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HD PBL 3 Flashcards

1
Q

How does foetal hypoxia appear on a CTG?

A
  1. Flat trace (loos of beat-to-beat variations)
  2. Bradycardia
  3. Tachycardia
  4. Type II dips/ late deceleration
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2
Q

What is the difference between type I dips/early decelerations and type II dips/late deceleration?

A

Type I dips/early decelerations: deceleration occurs with uterine contractions = physiological
Type II dips/late decelerations: decelerations that cotinue after uterine contract = pathological (sign of hypoxia + foetal distress)

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3
Q

What are variable decelerations on a CTG a sign of?

A

Umbilical cord compression

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4
Q

When can ventouse (assisted delivery) be used?

A

baby >34 weeks (before that, head is too soft)

2nd stage of labour

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5
Q

When is ventouse/assisted delivery indicated?

A
  1. Maternal exhaustion
  2. Foetal distress
  3. Prolonged 2nd stage of labour
  4. Materal illness (prolonged pushing can be dangerous)
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6
Q

What criteria must be fulfilled before using ventouse method?

A
  1. Ruptured membranes
  2. Fully dilated cervix
  3. Foetal cephalic presentation
  4. Empty bladder
  5. No pelvic contracutre/obstruction
  6. Adequate analgesia
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7
Q

What is meconium?

A

Contents of the foetal bowel

Desquamated bowel cells containing bile and enzymes

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8
Q

What is meconium aspiration? When does it arise?

A

Occurs during hypoxia
Foetal bowel contents are emptied into the amniotic fluid/cavity
Foetus then inhales this meconium

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9
Q

What are the short and long-term complications of meconium aspiration?

A

Short-term:

  • airway obstruction
  • surfactant dysfunction
  • pulmonary oedema
  • pulmonary vasoconstriction and bronchoconstriction

Long-term (neuro consequences):

  • seizures
  • learning difficulties
  • cerebral palsy
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10
Q

What is APGAR?

A

1-5 minute assessment on overall appearance + health of baby
- Appearance (skin)
- Pulse
- Grimace (reflex)
- Activity
- Respiration
All of these are scored from 0-2 to give a total score out of 10

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11
Q

How would a baby appear with an APGAR score of 0, 5, 10?

A

0:

  • skin = pale/blue
  • pulse = absent
  • reflex = no response
  • activity = none
  • respiration = absent

5:
- skin = blue at extremities + body is pinkish
- pulse = <100 BPM
- reflex = grimace
- activity = some flexion
- respiration = weak, irregular, gasping

10:

  • skin = no cyanosis; all pink
  • pulse = >100 BPM
  • reflex = cry on stimulation
  • activity = flexed arms + legs; resist extension
  • respiration = strong, robust crying
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12
Q

What APGAR scores would be considered normal, fairly low and critically low?

A

Normal = 7-10
Fairly low = 4-6
Critically low = <3

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13
Q

What is HIE?

A

Hypoxic ischaemic encephalopathy

  • acute/subacute injury due to asphyxia
  • neurological condition as a result of perinatal asphyxia**
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14
Q

How does mild (Grade I) HIE usually present?

A
  1. Alertness: hyperalert
  2. Muscle tone: normal/increased
  3. Seizures: none
  4. Pupils: dilated + reactive
  5. Respiration: regular
  6. Duration: <24 hours
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15
Q

How does moderate (Grade II) HIE usually present?

A
  1. Alertness: lethargic
  2. Muscle tone: hypotonic
  3. Seizures: frequent
  4. Pupils: small + reactive
  5. Respiration: periodic
  6. Duration: 2-14 days
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16
Q

How does severe (Grade III) HIE usually present? What is the mortality rate?

A
  1. Alertness: coma
  2. Muscle tone: flaccid
  3. Seizures: uncommon
  4. Pupils: variable, fixed
  5. Respiration: apnoea
  6. Duration: weeks

Mortality = ~75%
>80% of survivors will have neurological issues

17
Q

How is asphyxia/HIE managed?

A
  1. Cooling:
    - APGAR <5 at 10 minutes
    - Need for resuscitation after 10 minutes
    - Infant ≥ 36 weeks
    - moderate to severe HIE
  2. Anticonvulsants:
    - upon the 1st sign of neurological dysfunction
    - important in order to preserve LT cognitive and developmental impairment
18
Q

What anticonvulsant is usually used for HIE/birth asphyxia? What is its MOA?

A

Phenobarbitol

Acts on GABAa receptors - prolongs Cl- channel opening - increases synaptic inhibition

19
Q

Describe the process of therapeutic hypothermia? What are the effects of this treatment?

A

33-34°C for 72hours
Slow rewarming of 0.5°C every hour
Moderate to severe HIE
Reduces the brain’s demand for O2 and slows inflammation processes

20
Q

Define hypoxia.

A

An inadequate supply of O2 to tissues/low O2 tension

**not lack of O2

21
Q

What is the normal range for foetal HR?

A

120-160 BPM

22
Q

Give 3 long-term neurological developmental difficulties that arise from perinatal asphyxia?

A

Any 3 from:

  • cerebral palsy
  • cortical blindness/blindess
  • learning difficulties
  • epilepsy
  • deafness
23
Q

What is the location of the transducers for a CTG?

A
  1. Over uterine fundus

2. Above position of the foetal heart/on the foetal head

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