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Pediatrics > High risk pregnancy > Flashcards

High risk pregnancy Flashcards

1
Q

What are the components of the APGAR scale?

A

Appearance
Pulse
Grimace
Activity
Respiratory effort

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2
Q

What should you be evaluating for the A portion of the APGAR scale?

A

Appearance
Skin Color

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3
Q

Describe how an infant would present with the score of 1, and 2 on the APGAR scale for category A

A

0 - Pale blue
1 - body pink, extremities blue
2 - Body and extremities pink

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4
Q

Describe how an infant would present with the score of 0, 1 and 2 on the APGAR scale for the category of P

A

0 - no heart rate
1 - <100 bpm
2 - >100 bpm

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5
Q

Describe the G category of the APGAR scale

A

reflex irritability in response to stimuli
Basically does the baby respond if you piss it off

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6
Q

Describe how an infant would present with the score of 0, 1 and 2 on the APGAR scale for the category of G

A

0 - No response
1 - Grimace
2 - Cry cough sneeze

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7
Q

Describe how an infant would present with the score of 0, 1 and 2 on the APGAR scale for the category of A

A

0 - Limp
1 - some flexion
2 - well flexed

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8
Q

Describe how an infant would present with the score of 0, 1 and 2 on the APGAR scale for the category of R

A

0 - none
1 - weak or irregular
2 - strong cry

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9
Q

What can an ultrasound assess?

A

Fetal structure and activity

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10
Q

What can an ultrasound evaluate?

A
  1. Amniotic fluid level
  2. Placenta location
  3. fetal abnormalities
  4. Fetal Size and position
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11
Q

Why is it important to measure the heart rate of the fetus during delivery?

A

To ensure that the decelerations of the fetal heart rate are synchronized with the maternal contractions

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12
Q

What are early decelerations associated with?

A
  1. Associated with fetal head compression during contractions
  2. Lowest heart rate is at the peak of the contraction
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13
Q

T/F: early decelerations are not normal

A

False. Early decelerations are normal and indicate a proper response to the stimuli

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14
Q

What can cause late decelerations?

A
  1. Increase in fetal systemic blood pressure causes a drop in heart rate
  2. problems with chemo and baroreceptors
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15
Q

What is a fetal BPP?

A

fetal biophysical profile

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16
Q

What are the assessments of the fetal biophysical profile?

A
  1. Fetal tone
  2. fetal breathing movements
  3. Fetal body movements
  4. Amniotic fluid volume
  5. Results of the non-stress test
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17
Q

What tools are used to perform the fetal biophysical profile?

A

Ultrasound and non-stress test

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18
Q

What scores on the fetal BPP are indicative of good outcomes?

A

> 8

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19
Q

What scores on the fetal BPP are indicative of fetal compromise?

A

<4

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20
Q

What is an amniocentesis?

A

Invasive diagnostic test performed by inserting a needle into the uterus into the amniotic sac to withdraw amniotic fluid

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21
Q

What can an amniocentesis identify?

A
  1. Chromosome abnormalities
  2. Lung Maturity
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22
Q

When can an amniocentesis be performed?

A

16-18 weeks gestation

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23
Q

What information would we gather when assessing whether or not a patient is high risk pregnancy?

A
  1. Chronic conditions
  2. Past pregnancies
  3. Maternal Age
  4. Infections
  5. Pregnancy complications
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24
Q

Give some examples of indications of a high risk pregnancy

A
  1. Advanced maternal age
  2. Maternal hypertension
  3. Diabetes
  4. Placental disorders
  5. Umbilical cord disorders
  6. abnormal amniotic fluid
  7. substance abuse
  8. multiples
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25
Q

What are examples of viral infections that can result in a high risk pregnancy?

A

Hepatitis and HIV

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26
Q

What is the most common bacterial infection that indicates a high risk pregnancy?

A

Group B streptococci

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27
Q

What maternal habits could result in a high risk pregnancy?

A
  1. Smoking
  2. Alcohol
  3. Opioids
28
Q

Describe placenta previa

A

implantation occurs abnormally low in the uterus partially or completely obstructing the cervix

29
Q

What is a placental abruption?

A

the placental partially or completely separates from the uterine wall

30
Q

What are maternal complications associated with placental abruption?

A
  1. Hemorrhage
  2. Preterm delivery
  3. Shock
  4. Acute renal Failure
  5. DeathW
31
Q

What are fetal complications associated with placental abruption?

A
  1. Insufficient blood supply to the fetus
  2. Hypoxia
  3. death
32
Q

Describe preclampsia?

A

chronic hypertension due to pregnancy

33
Q

What are symptoms associated with preclampsia?

A

headache, blurry vision, stomach pain

34
Q

What blood pressures are required for preclampsia?

A

> 140/>90

35
Q

What is the only known cure for preclampsia?

A

yeetus the fetus/ delivery

36
Q

Describe eclampsia

A

Hypertension with seizures

37
Q

What is HELLP syndrome?

A

Life threatening pregnancy condition

38
Q

What are the components of HELLP?

A

Hemolysis
Elevated liver enzymes
Low platelets

39
Q

What is gestational diabetes?

A

insulin resistance due to pregnancy hormones that resolves after pregnancy

40
Q

What are treatment options for gestational diabetes?

A

Diet and insulin

41
Q

What are are some maternal complications associated with gestational diabetes?

A
  1. Spontaneous abortion
  2. Preclampsia
  3. preterm labor or delivery
  4. Polyhydramnios
42
Q

What are are some fetal complications associated with gestational diabetes?

A
  1. Congenital anomolies
  2. Macrosomia
  3. Intrauterine growth restriction
  4. delayed lung maturity
  5. respiratory distress
43
Q

What is polyhydramnios?

A

more than the normal amount of amniotic fluid

44
Q

What is oligohydramnios?

A

lower than normal amniotic fluid

45
Q

What is PROM

A

pre-labor rupture of membranes = water broke

46
Q

What are the 3 umbrella terms for fetal orientation?

A

Cephalic-head first
Breech - butt or feet first
Transverse - shoulder first

47
Q

What is the application of corticosteroids in preterm labor?

A

antenatal corticosteroid therapy leads to improvement in lung function by enhancing lung maturation

48
Q

What can antenatal corticosteroid therapy reduce the instance of?

A
  1. RDS
  2. Intracranial ventricular hemorrhage
  3. necrotizing enterocolitis
  4. Sepsis
  5. Neonatal mortality
49
Q

What steroids are generally given in preterm labor?

A

Betamethasone and dexamethasone

50
Q

What are the tests to determine lung maturity?

A
  1. Shake test/ Foam stability index
  2. L/S ratio
  3. PG
  4. PC or DPPC
51
Q

What does the foam stability index test?

A
  1. Assess total surfactant activity
  2. Mix amniotic fluid sample with ethanol and shake, if a stable ring forms, surfactant is present
52
Q

What lamellar body count indicates immature lungs? Mature lungs?

A

<15000 = immature lungs
>50000 = mature lungs

53
Q

What does the L/S ratio examine?

A

lecithin/sphingomelin

54
Q

What L/S ratio is associated with good outcomes?

A

2:1

55
Q

What does a L/S ratio of less than 2:1 indicate?

A

hyaline membrane disease or RDS

56
Q

If a infant has an L/S ratio of less than 2:1, what treatment is recommended?

A

Surfactant replacement

57
Q

What compound in the alveoli indicates that the fetal lung development has reached an advanced state?

A

PG
phosphatidyglycerol

58
Q

At what point does PG appear in the amniotic fluid?

A

about 35 weeks

59
Q

When is a pregnancy considered post term?

A

> 42 weeks

60
Q

What factors could contribute to a post term pregnancy?

A
  1. Prior post term pregnancy
  2. maternal obesity
  3. Increasing maternal Age
  4. Nullparity- hasnt given birth before
61
Q

What problems are associated with post term pregnancy?

A
  1. Fetal asphyxia secondary to hypoxemia
  2. decreased tolerance for labor and delivery
  3. Meconium aspiration syndrome
  4. Persistent pulmonary hypertension of the newborn
62
Q

What are maternal risks associated with post term birth?

A
  1. C-section
  2. Dysfunctional labor
  3. Infection
  4. Postpartum hemorrhage
63
Q

What are fetal risks associated with post term birth?

A
  1. Still birth
  2. Neonatal seizures
  3. Meconium aspiration
  4. Lower APGAR scores
  5. Umbilical cord compression
64
Q

When is labor considered preterm?

A

when uterine contractions occur between 20 and 37 weeks gestation

65
Q

When is a delivery considered preterm?

A

Delivery occurring after 20 weeks gestation but prior to 37 weeks

Pediatrics (10 decks)

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