Peri Day 2

Front 1

Placenta

Back 1

The nutrient, gas exchange and waste removal organ of the fetus

6 to 8 inches in diameter

Occupies 1/3 of intrauterine surface

Front 2

Placenta

Back 2

Moms arterial blood O2, diffuses into umbilical vein

Fetal blood picks up O2

Blood goes to through fetal circulation

Fetal blood, high in CO2, returns back to the placenta via umbilical arteries

CO2 diffuses into moms venous system and it is exhaled

Front 3

Closer look at placenta

Back 3

The embryo implants into the uterus by finger like projections (chorionic villi)

:These contain fetal vessels

As these continus to grow, the endometrium erodes, creating pockets (intervillous spaces)

:These contain maternal blood

Cotyledon: grouping of 15 to 28 villi and intervillous spaces

Front 4

Closer look at placenta

Back 4

Gas exchange takes place between fetal and maternal blood

No contact between either blood source

Placenta to attack and build the upper 1/3 of the baby cavity, it stays away from the cervical opeing, so birth is not obstructed in any way.

Front 5

Umbilical cord

Back 5

lifeline between fetus and mother

Mean length 55 cm (22 inches)

3 vessels surrounded by whartons jelly

:2 umbilical arteries/ 1 umbilical cord

AMNION: sack that surrounds the fetus and amniotic fluid

Front 6

Amniotic fluid

Back 6

1t 40 weeks, 1 liter of fluid

produced at 7 days

Made of maternal and amniotic membrane fluid

gIt is always being replenished and reabsorbed

24 to 26 weeks the fetal skin is permeable

Front 7

Amniotic fluid

Back 7

Skin starts to harden after 26 weeks, so skin is impermeable to the fluid (keratinization)

Absorption is now done by fetal swalling (500 ml/day) and

Fluid in the amniotic sack is replenished by fetal urination and lung fluids (500 ml/day)

Front 8

Purpose of amniotic fluid

Back 8

Allows for fetal movement

Protects from shock or maternal movement

Thermoregulation

Helps metabolism by giving fluids to fetus

Front 9

Polyhydramnios

Back 9

Abnormally high amounts of fluid

:Greater than 2000 ml

Indicates a "swallowing problem of fetus

:May also indicate abnormalities such as

::anencephaly

::Esophageal atresia

::TE fistula

Complication from this

:PROM (premature rupture of membrane)

:Lead to prolapse of cord

:A premature delivery

Front 10

Oligohydraminos

Back 10

Decreased amount of amniotic fluid less than 500 ml

Caused by:

:Urinary tract defect

:Post term preganacy

Coplications

:adhesion of body parts

:compression of the umbilical cord leading to asphyxia

:lung hypoplasia (failure of lung to deelop_

:limb deformaties

:Potters syndrome (worse case scenario, this is always fatal)

Front 11

Fetal blood

Back 11

Higher affinity for oxygen due to higher hemoglobin content

Lower levels of 2,3 DPG so the OXYGEN DISSOCIATION CURVE SHIFTS TO THE LEFT

P50= 7.8 mmHg lower than the adult P50 of 27 mmHg

Highest PaO2 is in the umbilical vein (29 mmHG) SaO2= 80%

Front 12

Chemoreceptors

Back 12

Not present (or non functional) in fetus due to immaturity of carotid sinus

Located in carotid arteries and aorta

Sensitive to PaO2, PaCO2, pH

Regulation of ventilation and the baby's first breath

Cental chemo receptors are located in the brain steam, they are the primary chemoreceptors (depedant on CO2)

Front 13

Fetal to neonatal circulation

Back 13

Foramen ovale closes

Ductus arteriosus closes

Ductus venosus closed

Decreased PVR for circulation to the lung

Front 14

Decreased PVR/ lung circulation

Back 14

umbilical cord clamped

Less blood returns to the right side of heart, so pressures decrease

Left heart pressures increase because it is no longer pumping blood back to the low resistant placenta, it is now pumping to the systemic system

Lung fluid expelled, relieving pressure on the pulmonary vessels

Front 15

Decrease LVR/ lung circulation

Back 15

Pulmonary vessels can now expand, hold more blood, decreasing PVR

Breathing starts and PAO2 increases causing vasodilation

With better pulmonary perfusion more blood is circulated to left atrium so left heart/system pressures increase

Front 16

Ductus venosus closes

Back 16

Remains open but not blood flow, function stops right away

Automatically closes within 3 to 7 days

:functional closure happens when cord is cut

Due to lack of blood flow

Front 17

Foramen ovale closes

Back 17

Closes via a flap valve when left pressures exceed right heart pressures

Happens immdiately

If right heart pressures exceed left, the foramen ovale can reopen allowing for shunting

Front 18

Ductus arteriosus closes

Back 18

Constricts and closes due to an increase in O2 tension

Decreased PVR allows right ventricle to pump blood easier into the lung and onto left heart, so there is less blood flow through the ductus arteriosus

DA DOES NOT CLOSE IMMEDIATELY

can take 24 hours to functionally close and up to 3 weeks to to structurally close

Front 19

ductus arteriosus closes (most problems, and most connection with

Back 19

first hours: remains open but blood flow will be from the left to right because pressures are higher in left than right

Several hours later: constrictus due to higher PaO2

Functional closure 12 to 18 hours after birth

Total closed by 3 weeks

PROSTAGLANDINS keeps DA open in utero but are prohibited by high PaO2, causing constriction

INDOMETHICIN: GIven to hypoxic premature infants following delivery to help close DA (CLOSES DA)

Depending on CHD, need to keep open or to close

Front 20

Factors responsible for 1st breath

Back 20

TRANSIENT FETAL ASPHYXIA: fetal circulation is cut off. Hypoxia and hypercapnia arise. Chemoreceptors stimulated

THORAX COMPRESSED ON delivery, lung fluid removed, then reexpands for air entry

ENVIRONMENTAL STIMULATION

Front 21

First breath

Back 21

-60 to -100 cmH20, but decrease on subsequent breaths

VT= 40 cc initially, but only 20 cc exhaled

Establishing FRC, within a few hours after birth

Surfactant is present to decrease surface tension

If not can lead to RDS (respiratory distress syndrome)

Front 22

Prenatal history

Back 22

Risk factors Persings, Chapter 13

Front 23

High Risk moms

Back 23

Younger than 16, older than 40

History of previous births

Previous caesarian section, miscarriages, pre and postmature delivers, fetal/neonatal deaths

Smoking, drug use, alcohol abuse, diseases

Front 24

High Risk Labors

Back 24

Prolonged

Delayed birth after PROM (premature rupture of membrane)

Placental dislocation

Meconium stained amniotic fluid

Maternal medications

Front 25

Maternal disorders

Back 25

Toxemia

Pre eclampsia , increased blood pressure

Eclampsia: increased blood pressure with convulsions

Front 26

Uteroplacental insufficiency (UPI)

Back 26

Causes: pre and post maturity; maternal heart and pulmonary disease

Results of UPI:

:Lack of growth (IUGR) intrauterine growth retardation

:Death

:chronic fetal asphyxia

:Meconium stained amniotic fluid

Front 27

Diabetic mom (page 22)

Back 27

Complicates: 4% of US pregnancies

Mild form (controlled by diet): large infants (LGA) with no other problems. Infants have delayed lung maturation INFANTS HAVE DELAYED LUNG MATURATION

Insulin dependant: normal or small (SGA) babies with higher risk for hypoglycemia. Infants have increased lung maturation HYPOGLYCEMIA, INFANTS HAVE INCREASED LUNG MATURATION

Front 28

diabetic complications

Back 28

Mom has it, mom at risk for

chronic hypertension and pre: exlampsia

Mom has it and baby has problems with

Prematurity

Large infants with possible birth injury: shoulder displacement

Hyperinsulinemia: infant at risk for hypoglycemia after birth

UPI due to maternal hypertension, leading to hypoxia

Front 29

Infants of diabetic moms (IDM)

Back 29

Classic presentation: fat, large infant

If UPI present, there will be a decrease in fetal growth

Front 30

Smoking

Back 30

CO interferes with O2 supply with fetus

Nicotine crosses placenta (greater than 15 % higher than maternal levels)

Causes developmental delays

Danger of premature delivery

Front 31

Alcohol

Back 31

Freely crosses placental barrier

O.5- 2 per 1000 births

:1 in 9 women report binge drinking during pregnancy

:1 in 5 women report drinking during pregnancy

Most problematic in 1st tirmester

FETAL ALCHOHOL SYNDROME

the lifetime cost for one individual with FAS in 2016 was estimated to be 2.5 million $

Front 32

Drugs as a risk factor

Back 32

Sedatives: depress respirations. Poor muscle tone, trouble breathing/feeding after delivery

Narcotics: tremors, dyspnea, seizures, death from withdrawal, baby born addicted

Cocaine, causes placenta to detach too sooon. Causes bleeding, preterm birth and fetal death

Front 33

Torch syndrome materanl infections page 24

Back 33

Toxoplasmosis

Others

Rubella

Cytomegalovirus

Herpes

ALl have similiar clinical manifestattions, so all grouped together

Front 34

Toxoplasmosis (cat litter disesase)

Back 34

Protozoa found in cat feces or eating raw meat

Mother may be asymptomatic or fluish

Can cause congenital defects

Diagnosis with antibodies in blood serum

Front 35

RUbella

Back 35

Preventable if mom is vaccinated before conception

Highly contagious viral illness

Characterized by rash, swollen glands and join pain

May be asymptomatic

Affects fetus in first 5 months

Low body weight

Front 36

cytomegalovirus (CMV)

Back 36

member of herpes family

pregnant healthcare personnel should NOT treat infants with CMV

Spread by person to person contact

mom may be aymptomatic

Front 37

Herpes simplex type 2

Back 37

secually transmitted

acquired by fetus during birth via contact with genital secretions or following rupture of the membrane

c section preferred (if active)

Can affect CNS, skin, and has a high mortality if disseminated in the lung

Front 38

HIV infection

Back 38

Neonatal HIV is more commonly from infected mom

Risk factors for prenatal infections

:Mom is IV drug user

:Infant exposure to infected blood products or breast milk

Front 39

Transmission of HIV

Back 39

during delivery by coming in contact with moms blood

breast feeding

transufsion with infected blood

trasnplacental transfer (not all hiv moms pass the virus)

Zidovudine (AZT) antiretroviral drug, given prior too delivery to mom, then for 6 weeks to infant to reduce incidence of HIV coplications

Front 40

Manifestations of HIV

Back 40

failure to thrive (FTT)

Developmental delay

Infection risks

Treat with AZT, pentamidine (antimicrobial) to prevent and treat pneumocystis, steroids)

Front 41

Group B streptococcus

Back 41

Risk of death if premature delivery or PROM

Vaginal cultures at 35 to 37 weeks

Penicillin/ ampicillin

Front 42

Multiple gestations

Back 42

2 or more

Front 43

Complications of multiple gestation

Back 43

Premature labor and delivery

IUGR (intrauterine growth retardation): if identical twins, one twin will have a smaller placenta

Breech/ abnormal presentations during delivery (head up butt down)

Twin transufation syndrome (one twin bigger than other twin

Front 44

Twin transfusion syndrome

Back 44

One twin (larger)

Polycythemia,, CHF, hyperbilirubinemia

Second twin (smaller)

Anemic, shock from blood loss

Front 45

Placental problems

Back 45

Placental previa (to low in the uterus)

Rather than being attached to the upper wall of the uterus, the placenta lies low in the uterus, partially or completely covering the cervix

Front 46

Placenta previa: complications for baby and mom

Back 46

Associated with blood loss

IUGR due to poor placental perfusion

Fetal asphyxia

Life threatening hemorrhage

Cesarean delivery may be required

Front 47

Abruption placenta

Back 47

Tearing of the placenta away from the uterine wall prior to delivery

Mom can fall, or rear ended in a car accident, potential to rip placenta away from uterine wall

Front 48

Abruption placenta

Back 48

Normally attached placenta separates prematurely causing labor to begin

Maternal mortality up to 10 %, infant mortality up to 50%

Can be partial or complete

BLeeding can be visible or concealed

Risk if severe hypoxia and blood loss

Front 49

Abruption Placenta

Back 49

Maternal hypertension

Trauma

Shortened umbilical cord

Uterine abnormalities

Excessive number of previous pregnancies

Front 50

Abruption placenta risks for baby

Back 50

prematurity

Hypoxia

Hemorrhage

Front 51

Abruption placenta treatment

Back 51

Replaced blood volume to mother

Mother positioned on lateral position to allow maximum placental circulation

Intensive monitoring

Emergency C section delivery in cases of maternal shock or fetal distress