Dunn OB/GYN I Flashcards
prenatal care recommendations
office visit at 8-10 weeks of pregnancy
every 4 weeks - first 28 weeks
every 2-3 weeks - 28-36 weeks
every week - after 36 weeks
goal of prenatal care
coordination of care for detected medical and psychosocial risk factor
postpartum care
on or between 21 days and 56 days after delivery
quad screen test
maternal blood screen
AFP
hCG
estriol
inhibinA
AFP
produced by fetus
hCG
produced by placenta
estriol
produced fetus and placenta
inhibin A
produced by placenta and ovaries
decreased AFP and estriol
increased beta-hCG and inhibin A
trisomy 21
ultrasound - nuchal translucency
most likely chromosomal disorder compatible with life
trisomy 21
life expectance 60yo
most common genetic cause of mental retardation
trisomy 21
flat facies, epicanthial folds, duodenal atresia, congenital heart defects, alzheimers and leukemia risk
trisomy 21
decreased AFP, beta-hCG, and estriol
increased inhibin A
trisomy 18
edwards syndrome
trisomy 18
severe mental retardation, rocker bottom feet, micrognathia, low set ears, clenched hands, prominent occiput
trisomy 18
life of trisomy 18
most 5 - 15 days
only 8 % live beyond year
trisomy 13
pataus syndrome
pataus syndrome
US nuchal tranlucency
normal quad scree, possible beta-hCG decreased
trisomy 13
mental retardation, rocker bottom feet, microcephaly, cleft lip, cleft palate, holoprosencephaly, polydactyly
trisomy 13
life of trisomy 13
50% babies live a week
5% live a year
risk of quad screen
no known risks or side effects
when to perform quad screen
16-18 week of pregnancy
-all should be offered
indications:
- family hx
- > 35yo
- harmful med/drug use
- diabetes and insulin **
- viral infection
- exposed high radiation
diabetes and insulin pregnant mother
indication for quad screen
high levels of AFP
suggest neural tube defect
-spina bifida or anencephaly
most common reason for elevated AFP - inaccurate dating of pregnancyf
most common reason for elevated AFP
inaccurate dating of pregnancy
early gestation heart
sympathetic control
as develops - responds to parasympathetic
fetal heart tracing
baseline rate baseline variability accelerations decelerations changes over time frequency/intensity of contractions
baseline FHR
HR during 2 minute segment
-minimum 2 minutes
bradycardia
FHR <110
not usually sign of compromise
heart block, occiput posterior or transverse position
tachycardia
FHR >160
not sign of fetal distress
maternal fever, fetal hypoxia, fetal anemia, amnionitis, fetal heart failure
baseline change
decrease or increase in HR lasting longer than 10 minutes
baseline variability
fluctuations in rate of more than 2 cycles per minute
based on amplitude range
minimal variability
<5bpm
moderate variability
6-25bpm
marked
> 25bpm
sinusoidal pattern
no variability
smooth undulating pattern lasting at least 10 minutes with fixed period of 3-5 cycles per minute and amplitude of 5-15bpm
most significant intrapartum sign of fetal compromise
persistently minimal or absent FHR
decreased variability
fetal metabolic acidosis CNS depressants sleep cycles congenital anomalies fetal tachy betamethasone
acceleration
abrupt in crease in FHR above baseline
-onset to peak acceleration <2min duration
time from initial change in HR to time of return to baseline
accelerations <32 weeks
> 10bpm above baseline for >10 seconds
accelerations >32 weeks
> 15bpm above baseline for >15 seconds
prolonged accelerations
increase in HR lasts 2-10 minutes
absent accelerations for more than 80 minutes
increased infant morbidity
to induce accelerations
fetal scalp stimulation
fail to respond - acidosis 50% chance
reactivity
increase of 15bpm above baseline for 15 seconds
twice in 20 minute period**
34 weeks - 95% fetus reactive
episodic patterns deceleration
not associated with contractions
periodic patterns deceleration
associated with contractions
gradual
decrease and return to baseline from time of onset of dceleration to low point >30 seconds
abrupt
decrease in baseline of 15bpm with onset of decelerations to low point <30 seconds
early deceleration
decrease in FHR and onset of decelerations >30s
low point occurs with peak of contraction
late deceleration
onset of deceleration to low point >30s
occurs after beginning of contraction
low point after peak of contraction
variable deceleration
abrupt decrease in FHR of >15bpm per minute measured from most recently determined baseline rate
onset of deceleration to low point is 15s and <2 min
recurrent deceleration
occur with >50% of uterine contractions in any 20 minute segment
prolonged deceleration
decrease in FHR >15 bpm from mast recently determined baseline
deceleartion >2 minutes but less than 10 minutes
deceleration causes
maternal hypotension, uterine hyperactivity, cord prolapse, cord compression, abruption, artifact, maternal seizure
umbilical cord compression
prolonged deceleration
pelvic exam should be performed - to rule out umbilical cord prolapse or rapid descent of fetal head
late decelerations with preservation of beat to beat variability
mediated by arterial chemo receptors in mild hypoxia
low O2 in feta blood - fetal vasoconstriction - HTN
-HTN stimulate broreceptor - slow HR
late decelerations with no variability
hypoxia - lactic acid - suppress fetal nervous system
-decreased variability
myocardial depression - shallow decelerations
causes of late decelerations
uterine contractions, maternal hypotension, maternal hypoxemia
reduced placental exchange
management of late decelerations
patient on side - less IVC compression
discontinue oxytocin
IV hydration
scalp pH - >7.25 good
recurrent late decelerations
consideration of expeditious delivery
unless reversible maternal condition - diabetic ketoacidosis, pneumonia
acceleration shoulders
partial cord occlusion
