each -decel coincides with the onset and offset of the uterine contraction-3) Occurs as a result of vagal response to head compression during labor

Front 52

"Late Decelerations are not good…why?"

Back 52

"1) Begin 10-30 seconds after the beginning of a uterine contraction and end 10-30 seconds after the end of the uterinecontraction::2) Smooth and Repetitive::3) Classic sign of uteroplacental insufficiency and hypoxia

Front 53

What is the "OMINOUS SIGNAL OF FETAL DISTRESS!"

Back 53

COMBINATION OF LATE DECELS AND DECREASED/ABSENT FHR VARIABILITY

Front 54

Describe Variable Decelerations

Back 54

"Vary in depth, shape, and/or duration:Abrupt in onset and offset

Front 55

What is the likely cause of variable decels

Back 55

"Believed to be a result of vagal response to either umbilical cord compression or to substantial head compression during pushing

Front 56

Healthy fetus typically can tolerate mild-to-moderate variable decels not below ___BPM

Back 56

<80 BPM is bad

Front 57

Fetal Distress is reassuring” vs. “non-reassuring”, what is this?

Back 57

"Reassuring – suggest a restoration of confidence by a particular pattern:Non-reassuring – “inability to remove doubt”

Front 58

"What's the classic sign of utero-placental insufficiency and hypoxia?"

Back 58

Late Decels

Front 59

What did saf says "mirrors the contractions"

Back 59

early decels

Front 60

What's a contraction that just won't let up?

Back 60

Titanic

Front 61

What is the main thing anes can do to treat fetal brady and late decels

Back 61

Fix the HoTN!

Front 62

Per Rich. Periodic changes are actually…

Back 62

Periodic changes are FHR accelerations or decelerations that occur with contractions. Decelerations are routinely described as early, late, or variable.