HD2 Flashcards
- Below are two CTG traces. In each case, name and briefly describe the condition the fetal heart trace is showing (1 mark for each). (4 marks in total)
Trace A – tachycardia (1 mark). Fetal heart rate (FHR) consistently raised above the normal range (160 bpm) (1 mark)
Trace B – Late decelerations or Type II dips (1 mark). FHR returns to baseline after the contraction has ended (1 mark).
- Name three of the five criteria that are used to evaluate the clinical status of the newborn baby using the Apgar score. (3 marks)
Any three from the following list:
Appearance (skin colour), Pulse, Grimace (reflex irritability), Activity (muscle tone) and Respiration
- A newborn boy with Down syndrome is vomiting all his feeds. What is the most likely cause for this? (1 mark)
Duodenal atresia
- A 27 year old woman who is 12 weeks pregnant attends the antenatal clinic for the results of her nuchal translucency scan and serum screening tests. The results reveal she has an increased nuchal translucency and decreased pregnancy-associated plasma protein A (PAPP-A) levels. What is the single most appropriate intervention at this point and why? (3 marks)
Chorionic villus sampling (1 mark)
Her results indicate a risk of her baby having Down syndrome (1 mark)
CVS would give a definitive diagnosis via karyotyping (1 mark)
How does placenta previa present? [1]
- Bleeding without pain in third trimester
What is normal newborn resp rate? [1]
- Newborn respiratory rate: 30-60 breaths/min
State 4 acyanotic heart lesions
- Atrial septal defects
- Ventricular septal defects
- Patent ductus arteriosus
- Patent ductus arteriosus:
Describe difference in pre- and post-ductal coartation of the aorta? [2]
Pre-ductal: Ductus arteriosus persists to compensate for blood flow
Post-ductal: Collateral circulations needed to establish proper perfusion of body and legs (low BP after coarctation)
Describe 3 cyanotic heart lesions
Persistent truncus arteriosus:
Single artery arises from the heart
Large ventricular septal defect (blood mixing)
Progressive heart failure
Transposition of the great vessels:
No spiral septum formed (straight)
Usually also open ductus arteriosus
Catheterization and opening of fossa ovalis to allow blood mixing and buy time
Tetralogy of Fallot:
Ventricular septal defect
Overriding aorta (on top of septal defect)
Pulmonary stenosis
Right ventricular hypertrophy
Boot shaped on xray
State 5 CV changes in mother during pregnancy [5]
o Fluctuation in Hb and haematocrit
o Increased WBC
o Reduction in blood volume
o Reduction in CO / HR
o Reduced progesterone -> reduced tissue fluid
Describe the structural changes to new born nn the onset of ventilation and clamping of cord [5]
- Decreased pulmonary resistance
- Increased systemic resistance
- Increased oxygenation leads to closure of ductus arteriosus (aided by decreased PGs, anatomically closes within weeks) Functional: 12-15h / anatomical: 4-7d)
- Atrial pressure changes close foramen ovale
- Umbilical vein forms ligamentum teres (liver)
-
Umbilical arteries:
Partially become medial umbilical ligament
Partially open as branch of the internal iliac
Describe 5 consequencies of meconium aspiration [5]
o Airway obstruction -> increased lung resistance / hypoxia
o Infection
o Pulmonary inflammation
o Surfactant inactivation
o Persistent pulmonary hypertension
State 5 causes of non-reassuring fetal status [5]
Hypoxia
Maternal anaemia
Gestational hypertension
Intrauterine growth retardation
Meconium stained amniotic fluid
Presentation of non-reassuring fetal status [3]
Irregular heart beat
* Drop after maternal contraction can be sign of uteroplacental insufficiency
Problems with muscle tone / movements
Oligohydramnios
Complications of perinatal asphyxia? [4]
Hypoxia
Hypercapnia
Acidosis
Bradycardia
Management of perinatal asphyxia? [3]
-
Management:
Oxygen to mother
C-section
Mechanical breathing
Complications [4] and management [3] of shoulder dystocia?
Complications:
Erb’s palsy (brachial plexus)
Fetal fracture
Hypoxemic-ischaemic brain injury
Maternal tearing / bleeding
Management:
Change mother’s position
Turn baby’s shoulders (McRoberts maneuver)
Episiotomy
Describe difference between type 1 & 2 of excessive bleeding after pregnancy [2]
Primary: > 500ml within 24h of delivery
Secondary: 24h-6wks after delivery
Most common cause of PPH? [1]
- Most common cause: lack of uterine tone
Management of primary PPH?
Ergotamine
Misoprostol
Uterine massage
Blood transfusion
Removal of retained placenta
Tying off blood vessels
Laparotomy
Examination under anaesthetic
Bakri balloon
Compression sutures
Artery embolisation
Hysterectomy
Signs of uterine rupture? [5]
Abnormal fetal heart rate
Abdominal pain
Slow progress of labor
Vaginal bleeding
Rapid maternal heart rate
Risk factors for uterine rupture? [3]
- Most likely if previous C-section / large baby / induction
Complications of uterine rupture? [4]
Fetal hypoxia
Aspiration of amniotic fluid / infection
Maternal excessive bleeding
Laceration of cervix / vagina
How long does rapid labour occur in ?[1]
- Labour lasts 3-5h instead of 6-18h
Which is preffered: ventouse or forceps? [1]
ventose: fewer complications
Name two complicatins of ventouse delivery [2]
Vaginal laceration due to suction
Bruising / laceration of the face / fetal scalp
State what tachy- and bradycardia in fetus [2]
Tachycardia > 160bpm
Bradycardia < 100 bpm
Describe why a fetus HR decelerates during stress [1]
Hypoxic stress fetus reduces its heart rate to preserve myocardial oxygenation and perfusion
Unlike an adult, a fetus cannot increase its respiration depth and rate. This reduction in heart rate to reduce myocardial demand is referred to as a deceleration.
State three causes of late deceleration [3]
- Maternal hypotension
- Pre-eclampsia
- Uterine hyperstimulation
What do late fetal HR deceleration indicate? [1]
Show insufficient uteroplacental flow -> hypoxia / acidosis to the fetus
Describe why variable decelerations occur [4]
Umbilical cord compressed often in oligohydramnios
Vein gets compressed -> acceleration
Artery gets compressed -> rapid deceleration
Pressure reduced -> baseline
