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56 Cards in this Set
- Front
- Back
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What are the three maternal serum triple markers used to help detect elevated fetal risk?
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Alpha-fetoprotein (AFP)
Estriol Beta-human chorionic gonadotropin (hCG) |
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Low AFP values are associated with what?
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Trisomy 21 and 18
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What are three invasive fetal evaluation tests?
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Chorionic villus sampling (CVS) (placental bx)
Amniocentesis (20ml removed) Fetal blood sampling |
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What fetal test is done to determine fetal lung maturity?
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amniocentesis - determines surfactant levels
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What fetal test is done to detect fetal anemia?
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Cordocentesis
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What is a Fetal Nonstress test (NST)?
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measures FHR response to stimulation such as vibroacoustic stimulation, look for an increase of at least 15 beats for 15 seconds in specified period of time
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What fetal evaluation looks at
- fetal breathing movements - gross body movements - fetal tone - reactive heart rate (NST) - amniotic fluid volume |
Biophysical profile, a perfect score is a 10
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What is the purpose of fetal heart rate monitoring?
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to assess fetal oxygenation
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What is fetal asphyxia?
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oxygen deficit continuum that leads to hypoxemia, hypercarbia, acidemia, and acidosis
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What are the etiologies of fetal asphyxia?
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- Decreased maternal arterial O2 tension
- Inadequate uterine blood flow - Interruption of umbilical blood flow - Fetal pathology |
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What does good baseline variability indicate? what is good variability?
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Intact CNS and cardiac functions.
Varies 10-15 beats over 1 minute period |
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What is Variability affected by?
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Maternal drugs
Fetal sleep cycle Prematurity Fetal Tachycardia |
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What is loss of variability associated with?
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Decels most sensitive indicator of acidemia in the fetus
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True or False:
Fetal HR accelerates with contractions. |
True
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What does Fetal HR <110 for 10min or longer cause and what does it indicate?
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Can cause fetal hypoxia or be caused by hypoxia
May also result from bradyarrhythmias, drugs, or hypothermia |
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What is terminal bradycardia?
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A sudden, profound fetal bradycardia.
It may mean uterine rupture or abruption. If between 80-100 with good variability may watch for a while If less than 60, decels, or no variability go to section now |
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What are causes of fetal tachycardia (<160)?
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Early sign of hypoxia
Medications (terbutaline) Prematurity Maternal anxiety/fear Fetal infection Fetal movement or stimulation Fetal acidemia (if without variability) |
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Describe Early Decelerations
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Uniform, U-shaped
Slow onset and return to baseline Mirrors image of uterine contraction No acceleration of HR before or after decel Usually falls less than 20-30 BPM Good beat-to-beat variability |
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What are early Decels usually a result of?
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fetal head compression
- not usually associated with fetal compromise |
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Describe Variable Decelerations
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Most common pattern
Variable in duration, shape, size, and time No real relationship to contractions May progress to late decels |
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What is the likely cause of variable decelerations?
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Compression of umbilical cord against fetal body parts
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Describe Late Decelerations?
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Onset 30+ sec after onset of contraction
Peak of decel after peak of contraction Onset and return gradual and smooth |
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What are Late Decels a sign of?
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Uteroplacental insufficiency, severity of decel usually correlates to fetal hypoxia
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What are Late Decels usually caused by?
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Often seen with aortocaval compression syndrome, severe hypotension, abruptio, postmaturity, diabetes, pre-eclampsia/eclampsia
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Describe Prolonged Decelerations
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Loss of variability and baseline below 70 BPM for 2-3 minutes
Urgent need for intervention |
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Describe Sinosoidal variability pattern
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Resembles sine wave with frequency of 2-5 cycles per minute
Unknown cause |
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What is Sinosoidal Variability associated with?
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Fetal anemia
Has been seen after butorphanol (stadol) administration |
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What patterns are associated with increased risk for fetal acidemia? (3)
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Absent variabiltiy and persistent tachycardia or bradycarida (<80)
Absent or minimal variability and recurrent late decels, recurrent moderate or severe variable decels Sinusoidal pattern |
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What is the treatment if your patient has perisistant late decels with decreased variability?
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Turn on side
Stop Pitocin Increase IVF O2 Internal Monitor Amnioinfusion C-Section |
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What is the treatment if your patient has severe bradycardia?
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Turn on side
Stop Pitocin Increase IVF O2 Internal Monitor Amnioinfusion C-Section |
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What 3 structures allow preferential shunting of blood in utero?
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Ductus Venousus (liver)
Foramen Ovale (atrial septum) Ductus arteriosus (pulmonary artery to descending aorta) |
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What is the role of fetal circulation?
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To alow O2 rich blood with high glucose content to perfuse the prain, coronaries, upper extremities
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What is the pathway of O2 rich blood from placenta to Right atrium?
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Placenta - Umbilical vein - Ductus Venosus - IVC - RA
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What percent of fetal blood goes to pulmonary circulation and crosses ductus arteriosis providing systemic blood flow to the descending aorta?
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10%
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Where is the most O2 rich blood in the fetus?
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Umbilical vein
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True or False:
At birth lungs expand to normal FRC. |
True
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True or False:
During transitional circulation you will see alveolar PCO2 increases and alveolar PO2 increases. |
False, PCO2 decreases
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True or False:
During transitional circulation you will see marked decrease in pulmonary vascular resistance. |
True
will see increased pulm blood flow and increased pulm venous return to left heart |
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What is a result of R-L shunt via FO in healthy infants emerging from anesthesia?
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persistant arterial desaturation
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When does the DA close?
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Functionally closes by day 4 in 98%
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When is it likely for fetal circulation to persist past birth?
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Hypothermia, hypoxemia, acidosis. Caused from Opening of DA and FO
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When does DV close?
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within 1-2 weeks
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What is the treatment for Apgar scores of:
8-10 |
no special tx needed
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What is the treatment for Apgar scores of:
5-7 |
tactile stimulation and O2 (ppv if delayed improvement)
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What is the treatment for Apgar scores of:
3-4 |
PPV, HR and color should rapidly improve with PPV w/mask
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What is the treatment for Apgar scores of:
0-2 |
Ventilate immediately w/100% O2, intubate, start CPR, may need IV access
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Name three reasons for neonate depression.
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Anesthetics
Opioids Sedatives MgSO4 (give calcium) Intrauterine hypoxia and acidosis High or Low temp CNS trauma |
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How do you treat a newborn with HR 60-100?
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positive pressure (30-40cm H2O), maintain at end inspiration for 4-5sec to overcome surface tension of alveoli
Deliver subsequent breaths at rate of 40-60/min OG to decompress stomach if >2-3min WHen HR >100, assist spontaneous vent |
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How do you treat a newborn with HR <60?
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Chest compressions
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How do you treat a newborn with a HR 60-80 that is not responsive to 30sec of adequate ventilation?
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Chest compressions
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When can you stop chest compressions when resuscitating a neonate?
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stop compressions when HR >80
stop PPV when HR >120 |
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What is the drug of choice for neonatal resuscitation?
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Epinephrine
dose 0.1-0.3ml/kg of 1:10,000 concentration to ETT (dilute to 1-2ml w/NS) |
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When do you use Naloxone on a neonate?
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if severe respiratory depression and mom receive narcotics within past 4hrs
dose 0.1mg/kg to ETT |
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What is the dose of bicarbonate to correct neonatal acidosis?
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4.2% solution (0.5meq/ml)
Dose calculation is meq = base deficit x 0.3 x body weight Give half of calculated dose and recheck |
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How do you prevent meconium aspiration syndrome?
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suction nose and mouth before initial inspiratory effort
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What do you do if there is thick particulate meconium?
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may require laryngoscopy to visualize cords before breathing/ventilating
If no meconium found at level of cords intubate and suction before ventilating |
