Misoprostol (Cytotec) side effects
teratgenicity, fever, uterine tachysystole, shivering
oxytocin risk
hypo or hypertension, water intoxication/ hyponatremia
with mono mono twins you would expect to see
variables
maternal hyperthyroidism can cause the tracing to be
decreased variability, no accelerations
maternal hypothermia or glycemia
#NAME?
in the preterm infant you have 2 phases- active sleep 2F and quiet sleep F1
true
quiet sleep can be 4 minutes to 2 hours long in a mid trimester to 40 week patient
true
indomethacin
should be limited to 48 hours, can cause oliogohydraminos, can cause the PDA to close
uterine blood flow represents _______% of maternal blood flow
10-15
fetal blood flow bypasses the ______& _______
liver and lungs
high AFI=
high risk for cord prolapse range is 8-18
37 weeks pt with itching on palms and feet and nausea/vomiting. You can anticipate what syndromes
cholestatsis (gallbladder=n/v) and early delivery
what can cause malignant hyperthermia?
succicholine. Dantrolene can fix it (antidote)
severe pre-eclampsia at 24 weeks can cause what risks?
early delivery, abruption, IUGR
patient walks into triage 10cm breech G4p3. what do you get to help delivery?
get pipers? or may also be forceps?
high BP, no protein in urine, suspected abruption. what do you do next?
send a tox!
what carries oxygen into intervillous space? vein or arteries?
arteries
progesterone
inhibit PG
Prolactin
from anterior pituitary, stimulates lactation
leukocyte production increases or decreases in pregnancy?
increases
pregnancy mean an increase of ____ calories a day
300
bluish discoloration of cervix
chadwicks
striae gravidarum
stretch marks
hemorrhage after childbirth causes an systemic auto transfusion of _________
1000ml
preeclampsia risk factors
� Nulliparity
� Multiple gestation
� Advanced maternal age
� Chronic HTN
� Renal disease
� History of preeclampsia
conditions that mimic eclampisa/preeclampsia
cocaine, lupus, fatty liver, chronic renal failure
therapeutic magnesium level for pre eclampsia
5-8
improper management of the 3rd stage of labor can lead to
uterine inversion, cord avulsion
uterine contractions above 35mm Hg result in cut off blood flow a their peak true or false?
true
placenta abruption bleeds into the _____________
decidua basalis
rupture of the myometrium is a _______________--
life threatening emergency
fern tests has a _______ pH
7.3
pt SROMS, MD still feels a bag of fluid. What is it most likely?
a a bag of fluid from the amnion
risk factors for DIC
AFE, fetal demise, HELLP, trauma
allergies to aspirin? cannot have
indomethacin
positive coombs test indicates
Rh incompatibility. mom should receive rhogam if there's fetal abortion, after version,
Rh negative mother should get what shot
Rhogam
Positive maternal Coombs test means that maternal is negative blood type and baby is at risk for
jaundice
PUBS procedure, you need to bring what?
vecuronium (provides skeletal muscle relaxation in conjunction with anesthesiologists)
isoimmunization in pregnancy may lead to
umbilical transfusion, sinusoidal FHR
betamimetics can be used to decease morbidity when _________ are given
antenatal corticosteriods
TOLACs are at what percent to have a uterine rupture?
less than 1% & a greater then 60% chance of delivering vaginally. FHR changes are the first sign
baby is more at risk for getting a herpes infection if it's _______
primary
narcotics can cause _______ in the first hour of its administration
pruritus
epidural in the intrathecal space can cause a
high spinal block
A full description of a fetal heart rate tracing requires a qualitative and quantitative description of uterine contractions, as well as:
1. Baseline rate
2. Baseline fetal heart rate variability
3. Presence of accelerations
4. Periodic or episodic decelerations
5. Changes or trends of fetal heart rate patterns over time
No distinction is made between short-term variability (or beat-to-beat
Baseline fetal heart rate is the approximate mean fetal heart rate rounded to increments of 5 beats per minute (bpm) during a 10-minute segment, excluding:
1. Accelerations
2. Decelerations
3. Periods of marked variability (> 25 beats per minute)
baseline fetal heart rate
is the approximate mean fetal heart rate rounded to increments of 5 beats per minute during a 10-minute segment. Note that the baseline is defined as a single rate not as a range. In any 10-minute window the minimum baseline duration must be at least 2 mi
fetal bradycardia
is < 110 beats per minute
fetal tachycardia
is >160 bpm
Evaluation of a fetal heart rate pattern must take into account maternal medical conditions as well as estimated gestational age. true or false?
true
Baseline variability is defined as fluctuations in the baseline that are regular in amplitude and frequency. true or false?
false
Short-term (beat-to-beat) variability is distinct from long-term variability and should be visually determined and documented separately. true or false?
false----No distinction is made between short-term variability (or beat-to-beat variability or R-R wave period differences in the electrocardiogram) and long-term variability because in actual practice they are visually determined as a unit.
baseline variability
Baseline variability is defined as fluctuations in the baseline that are irregular in amplitude and frequency.
Acceleration is defined as a visually apparent gradual increase in the fetal heart rate above baseline. true or false?
false
At 32 weeks of gestation and beyond, a fetal heart rate acceleration is defined by a peak at least 20 beats per minute above the baseline and a duration of at least 20 seconds. true or false?
false. At 32 weeks of gestation and beyond, an acceleration has a peak of 15 beats per minute or more above the baseline, with a duration of 15 seconds or more, but less than 2 minutes from onset to return.
Before 32 weeks of gestation, an acceleration is defined as an abrupt increase in the fetal heart rate at least 10 beats per minute above baseline lasting at least 10 seconds.
true
Fetal heart rate variability is measurable only with a direct fetal electrode; it cannot be defined using an external Doppler device.
true or false?
false
acceleration
is defined as a visually apparent abrupt increase (defined as onset of acceleration to peak in < 30 seconds) in the fetal heart rate above the baseline.
abrupt
Abrupt = Onset to peak < 30 seconds
Abrupt = Onset to nadir < 30 seconds ( The decrease is ? 15 beats per minute, lasting ? 15 seconds, and < 2 minutes from onset to return to baseline.)
gradual
Gradual = Onset to peak ? 30 seconds
Gradual = Onset to nadir ? 30 seconds
what is abrupt or gradual pertaining to peak?
accelerations
what is abrupt or gradual pertaining to nadir?
decelerations
nadir
means the lowest point
prolonged acceleration
An acceleration that lasts 2 minutes or more, but less than 10 minutes,
baseline change
If an acceleration lasts 10 minutes or longer,
periodic vs episodic
Periodic patterns are those associated with uterine contractions. Periodic patterns occur with periodicity, as do uterine contractions. On the other hand, episodic decelerations are those NOT associated with uterine contractions.
Late decelerations
A deceleration that begins after the onset of a uterine contraction, reaches its nadir (lowest point) after the peak of the contraction and takes at least 30 seconds to reach its lowest point. The deceleration is delayed in timing, with the nadir of the d
In most cases the onset, nadir, and recovery of a late deceleration occur before the beginning, peak, and ending of the contraction, respectively. true or false??
false
Early decelerations
A gradual deceleration that occurs in association with a uterine contraction and reaches its nadir (lowest point) at the same time as the peak of the contraction
Prolonged deceleration
a visually apparent decrease in the fetal heart rate below the baseline.
The decrease from the baseline is ? 15 beats per minute, lasting ? 2 minutes, but < 10 minutes from onset to return to baseline.
If the deceleration lasts 10 minutes or longer it is
Variable deceleration
a visually apparent abrupt decrease in the fetal heart rate.
Variable decelerations are categorized as "mild", "moderate" or "severe" based on depth and duration.
false
According to the 2008 NICHD Consensus Report, a 15 beat per minute decrease in the fetal heart rate that lasts for more than 10 minutes is defined as:
change in baseline
recurrent decelerations
Fetal heart rate decelerations occurring with ? 50% of uterine contractions in any 20-minute window. less than 50 is intermittent
sinusoidal pattern lasting for 20 minutes or greater is what category tracing?
category 3
recurrent variables lasting for 20 minutes or greater is what category tracing?
category 2
Category I fetal heart tracings include all of the following:
Baseline rate: 110 - 160 bpm
Baseline fetal heart rate variability: moderate
Accelerations: present or absent
Late or variable decelerations: absent
Early decelerations: present or absent
A sinusoidal fetal heart rate pattern
is a visually apparent, smooth, sine wave-like undulating pattern in the fetal heart rate baseline with a cycle frequency of 3-5 per minute which persists for 20 minutes or more.
Category III fetal heart rate tracings include at least one of the following:
Absent baseline fetal heart rate variability and recurrent late decelerations
Absent baseline fetal heart rate variability with recurrent variable decelerations
Absent variability with bradycardia for at least 10 minutes
Sinusoidal pattern for at least 20
baseline FHR
Baseline fetal heart rate is the approximate mean fetal heart rate rounded to increments of 5 beats/minute during a 10 minute segment.
variability
defined as fluctuations in the baseline that are irregular in amplitude and frequency. Amplitude is measured from peak-to-trough in beats per minute.
According to the 2014 ACOG-AAP consensus report, Neonatal Encephalopathy and Neurologic Outcome, fetal heart rate accelerations and/or moderate variability reliably predict the absence of ongoing fetal _____________.
fetal hypoxic neurologic injury (this is principal #1)
A Catetory II tracing _____________.
...
Minimal or absent fetal heart rate variability alone (no accels/moderate variability) reliably predicts _______________.
fetal compromise
The presence of ongoing hypoxic fetal neurologic injury is reliably excluded by the observation of ________________.
moderate variability and accelerations
fetal oxygenation pathway
transfer of oxygen from environment to fetus. 1. environment 2. lungs 3.heart. 4. vasculature 5. uterus 6. placenta 7. cord. delaying/interruption of this path can result in injury
fetal oxygenation pathway injuiries
1. hypoxemia (decreased pO2) 2. hypoxia, 3. metabolic acidosis (from lactic acid build up) 4. metabolic academia
2 main principles of FHR interpretation
Principle # 1: Variable, late or prolonged decelerations signal interruption of the oxygen pathway at one or more points.
Principle # 2: Moderate variability and/or accelerations reliably predict the absence of on-going fetal hypoxic neurologic injury at
variables mean
cord compression due to arteries being compressed
late decels
means uteroplacental insufficencieny (uterus/placenta blood flow altered)
variable, late or prolonged decels mean
signal interruption at one or more points in the oxygenation pathway (this is principal #2)
For low risk patients, routine intrapartum surveillance includes review of the fetal heart rate tracing at least every ________________.
every 30 minutes for the first stage of active labor
If a fetal heart rate tracing progresses to Category III despite conservative corrective measures, what is the usual next step?
expedite delivery
Which of these is a common assessment of the oxygen pathway at the level of the vasculature?
check BP
Corrective measures used to improve fetal oxygenation include:
maternal positioning, consider an amnioinfusion, supplemental oxygenation, stop pitocin
routine surveillance
For low risk patients. Category I tracing. Q30 in 1st stage of labor & Q15 in second stage of labor
heightened surveillance
high risk patients, Category I tracing. Q15 in 1st stage Q5 in second stage
narcotics/ Mg Sulfate
reduced variability, reduced frequency of accelerations
Butorphanol
transient sinusoidal pattern
cocaine/ Betamethasone
reduced variability
terbutaline
increase in FHR baseline and incidence of tachycardia
ABCD
A)assess oxygenation pathway
B) begin corrective measures
(reassessment FHR category between AB to CD-- look for significant decelerations or presence of moderate variability/accels then decide next step of action),
C) Clear obstacles for/to rapid deliver
corrective measures
apply oxygen 10L/min for 15 minutes, consider relaxant/reduce stimulant, fluid bolus/correct hypotension, consider amnioinfusion. do you need to do open glottis pushing or push every other? document!
alert Drs and assess the oxygen pathway
Vascular-is mother bleeding?or hypotensive arrthymia? lungs- is she fluid overloaded? etc.
clear obstacles
is OR prepped w/ necessary equipment? is there obstacles with in the room?is staff notified/appropriate communication? DO you have mothers informed consent? is moms labs resulted/ does she have IV access? Does baby have anomalies? DO we know gestation age
decision to delivery time?
consider staff experience/availability/training & response time. Has mom had a previous c-section? do we know baby estimated wt/ age? Did we use a uterine relaxant? Did/Does mom not push well?
expedite delivery
can mom push baby out before we would reach OR or have a metabolic academia baby?
terbutaline can cause
fetal hypoglycemia, loss of variability, and fetal tachycardia
betamethasone can cause
a low BPP at 48 hours, decrease in variability, given prior to 34 weeks, a loss of accelerations
macrosomia
fetal weight over 4500g
maternal lupus is associated with what?
fetal heart block
abruption can lead to DIC because of too much what in the blood?
thromboplastin
a _______ OCT requires the patient to have 3 contractions in 10 minutes with no late decelerations
negative
contraindications to performing an OCT
twins, placenta previa, vasa previa, cervical incompetence
a non reactive tracing is an absence of what in a 40 minute window?
2 accelerations
beyond 41 weeks it is common to see what with amniotic fluid?
olioghydraminos
a mature fetus would be expected to have L/S (lecithin to Sphingomyelin) ratio on _____ and the ____ of PG (phosphatidylglycerol
2.0, presence
preterm infants have a immature _____ system causing the FHR to be slightly higher then term infants
parasympathetic
for a patient experiencing recurrent variable with pushing, the provider may ________
push w/ every other contrx, use open glottis pushing, push
variability is fluctuations that are ______ in amplitude and frequency
irregular
evidence obtained from RCTs (randomized controlled trials)
level 1
FHR 170bpm, minimal variability, recurrent variables decels, no accelerations
category 2
FHR 110, moderate variability, no access, no decels
category 1
marked variability, no access, no decels
category 2
FHR 120, minimal variability, prolonged 6 minute declaration to 60 bpm
category 2
sinusoidal for 25 minutes
category 3
FHR 135, intermittent variables, accels
category 2
FHR 155, minimal variability, recurrent variables, no accels
category 2 indeterminate
FHR 115 early decels, no accels, moderate variability
category 1
scalp stim should never be used to correct what
decelerations or bradycardia
a sinusoidal pattern may be described in association with ________
severe fetal anemia, chore, fetal sepsis, narcotic administration
contraction paper runs at what speed?
3cm/minute
contraindications to fetal scalp electrode placement
face presentation, placenta previa, + Hep C, HIV. & CAUTION with BGS +/syphillis/gonorrhea/premature fetus
IUPC requires
removal if blood in catheter and for patient to have rupture of fluids
what is required for an term amnioinfusion
NOT:FSE, fluid warmer, YES, MUST HAVE: isotonic fluid, IUPC
indications for amnioinfusion
oliogohydramnios w/ variables, variables. Not lates or thick mec
acceptable methods to provoke access include
scalp stim, halogen light stimulations, placing an artificial larynx over the fetal head
lactic acid accumulates in the tissue during
anaerobic metabolism
28 weeker w/ O- blood was in a MVA. She needs what important test?
kleihauer-betke
fetal kick counts
10 movements in 1 hr
your patient is on 120mg of methadone/day. She is requesting something to help for labor pain, she can have
hot packs, epidural.
prolonged decel
is at least 2 minutes long and can have either a gradual or abrupt drop
a base deficit of greater than or equal to ____ is sufficient enough to cause cerebral palsy
12
umbilical cord arterial blood pH of less than ____ is criteria to cause cerebral palsy
7
onset to nadir is greater than or equal to 30 seconds
late or early decelerations
baseline is for how long?
2 minutes at least and not necessarily continuous
at term, maternal blood flow to fetus is
700cc/min
uterine _______ carries oxygenated blood into the intervillous space
artery
fetal bradycardia can be cause by
sjorgens antibodies, heart block, CMV, maternal hypoglycemia
betaminmetics can cause
tachycardia
supine position compresses what
inferior vena cava
the _______ allows blood to bypass the liver
ducts venous
blood transport that occurs between mom and baby happens by
simple diffusion
glucose and carbohydrates are transported between mom and baby via
facilitated diffusion
smalls leaks/tears in the placenta can result in
isoimmunization
conditions affecting the chronic villous surface area are _____, affecting gas exchange
infarction, hemorrhage, thrombus infection
misoprostol is FDA approved
false