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RESP 5017 > 1. Pregnancy, Labour, Delivery - Maternal Newborn Risk Factors > Flashcards

1. Pregnancy, Labour, Delivery - Maternal Newborn Risk Factors Flashcards

1
Q

What does GTPAL stand for?

A 
G = Gravida: # of total pregnancies 
T = Term: deliveries > 37 wks
P = Premature: deliveries < 37 wks
A = Abortions: spontaneous, therapeutic, early fetal death < 20 wks
L = Living
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2
Q

When performing an ultrasound on a pregnant mother, what is observed/determined at 5 wks? 8-11 wks? 18-20 wks?

A

5 wks: diagnosis and confirmation of early pregnancy, confirm implantation in uterus
8-11 wks: Dating ultrasound
18-20 wks: Anatomic ultrasound, gender determination

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3
Q
  1. What is an amniocentesis?
  2. When is it performed during gestation?
  3. Why is it performed?
A
  1. Amniocentesis is an invasive procedure where a needle is inserted through the uterine wall to obtain a sample of fluid from the amniotic sac under ultrasound
  2. Performed around 15-22 wks
  3. Performed to collect amniotic fluid sample, used for genetic testing, congenital malformations, and determining fetal lung maturity
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4
Q

What is measured in fetal lung maturity testing? (Hint: 4 things)

A
  1. Lamellar body count
  2. L/S Ratio
  3. PG levels
  4. Foam Stability Index (FSI)
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5
Q
  1. What do lamellar bodies do?
  2. When do they appear in amniotic fluid during gestation?
  3. What are they a direct measurement of?
A
  1. Lamellar bodies store surfactant in type II pneumocytes
  2. 28-32 wks, increasing exponentially
  3. Surfactant production
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6
Q

Intact lamellar bodies concentration can be analyzed.

  1. What measured value indicates lung maturity?
  2. What are lamellar bodies affected by?
A
  1. > /= 32,000

2. Meconium and blood

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7
Q
  1. What is the L/S ratio?
  2. What happens to Lecithin as lungs become more mature, and what happens to Sphingomyelin?
  3. What does an L:S ratio of 2:1 mean and when does this occur? What about a ratio of < 2:1?
  4. When is this measurement inaccurate?
A
  1. Comparison of protein ingredients of fetal amniotic fluid to assess lung maturity
  2. Lecithin increases as lungs mature, Sphingomyelin stays constant
  3. 2:1 = mature surfactant and lungs, around 35 wks
    < 2:1 = high chance of lung immaturity, RDS
  4. Diabetic mothers, RH sensitization, bloodstained fluid
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8
Q
  1. What do PG levels show?
  2. What is PG and when does it increase in amniotic fluid during gestation?
  3. What is PG NOT affected by?
A
  1. Lung maturity
  2. Minor surfactant phospholipid, increasing after 35 wks
  3. Blood or meconium
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9
Q
  1. How is an FSI (formerly known as shake test) performed? What does a positive test show and represent? Negative test?
  2. What interferes with results?
A
  1. Mix amniotic fluid w/ 95% ethanol, shake 15 sec, wait 15 min

Pos test: presence of stable ring of bubbles/foam = surfactant present
Neg test: lung immaturity

  1. Blood or meconium
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10
Q
  1. What is a biophysical profile?
  2. What is a normal score? What score is equivocal? What is abnormal?
  3. What does an abnormal score indicate?
A
  1. Test used to assess placental function and infants well being
  2. Normal = 8-10
    Equivocal = 6, repeat in 24h
    Abnormal = 0-4
  3. Poor placental function and indicates immediate delivery
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11
Q
  1. What are the 5 biophysical variables and their normal values?
  2. What score does a normal value receive? Abnormal?
A
  1. a) Fetal breathing movements = 1 or more episodes of FBM >/= 30s within 30 min
    b) Gross body movements = 3 or more body/limb movements w/i 30 mins
    c) Fetal tone = 1 or more episodes of extension and flexion of limbs, hand, or trunk
    d) Reactive FHR = 2 or more episodes of acceleration of >/= 15 bpm lasting >15s associated w/ fetal movement in 20-40 min
    e) Qualitative AFV = 1 or more pockets of fluid measuring >/= 1 cm
  2. Normal = 2, Abnormal = 0
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12
Q

What do both the Nonstress and Contraction Stress Test measure?

A

Placental function

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13
Q
  1. What does the Nonstress test look at? What should you see in the fetus?
  2. What is a reactive NST? Nonreactive NST?
A
  1. Fetal heart rate response when fetus moves spontaneously, should see rise in HR
  2. Reactive = 2 increase in HR > 15 beats > 15s within 20 mins
    Nonreactive = < 2 increase in HR
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14
Q
  1. What does the Contraction Stress Test look at?

2. What is a negative CST? Positive CST?

A
  1. Looks at fetal heart rate response with uterine contractions
  2. Negative = no decrease in FHR with 3 contractions over 10 mins
    Positive = FHR decreases during contractions (early, late, and variable decelerations)
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15
Q
  1. What do early decelerations coincide with? Why do they happen?
  2. What are late decelerations due to? When do they begin and what are they associated with?
  3. What are variable decelerations due to? What are repetitive variable decelerations associated with?
A
  1. Uterine contractions, due to fetal head compression and pose little threat to the infant
  2. Uteroplacental insufficiency, beginning at peak of contraction and are associated with fetal distress
  3. Cord compression, repetitive are associated with fetal hypoxia risk
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16
Q
  1. When is a GBS vag/rectal swab performed?
  2. What is a GBS + mother treated with? How many doses and how far apart? Does this mean the baby is OK?
  3. What should be done to infants born to a GBS + mother without prophylaxis?
A
  1. 34-37 wks
  2. IV penicillin, 2 doses 4 hrs apart, baby should be OK! :)
  3. Baby should be monitored, CBC, prophylactic antibiotics
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17
Q
  1. When is an Early Onset Neonatal GBS + mother identified? What does it present as?
  2. When is a Late Onset Neonatal GBS + mother identified? What does it present as?
A
  1. < 7 days, often w/I 12 hrs, presents as pneumonia, sepsis, meningitis
  2. > 7 days, usually 3-4 wks, presents as sepsis, meningitis
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18
Q

What should be done if a mother has an HSV outbreak during pregnancy, and lesions are present during labour?

A

Treat mother prior to labour with acyclovir, and deliver baby by C-section

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19
Q
  1. Who is screened for HIV during pregnancy?
  2. How is it treated?
  3. How is the baby delivered and what is the mom advised of?
A
  1. All pregnant women
  2. Mom and baby treated with antiretroviral drugs
  3. C-section, no breast feeding advised
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20
Q
  1. Who is screened for HBV during pregnancy?
  2. If mother is positive, what is given to the baby and when are they vaccinated?
  3. How much does this treatment reduce infection?
A
  1. All pregnant women
  2. Anti-hepatitis B immunoglobulin, vaccinated in first 12h of life
  3. 95%
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21
Q
  1. What may alcohol affect during and after pregnancy?

2. What does severity of FAS depend on?

A
  1. Development, growth restriction, high risk of brain, cardiac, spinal, craniofacial abnormalities
  2. Amount of alcohol ingested, when ingested (worse earlier!)
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22
Q
  1. What does smoking during pregnancy affect/cause?

2. What is there an increased risk of?

A
  1. Placental oxygen supply, causes low birth weight

2. PROM, premature labour, placental abruption, placenta previa, high risk of SIDS

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23
Q

What is ingestion of drugs during pregnancy a risk of?

A

Low birth weight, premature labour, placenta abruption, congenital malformation, drug withdrawal after birth

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24
Q

How is the Amniotic Fluid Index (AFI) calculated?

A

By measuring the depth of the largest pocket of fluid in 4 quadrants

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25
Q

What is Oligohydramnios and what can it cause in the fetus?

A

Represents too little fluid < 5cm, and can cause renal agenesis, urinary tract obstruction, ruptured membranes, limb deformities, and lung hypoplasia

26
Q

What is Polyhydramnios and what can it cause in the baby?

A

Represents too much fluid > 24cm, and is associated with abnormalities of swallowing amniotic fluid such as anencephaly, esophageal atresia, hydrops, and PROM

27
Q

What problems can Gestational Diabetes of the mother cause for the fetus?

A

Large gestational age (big baby, risk for C/S, birth trauma), congenital abnormalities, hypoglycemia, hyperbilirubinemia, delayed lung maturity

28
Q

What happens in Gestational Diabetes that causes delayed lung maturity that can lead to RDS? (Hint: 4 ordered steps)

A
  1. ↑ maternal glucose crosses placenta
  2. Fetal insulin ↑ (maternal insulin doesn’t cross placenta)
  3. ↑ fetal insulin ↓ cortisol and delays surfactant production
  4. ↑ fetal insulin bluntness “cortisol surge” before delivery and may lead to ↑ RDS
29
Q

What is pregnancy induced hypertension?

A

BP > 140/90 after 20 wks gestation without proteinuria

30
Q
  1. What is preeclampsia? What is the BP in severe preeclampsia?
  2. What is eclampsia?
A
  1. Hypertension + proteinuria, severe preeclampsia is BP > 160/110
  2. Presence of tonic-clonic seizures in a woman with preeclampsia
31
Q

What is HELLP syndrome?

A

Syndrome including hemoptysis, elevated liver enzymes and low platelet count

32
Q
  1. How is pregnancy induced hypertension, preeclampsia, eclampsia, and HELLP syndrome treated?
  2. Neonatal indications?
A
  1. Deliver infant (remove placenta), magnesium sulphate, labetalol
  2. Premature delivery, placental insufficiency, low birth weight, neuromuscular and respiratory depression from magnesium sulphate
33
Q
  1. What is fetal hydrops?

2. What are the symptoms?

A
  1. Abnormal amounts of fluid buildup in two or more body cavities
  2. Pleural effusions, liver swelling, heart failure, severe anemia, severe jaundice, total body swelling
34
Q

What are the two types of fetal hydrops and what causes each?

A
  1. Immune hydrops fetalis: Most often a complication of a severe form of Rh incompatibility
  2. Nonimmune hydrops fetalis: Disease/medical condition affects the body’s ability to manage fluid (eg. heart failure)
35
Q

What risks do multiple gestations pose for the mother?

A
  1. Increased demand on mother (blood flow, glucose management, abdominal/uterine stretching)
  2. Higher antepartum/intrapartum risk factors
  3. Increased premature labour
36
Q

What are dizygotic twins and what characteristics do they have? Are they identical or non identical?

A

2 ovum fertilized by 2 sperm, they have 2 chorions (di-chorionic) and 2 amnions (di-amniotic)

37
Q
  1. What are monozygotic twins? What are the types of monozygotic twins and when do they split?
  2. What happens if the ovum splits > 12d?
A
  1. Single fertilized ovum splits after conception = identical twins
    Types: Di-chorionic, Di-amniotic (Split < 2d) Monochorionic/Diamniotic (Split 3-8d)
    Monochorionic/Monoamniotic (Split 9-12d, rare)
  2. Monozygotic fertilized ovum only partially splits resulting in conjoined twins
38
Q

What is TTTS? What types of twins are at risk for this, and what may occur when TTTS happens?

A

Twin-to-Twin Transfusion Syndrome, twins with a shared placenta are at risk (Monochorionic/Diamniotic, Monochorionic/Monoamniotic)

May result in transfusion of blood from one twin to the other (donor —> recipient)

39
Q
  1. What is Rh factor?
  2. What % of people are Rh+? Rh-?
  3. When the mother is Rh- and the father is Rh+, what rxn may occur?
  4. What does this mean for the mother and her pregnancies?
A
  1. Protein in RBC’s
  2. Rh + = 85%, Rh - = 15%
  3. Baby could end up Rh +, some fetal blood enters maternal circulation, can cause antibody rxn
  4. First baby will be OK, but mother produces antigens that can attack next babies RBCs leading to severe hemolytic disease (fetal hydrops)
40
Q
  1. What is given to the Rh - mother to prevent Rh antibody production? When is this given?
  2. How long does this last on the mother? When is it often given again?
A
  1. Rh immunoglobulin is given via injection, given at 28 wks
  2. Rhig lasts 12 wks, so often given again within 72h after birth
41
Q
  1. What is premature birth the highest cause of?
  2. What can cause premature birth?
  3. What body organ is most at risk when a baby is born premature?
A
  1. Infant death
  2. Infection, ROM, placental insufficiency, lifestyle factors
  3. Lungs
42
Q
  1. What medications are used to prevent premature birth? (Hint: 4 categories)
  2. What are the types of Tocolytics used? (Hint: 4 of them)
A
  1. IV fluids, Tocolytics (stop/slow contractions), Antenatal corticosteroids (to mature infants lungs), Antibiotics
  2. Magnesium sulphate, Terbutaline (B2 adrenergic recepter agonist), Nifedipine (Ca2+ channel blocker), Indomethacin (inhibits prostaglandins)
43
Q
  1. What is PROM?
  2. What is pPROM?
  3. What is Prolonged PROM or pPROM?
A
  1. Prelabour rupture of membranes, ruptures before onset of contractions
  2. Preterm prelabour rupture of membranes, ROM prior to contractions in infants < 37 wks gestation
  3. ROM > 24 hrs (gush or slow leak)
44
Q

What are the neonatal risk factors for PROM?

A
  • Preterm labour and delivery
  • Maternal/fetal infection (chorioamnionitis)
  • Cord compression/prolapse
  • Placental abruption
  • Early pPROM < 26 wks leads to oligohydramnios (pulm. hypoplasia, fetal restriction deformation (contractures)
45
Q

What is the uterine wall at risk of when the placenta attaches too deep, into/through uterine muscle (myometrium)?

A

At risk for detachment and bleeding

46
Q

What are the 3 types of abnormal placental attachment and how common is each type? What does each type mean?

A 
Placenta Accreta (75-78%): placenta attaches to myometrium 
Placenta Increta (17%): Placenta penetrates myometrium 
Placenta Precreta (5-7%): Placenta penetrates entire myometrium to the outer uterine wall, risk for attachment to other organs such as rectum or bladder
47
Q
  1. What is placental abruption? What can form from the abruption and what does this cause?
  2. What may be required of the mother depending on severity?
A
  1. Premature separation of placental lining from the uterine wall
    Hematoma formation may further separate placenta from uterine wall, further compromising fetal blood supply, risk of fetal distress
  2. May need imminent deliver (C/S)
48
Q
  1. What is partial placenta previa? What is complete placenta previa?
  2. What is disrupted as this area thins in prep for labour? What can happen as a result of this?
  3. What type of delivery is suggested and at what week gestation?
A
  1. Partial: placental edge partially covers the cervical opening
    Complete: Complete implantation over cervical opening
  2. Placental attachment disrupted, can cause hemorrhage, fetal anemia, high risk for preterm delivery
  3. C-section, at 36-37 wks prior to onset of labour
49
Q
  1. What is a prolapsed cord? What type of delivery is emergent?
  2. While the OR is being prepared what position is the mom in?
  3. What happens if baby is not delivered quick enough?
A
  1. When cord precedes fetus when exiting uterus, emergent C/S
  2. Trendelenberg, nurse/doc may insert hand into vagina to take pressure off cord
  3. Lack of fetal blood flow and oxygen, death :(
50
Q

What are the 5 steps in delivery? (last step is technically after)

A
  1. ROM
  2. Effacement (shortening)
  3. Dilatation of cervix to approx. 10 cm
  4. Uterine contractions stronger, longer
  5. After delivery of baby placenta is delivered
51
Q
  1. What med is used to induce labour?
  2. What mechanical methods are used to induce labour?
  3. Other methods?
A
  1. Oxytocin
  2. Foley catheter balloon, osmotic dilator into cervical canal
  3. PGE1 or cervical gel, artificially rupture membranes
52
Q

What is used to monitor the baby during delivery/after birth?

A

Electronic fetal heart rate monitor, fetal scalp HR monitor, umbilical cord blood gas (after birth)

53
Q

What does a blood gas look like from the Umbilical Arteries?

A

pH: 7.25
BE: -4
PCO2: 53
PO2: 18

54
Q

What does a blood gas look like from the Umbilical Vein?

A

pH: 7.33
BE: -3.5
PCO2: 40
PO2: 28

55
Q

What is the vertex fetal presentation?

A

Normal presentation, head first, face towards moms back

56
Q

What does shoulder dystocia cause?

A

Brachial plexus injury, clavicle fracture

57
Q

What risk does fetal breech position pose? What can be done to minimize risks?

A

High risk for cord prolapse or compression, C/S done to minimize risks

58
Q
  1. What % of deliveries are C/S?
  2. What are indications to perform a C/S?
  3. What is there an increased incidence of with C/S?
A
  1. 25%
  2. Fetal distress, failure to progress, fetal position (breech, transverse), placenta previa, previous C/S, multiples
  3. TTN (transient tachypnea of newborn), esp. in cold sections
59
Q

What are the risks with forcep assisted delivery?

A

Forcep marks and bruising, facial palsy, skull fracture, intracranial bleeding

60
Q
  1. What is vacuum assisted delivery?

2. What is it a risk for?

A
  1. Traction by suction to fetal scalp

2. Cephalohematoma, caput succedaneum, subgaleal hemorrhage, intracranial hemorrhage

61
Q

When may fetal surgery be indicated?

A

Neural tube defects, congenital diaphragmatic hernia, congenital heart disease

RESP 5017 (19 decks)

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