Fetal and Neonatal Concerns Transitions Flashcards
1
Q
Describe the path of oxygenated blood from the placenta to the neonate.
A
- Aorta
- Uterine artery and ovarian artery
- Arcuate artery
- Arcuate vessel
- Basal and spiral artery
- Intervillous space
- Chorionic Villi
- Umbilical vein
- Fetus
- Umbilical arteries
- Uterine veins
- IVC
2
Q
When does fetal resuscitation start?
A
- During labor
3
Q
What is the most common cause of neonatal depression?
A
- Intrauterine asphyxia
4
Q
How long can the fetus compensate fetal hypoxia and what is this termed?
A
- 45 minutes
- Fetal stress
5
Q
When is fetal heart rate monitoring of the neonate?
A
- 24 weeks or above
6
Q
What is the most useful technique in monitoring fetal heart well being?
A
- Fetal heart rate monitoring 35-50%
7
Q
What are the three parameters that need to be monitored with fetal heart rate monitoring?
A
- Baseline heart rate
- Baseline variability
- Relationship to uterine contractions (Deceleration patterns)
8
Q
What is the normal heart rate range in the fetus and newborn?
A
- 110-160
9
Q
- Prematurity
- Mild fetal hypoxia
- Chorioamnionitis
- Maternal fever
- Maternally administered drugs (anticholinergics, B-agaonists)
- Maternal HYPOTHYROID
All have what effect on fetal heart rate?
A
- Increase fetal heart rate
10
Q
- Post-term pregnancy
- Fetal heart block
- Fetal asphyxia
All have what effect on fetal heart rate?
A
- Decrease fetal heart rate
11
Q
What are two causes of prolonged decelerations in the fetus?
A
- Neuraxial anesthesia and precipitous BP drop of the mother
- Cord prolapse
12
Q
What is a measure of an intact neurological system, indicates optimal fetal oxygenation, and is a measure of fetal oxygen reserve?
A
- Variability
- THE SINGLE MOST IMPORTANT CHARACTERISTIC OF FHR
13
Q
What is indicated by FHR variability of <5bpm?
A
- Minimal variability
14
Q
What is indicated by FHR variability of 6-25 bpm?
A
- Moderate variability
15
Q
What is indicated by FHR variability > 25 bpm?
A
- Marked variability
16
Q
What may be occurring when there is sustained decreased baseline variability?
A
- Fetal asphyxia
17
Q
What is the best way to assess fetal heart rate variability?
A
- Fetal scalp electrodes
18
Q
- CNS depressants (opioids, barbiturates, Mg+, benzos)
- Parasympatholytics (glyco, atropine)
- Prematurity
- Fetal dysrrhythmias
- Anencephaly
May all present with what significant finding in FHR?
A
- Decreased variability
19
Q
What is indicative of a sinusoidal pattern in FHR?
A
- FETAL DEPRESSION
- Hypoxia
- Drugs
- Anemia
20
Q
This FHR finding is defined as increases of 15 beats/min or more lasting than 15 seconds
A
- Accelerations
- Reflect normal oxygenation and usually r/t to fetal movement and uterine pressure
21
Q
- Fetal sleep
- Drugs (opioids, Mg+, Atropine)
- Hypoxia
- Are all factors that have what effect on FHR?
A
- Decrease accelerations
- Normal fetuses have 15-40 accelerations per hour
22
Q
The absence of baseline variability AND accelerations indicates what?
A
- NONREASSURING FETAL HEART PATTERNS AND MAY BE A SIGN OF FETAL COMPROMISE
- VERY IMPORTANT!
23
Q
What may be an absence of variability indicate?
A
- Neurological deficit
24
Q
What deceleration pattern is thought to be a response to fetal head compression or stretching of the neck during uterine contractions and is generally not associated with distress
A
- Early decelerations
25
What deceleration pattern occurs at the peak or following a uterine contraction and is associated with fetal compromise and uteroplacental insufficiency?
- Late Decelerations
26
What deceleration pattern is thought to be from chord compression and intermittent decreases in uterine blood flow and is the most common type of deceleration?
- Variable decelerations
27
What deceleration pattern is associated with fetal asphyxia when above 60 bpm, lasts longer than 60 sec. or occurs in a pattern that lasts longer than 30 min.?
- Prolonged decelerations
- EMERGENCY
- May indicate a chord prolapse
28
With a fetal scalp pH what does a pH of <7.20 indicate? >7.20?
- Depressed neonate (more acidotic)
| - Vigorous neonate
29
- What is the normal breathing rate of the newborn?
- What is the normal heart rate of the newborn?
- BP's?
- 30-60 breaths/minute (begins 30 sec. after birth and is sustained within 90 sec.)
- 120-160
- 50/25 for neonates 1-2 kg.
- 70/40 for neonates >3 kg
30
What does APGAR stand for and what is it measuring?
- Appearance (blue, pink, acrocyanotic)
- Pulse (absent, <100, >100)
- Grimace (floppy, minimal stimulation response, prompt stimulation response)
- Activity (absent, flexed arms, active)
- Respiration (none, slow and irregular, vigorous cry)
31
What are the four factors that put the neonate at risk for persistent fetal circulation? What do these factors effect that makes the neonate revert to persistent fetal circulation?
- Acidosis
- Hypoxia
- Hypovolemia
- Hypothermia
- Increased PVR
32
What are the factors that make the neonate born by C/S at risk for persistent fetal circulation?
- 2/3 of fetal lung fluid is expelled during vaginal delivery
- Increased residual lung fluid
33
- Release of surfactant
- Flow to vital organs
- Thermoregulation
- Are all important for what important process to fetal transition?
- Catecholamine surge
34
What are the ways in which a wet baby can lose heat?
- Conduction
- Convection
- Evaporation (most heat loss AT birth)
- Radiation (most heat loss AFTER birth)
35
When are APGAR scores taken?
- 1 and 5 minutes after birth
36
What does an APGAR score of 5-7 indicate?
- Mild asphyxiation (100% 02 blow across the face)
37
What does an APGAR score of 3-4 indicate?
- Moderate asphyxiation (temporary assisted positive pressure ventilation w/ bag/mask)
38
What does an APGAR score of 0-2 indicate?
- Severe depression (immediate intubation and chest compressions may be required)
39
When analyzing umbilical cord gas and pH, what is worse, metabolic or respiratory acidosis?
- Metabolic acidosis is a more ominous sign than respiratory acidosis
40
What interventions are necessary if the infant is having respiratory depression caused by opioids administered to mom?
- Nalaxone 0.1mg/kg, IV, ET, IO, SQ
| - Caution for acute withdrawal in infants of addicted mothers
41
When neonatal resuscitation is necessary, bag/mask PPV is attempted unsuccessfully, what is important to perform after intubation w/ and ETT?
- Resume PPV w/ 100% 02 until infant is stable
| - REDUCE FI02 AS SOON AS POSSIBLE
42
When are chest compressions indicated during neonatal resuscitation?
- When HR < 60 bpm
- Ventilation ratio is 3:1, the rate is 90 per minute
- Stop compressions when HR > 60 bpm
- Continue ventilations until HR > 100 bpm
43
How is fluid resuscitation of the neonate done?
- With NS or LR at 10 mL/kg over 5-10 min.
44
What are the two drugs that need to be available during neonatal resuscitation?
- Epinephrine
| - Sodium bicarbonate
45
What is the neonatal drug of choice for treating bradycardia?
- Epinephrine
- 0.01-0.03 mg/kg (0.1mg-0.3 mL/kg of 1:10,000 solution)
- Used if HR < 60 bpm after ventilation and chest compressions
- q 3-5 minutes
46
What medication is given after prolonged neonatal resuscitation, after it is determined the neonate is acidotic, 1-2mEQ/kg of a 0.5 mEQ/mL solution
- Sodium bicarbonate
47
What is associated with a release of thick meconium into the amniotic fluid, especially after 42 weeks of gestation?
- Fetal distress
- Happens in 10-12% of deliveries
- Neonatal gasping can cause meconium to enter the lungs (can develop into severe respiratory distress in 15% of cases, and/or persistent fetal circulation)
48
- Amnioinfusion prior to delivery
- Bulb suctioning of thin, watery contents
- Intubation and tracheal suctioning
- Are all treatments for what complication of delivery of the fetus?
- Meconium stained neonates
49
- Hypotension (w/ persistent fetal circulation)
- Hypotonicity
- Peripheral dilation
- Are all S/S of what postpartum complication
- Magnesium toxicity
- Consider intubation and mechanical ventilation
- Occurs when mothers have been administered high doses of Mg+
- Mg+ will decrease over 24-72 hours
- Antidote: Ca++
50
What is the most common metabolic problem in neonates?
- Hypoglycemia
| - Will cause neurologic damage if not treated
51
After 3 days of life, what are the normal blood glucose levels?
- 75-90 mg/dL
| - < 45 mg/dL considered hypoglycemic in first 3 days of life
52
- Lethargy
- Apnea
- Cyanosis
- Seizures
- Hypotonia
- Are all S/S of what metabolic disorder of the neonate?
- Hypoglycemia
53
What are the common causes of hypoglycemia in the neonate?
- Hypoxemia
- Sepsis
- High levels of circulating insulin
54
What is a unique consideration in blood cell product administration of the neonate?
- Products need to be irradiated to reduce the risk of transfusion-associated GVHD
55
What is a consequence of neonates having more type II (fast twitch) and less type I (slow twitch) in the first 28 days of life?
- Neonates experience respiratory distress faster
