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OB Test 3 > Fetal Resuscitation > Flashcards

Fetal Resuscitation Flashcards

1
Q

Neurologic injury in the fetus depends on?

A

Duration of hypoxia from disruption of placental flow of oxygen and nutrients

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2
Q

Maternal infection and inflammation can cause what?

A

Neuro developmental abnormalities

  • schizophrenia
  • autism
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3
Q

What is complete asphyxia?

A

Total placental abruption

Umbilical cord occlusion

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4
Q

What is incomplete asphyxia?

A

Anytime oxygen delivery is inadequate to meet needs

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5
Q

Causes of incomplete asphyxia

A

Aortocaval compression
HTN
Hypotension…

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6
Q

Fetal assessment: neurobehavioral scale

A

HR
Motor activity
Existing behavioral state
Responsiveness to external stimuli

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7
Q

Anesthesia and fetal brain injury

A

All needs more studies

  • labor anesthesia
  • parenteral opioids
  • neuraxial
  • inhalation agent
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8
Q

What drug is thought is help with neuroprotection?

A

Magnesium

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9
Q

What may improve outcomes in neonates at risk for hypoxic ischemic encephalopathy?

A

Hypothermia

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10
Q

Fetal circulation

A 
Placenta
Umbilical vein and ductus venosus 
To inferior vena cava
Right heart 
Foremen ovale to 
Left heart 
Ascending aorta 
Patent ductus arteriosis 
Descending aorta 
Blood returns to placenta via umbilical arteries
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11
Q

What affect does clamping the umbilical cord have?

A

Increase SVR

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12
Q

Why does lower oxygenated blood supply the lower body while the more oxygenated blood supplies the upper?

A

PVR is higher than SVR so most of the blood from the RV is pushed through ductus arteriosis into lower body circulation
-lower body also requires less O2 than brain and heart

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13
Q

Decreased PVR occurs from what? Leading to what?

A

Expansion of the lungs and increased alveolar oxygen tension and pH
Greater pulmonary artery blood flow

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14
Q

What does increased pulmonary artery blood flow cause?

A

Improved oxygenation and higher LA pressure > diminishes shunting across foramen ovale

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15
Q

What causes constriction of the ductus arteriosis and closure of the foramen ovale?

A

Increased PO2 and SVR

Decreased PVR

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16
Q

Fetal breathing movements are seen when? How do they change?

A

11 weeks gestation
Increase with gestational age
Decrease days before onset of labor

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17
Q

What is contained in the fetal lungs?

A

Ultra-filtrate of plasma (fluid)

  • partial reabsorption
  • 2/3 expelled
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18
Q

What increases residual fluid in fetal lungs?

A

Preterm
C-section
-vaginal delivery helps push out some fluid

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19
Q

First breath occurs when? Establishes what?

A

~ 9 seconds after delivery

FRC

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20
Q

When is surfactant present in the alveoli?

A

By 20 weeks gestation

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21
Q

When is surfactant present within the lumen of the airways?

A

28-32 weeks gestation

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22
Q

When are significant amounts of surfactant in terminal airways?

A

34-38 weeks gestation

23
Q

When is induction of labor held off till 36-38 weeks?

A

For surfactant

24
Q

Transition to extrauterine life is asssociated with what?

A

Catecholamine surge

-helps surfactant production

25
Q

How do neonates respond to cold?

A

Increase their metabolic rate and release norepinephrine

26
Q

What does this increase in metabolic rate and release of norepinephrine response facilitate?

A

Oxidation of brown fat

27
Q

The oxidation of this mitochonrida containing brown fat results in what?

A

Non-shivering thermogenesis

28
Q

What percentage of neonates require some form of resuscitation?

A

10%

29
Q

What can help predict the need for some form of neonatal resuscitation?

A

Preterm
Intrauterine insults
Congenital anomalies

30
Q

What is normal fetal HR?

A

120-160

Book says 110-160

31
Q

What does a normal fetal HR indicate?

A

Normal uteroplacental perfusion
Intact CNS
Normal fetal pH of 7.25-7.45

32
Q

What fetal pH is pre-pathological and what measures can be taken to help correct it?

A

7.20-7.25
O2 supplementation to mom
Change position (aortocaval compression)

33
Q

What causes early decelerations? When do they occur?

A

Occur simultaneous with uterine contraction

Head compression

34
Q

What causes late decelerations? When do they occur?

A

Begin after uterine contraction and end after completion of contraction
Decreased uteroplacental perfusion due to maternal hypotension, hypovolemia, maternal acidosis, preeclampsia, HTN

35
Q

What causes variable decelerations? When do they occur?

A

Umbilical cord compression or other reduced blood flow states like HTN and decreased arterial O2 tension

36
Q

What decelerations are normal?

A

Early

37
Q

Which deceleration are bad?

A

Late

38
Q

Which deceleration may or may not be tolerated?

A

Variable

39
Q

When are APGAR scores performed?

A

1 and 5 minutes after delivery

40
Q 
A
P
G
A
R
A 
Appearance
Pulse
Grimace
Activity
Respirations
41
Q

How is each category rated?

A

Scale of 0-2

42
Q

Zeros for APGAR

A 
Appearance: blue; pale
Pulse: absent 
Grimace: floppy 
Activity: absent 
Respirations: absent
43
Q

1s for APGAR:

A 
Appearance: pink body; blue extremities 
Pulse: below 100
Grimace: minimal response to stimulate 
Activity: flexed arms and legs 
Respirations: slow and irregular
44
Q

2s for APGAR:

A 
Appearance: pink
Pulse: above 100
Grimace: prompt response to stimuli 
Activity: active
Respirations: vigorous cry
45
Q

What is the normal RR for neonate?

A

30-60

46
Q

What should the initial assessment of the fetus look like?

A

RR: 30-60
Neurologic: vigorous activity
HR: 80-205
Gestational age

47
Q

What can delayed cord clamping increase?

A

Iron stores

BP

48
Q

What does high concentration of O2 raise?

A

Production of oxygen free radicals

49
Q

What are oxygen free radicals linked to?

A

Hypoxia-deoxygenation injury

50
Q

How old for LMA use in infant?

A

34 weeks gestation or later

51
Q

O2 level use by age

A

Term: room air
Preterm: FiO2 30-90% lower asap

52
Q

What is this high concentration of O2 linked to?

A 
Vision loss
Childhood cancer (supplements O2 over 3 minutes)
53
Q

Saturation of what for a neonate is acceptable

A

85-92%

OB Test 3 (3 decks)

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