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NURS787 Exam 2 > Fetal Well-Being In Labor > Flashcards

Fetal Well-Being In Labor Flashcards

1
Q

When does implantation occur?

A

b/w days 6-10

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2
Q

What is the function of the trophoblast layer?

A
  • invades decidua basalis
  • remodels spiral arteries
  • form placenta
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3
Q

When does the placenta begin to function?

A

10-12wks GA

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4
Q

What is the function of the syncytiotrophoblast?

A

outer trophoblast layer

  • sends finger-like projections into endometrium
  • develop lacunae that fill with serum from spiral arteries –> nourish trophoblast
  • communication b/w lacunae and uterine vessels begin uteroplacental circulation
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5
Q

What is the function of the cytotrophoblast?

A

inner layer of trophoblasts

  • become chorionic villi
  • establish venous network that supplies fetus
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6
Q

When does fetal blood circulation begin?

A

~21 days w/in chorionic villi

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7
Q

Where does gas exchange occur?

A

intervillous space of placenta

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8
Q

What are the 4 types of diffusion?

A

1) simple = from high concentration to low concentration (e.g. O2, CO2)
2) facilitated diffusion: requires transporter but no energy (e.g. glucose, cholesterol)
3) active transport = against concentration gradient; needs transporter (e.g. amino acids, vitamins, Fe)
4) pinocytosis: carrier engulfs molecule and moves it across placental barrier (e.g. IgG)

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9
Q

What is required for optimal uteroplacental circulation?

A

1) adequate maternal blood flow to intervillous space
2) large placental area for gas and nutrient exchange
3) efficient gas/nutrient diffusion
4) unimpaired umbilical vein circulation
5) adequate oxygen transport capacity in fetus

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10
Q

What maternal pre-existing conditions can impede uteroplacental circulation?

A
  • HTN
  • CAD
  • DM
  • renal disease
  • smoking
  • abruption
  • pre-eclampsia
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11
Q

What are the primary functions of the sympathetic nervous in the fetus?

A

1) increase FHR
2) vasoconstriction
3) increase fetal BP

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12
Q

What controls FHTs?

A

1) SNS
2) PNS
3) CNS
4) chemoreceptors
5) baroreceptors

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13
Q

When during pregnancy is the sympathetic nervous system dominant?

A

1st trimester

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14
Q

When during pregnancy does the parasympathetic nervous system mature and dominate?

A

2nd trimester

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15
Q

What is the overall effect of the PNS on FHR?

A

gradually slows baseline HR

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16
Q

What mediates the PNS?

A

vagus nerve

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17
Q

What sets the highest intrinsic HR?

A

SA node

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18
Q

What causes FHR variability?

A

vagal stimulation –> varies interval b/w successive beats –> changes FHR

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19
Q

Where are chemoreceptors located?

A

1) aortic arch

2) CNS

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20
Q

What stimulates chemoreceptor response?

A

1) O2 content

2) CO2 content - if increased –> chemoreceptors alert medulla oblongata to stimulate vagus nerve –> slows FHR

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21
Q

Where are baroreceptors located?

A

1) aortic arch

2) carotid arch

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22
Q

What stimulates baroreceptor response?

A

increased BP –> quick reflex vagus nerve response –> slows FHR

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23
Q

Chemoreceptors affect (short/long)-term control of FHR.

A

long

24
Q

What type of control do baroreceptors offer?

A

short-term control of HR and BP

25
Q

What is the most common cause of fetal tachycardia?

A

maternal fever

26
Q

How can intermittent auscultation be performed?

A

1) fetoscope
2) doppler
3) external U/S transducer on EFM

27
Q

What can an intrauterine pressure catheter tell us?

A

contraction. ..
1) resting tone
2) pressure
3) timing of onset, peak, completion
4) amnioinfusion possible

28
Q

What are contraindications to internal monitoring?

A

1) placenta previa
2) active infection
3) unknown fetal presentation/position - do not place on fontanel or genitalia
4) face presentation

29
Q

What interval of time between contractions is associated with fetal cerebral oxygenation?

A

~60sec

30
Q

How can one differentiate among mild, moderate, and strong contractions using external palpation?

A

contractions must be >10mmHg

mild: tip of nose - easily indented
moderate: chin
strong - forehead - cannot indent

31
Q

What are ACNM recommendations for FHR auscultation?

A

active phase of labor: q15-30 mins

second stage: q5min

32
Q

How should auscultation of FHR be performed?

A
  • listen through contraction + some time after

- if no decel noted –> listen at peak of contraction + 30-60sec after

33
Q

What is commonly the cause of pseudosinusoidal variability?

A

opioid administration

34
Q

What is considered “recurrent?”

A

event occurs for >50% of contractions in a 20mins window

35
Q

What is considered “intermittent?”

A

event occurs w/ <50% of contractions in 20 mins

36
Q

Define tachysystole

A

> 5 contractions in 10 mins over 30 min window

37
Q

What is happening during an early decel?

A

fetal head compression

  • intracranial pressure –> stimulates vagal nerve –> slows FHR
  • baroreceptor-mediated
38
Q

What is happening during a late decel?

A

placental insufficiency

  • transient hypoxia during/after contraction –> stimulates chemoreceptors –> alpha-adrenergic response –> central HTN –> baroreceptor response –> decreased FHR
  • chemoreceptor-mediated
39
Q

What is happening during a variable decel?

A

cord compression

  • umbilical vein compression –> decreased preload = spike (“shoulder”) prior to onset
  • umbilical artery compression –> increased afterload –> decreased HR
40
Q

What can cause a variable decel?

A
  • nuchal chord
  • knots in cord
  • oligo
  • prolapsed cord
  • cord compressed by pelvic bones or body
41
Q

What are interventions for concerning tracings?

A
  • O2 administration for 10-30 mins
  • maternal repositioning
  • IV fluid bolus
  • reduction of uterine activity
  • amnio infusion
  • alteration of 2nd stage efforts (e.g. pushing every other contraction, change positions, push side-lying)
42
Q

How is fetal tachycardia defined?

A

FHR baseline >160 for 10 mins or more

43
Q

How is fetal bradycardia defined?

A

FHR baseline <110 for 10 mins or more

44
Q

What does sinusoidal pattern indicate?

A

fetal anemia OR severe asphyxiation

45
Q

What are indications for amnioinfusion?

A

1) laboring preterm pt w/ PROM
2) otherwise uncorrectable variable decels
3) significant oligo at term, undergoing IOL
4) presence of moderate to thick mec

46
Q

When wouldn’t one expect to see meconium-stained fluid?

A

<34wks GA

47
Q

What does fresh meconium look like?

A

dark, green-brown

48
Q

When does meconium turn muddy brown/light tan?

A

several hours after expulsion

49
Q

What does stained membranes indicate?

A

meconium occurred more than several hours ago

50
Q

From where should cord blood gases be collected?

A

blood from umbilical arteries from 10-30cm segment of cord

51
Q

When are cord gases indicated?

A

1) abnormal/unclear FHT
2) depressed newborn
3) pre-term, IUGR
4) menocium, intubation for mec
5) chorioamnionitis, maternal disease

52
Q

What are normal umbilical artery blood gases?

A

pH 7.28
PCO2 50mmHg
PO2 15mmHg
base excess -3 meq/L

53
Q

What are normal umbilical vein blood gases?

A

pH 7.35
PCO2 40mmHg
PO2 30mmHg
base excess -3 meq/L

54
Q

What blood gases are indicative of respiratory acidemia?

A

umbilical artery

pH 7.15
PCO2 70

55
Q

What blood gases are indicative of metabolic acidemia?

A

umbilical artery
pH 7.10
BE -15

umbilical vein
pH 7.15
BE -12

NURS787 Exam 2 (8 decks)

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