high risk pregnancy Flashcards
apgar score
done immediatley after birth at
- 1 minute,
- 5 mins =
- 7+ pts is good
- <3 pts suggests cerebal palsy and perm neuro damage
- and as needed intervals
score of 7-10 means good health
4 and 6- ventilation assistance
4 means that prompt, life-saving measures may be called for.
what characterises a high risk pregnancy
maternal rf
fetal rf
Maternal
- maternal age over 35 under 16
- chronic disease(HTN,DM thyroid)
- preeclampsia
- IUGR
- previous still birth
- post term ( 2 weeks past DD)
- mx preg
- previous cervical incomp
- rh iso immuization
explain placental insufficiency
disorder of fetomaternal circ causing insuff BF to placenta via umbillical cored leading to impaired 02 exchange impared fetal growth and fetal metabolic acidosis
the earlier this occurs in preg the worse the prognosis
can be acute or chronic
what is acute placental insufficiency
acute consequences of fetal hypoxia and intra uterine death occur in w/in mins to hours
d/2
- supine hypotensive IVC syndrome
- placental abruption/ previa
- prolonged uterine contraction
treatment
- left lateral posish for shivcs
- IMMEDIATE C SECTION
what is chronic placental inssuficiency
long term placental insufficiency causing intrauterine death or intra uterine growth restriction which may lead to preterm labour
causes
- maternal conditions (smoking, maternal disease-DM, HTM, ANEMIA)
- preg assoc conditions= PREECLAMSIA, rh isoincompatibility
complications of placental insufficiency
maternal
- preeeclampsia
- preterm labour
fetal
- cerebral palsy( d/2 fetal hypoxia)
- intrauterine death
- learning disability
diagnostic procedures for placental insuff in 2st trimester
- early ID of preg in 1st trimester using US
- detects fetal anomalies (US)
- observe fhr and breathing (NST,ST,BPP)
- amniotic fluid index
- locate and grade placenta (lower number is better as less calcifications)
- amniocentesis/ CVS
- Determine fetal position
- doppler
*
use of doppler in placental insuff
determines the blood flow
asseses placental function
used to manage:IUGR; preterm labour; prolonged preg; mx preg
NST
determines health of baby in the uterus by measuring FHR in relation to movement and uterine contraction
REACTIVE
- 2+ fhr accel of 15bpm for 15sec in 20mins
NON REACTIVE
- no reaction in 30 mins
- other tests req
biophysical profile
preanatal US when NST is unreactive
scoring
2=normal finding
0=abnormal finding
overall score dictates management
- 4= unduce labour at 30-32 wks
- persistently below 4 for 120mins= imm labour induction
what is the oxytocin contraction stress test
evaluates the respiratory function of the placenta by monitoring FHR in response to uterine contraction stim by oxytocin or nipple stimulations
-ve test= good response
- 3 good contractions that last 40 secs in 10 min period
- no late deccelerations during this period
+ve test = bad response
- persistent late deccelerations in 50% of contractions
amniocentesis = 15-17 weeks gestation
needle pens abdom and uterine wall to collect amniotic fluid
measurements
- abnormal AFP(reduced in downs increased in spina bifida)
- hCG lvls
- ue3??
- lecithin/ sphingomyelin rattio= for fetal lung maturation
possible complications
infection => abortion
chorionic villi sampling
10-12 weeks from placenta
what is the normal fetal heart rate
110-160 bpm = 140bpm
fetal heart sounds can be monitred by fetoscope
cardiac abnormalities measured by fetal echo in 2-3rd trimester
what are deccelerations
decrease in FHR by 15bpm caused by reduced bf/02 to fetus
Early = reduced FHR before midpoint of uterine contration
- inconsequenction
- d/2 head compression during contraction causing vagal nerve stim
Variable = abrupt changes in FHR w/ no connection to uterine contractions
- can nbe d/2 refluex tachy cardia/ cord compression
- mild cord compression up to 40 secs ,mod up tp 60 secs= inconsequntial
- cord compression over 60 secs leads to fetal acidosis
- Leads to NADIR in under 30 secs
- if under 50% (INTERMITTENT) are variable deccelrations then no intervention
- rx: if over 50% (RECCURENT) are variable= intrauterine resuscitations
- failure?=> emergency C-section
late deccelerations = persists after midpoint of contraction( max contraction curve)
- suggests uteroplacental insufficiency is present as contraction worsens fetal bf that’s already compromised - hypoxia
- onset to NADIR is gradual and over 30 secs
- RX: intrauterine ressuc in all cases
- failure?+ emergency c- section
- RX: intrauterine ressuc in all cases
early decelerations
Early = reduced FHR before midpoint of uterine contration
inconsequenction
d/2 head compression during contraction causing vagal nerve stim
variable deccelerations
Variable = abrupt changes in FHR w/ no connection to uterine contractions
can nbe d/2 refluex tachy cardia/ cord compression
mild cord compression up to 40 secs ,mod up tp 60 secs= inconsequntial
cord compression over 60 secs leads to fetal acidosis
Leads to NADIR in under 30 secs
if under 50% (INTERMITTENT) are variable deccelrations then no intervention
rx: if over 50% (RECCURENT) are variable= intrauterine resuscitations
failure?=> emergency C-section
late decelerations
ate deccelerations = persists after midpoint of contraction( max contraction curve)
suggests uteroplacental insufficiency is present as contraction worsens fetal bf that’s already compromised - hypoxia
onset to NADIR is gradual and over 30 secsRX: intrauterine ressuc in all cases
failure?+ emergency c- section
what is nadir
the lowest or most unsuccessful point in a situation.
“asking that question was the nadir of my career”
synonyms:the lowest point, the all-time low, the lowest level, low-water mark, the bottom, as low as one can get, rock-bottom, the depths; More
what is intrauterine growth restriction
lower than normal fetal growth characterized by an estimated fetal weight below the 10th percentile for a given gestational age.
- Symmetrical IUGR is caused by direct fetal factors in the early stages of gestation
- early intrauterine infections,
- genetic abrnorm
- teratogenic drugs( ACE inhib)
- uterine malform
-
Asymmetrical caused by factors outside the fetus that affect the fetus in the later stages of gestation
- placental insufficiency= abruption/preavia, smoking, mx preg, db, HTN
sx of IUGR
fetal
- Asymmetrical IUGR: disproportionate growth restriction
The dimensions of the head are normal while the body and limbs are thin and small.
- Symmetrical IUGR: global growth restriction
- Decreased or absent fetal movements
maternal
- Mostly asymptomatic
- Small uterus (e.g., a smaller abdomen than in previous pregnancies)
- Possible vaginal bleeding (e.g., placental abruption); preterm labor
dg lf IUGR
US:
- BELOW 10th percentile
- olgiohydromnious
- placental grading shows calcifications
doppler
- reduced diastolic flow
NST= LATE DECCEL
BPP= below 4
rx of IUGR
Treatment of the underlying condition (e.g., treatment of hypertension in pregnancy, gestational diabetes mellitus)
Close monitoring; of fetal status and placentaldevelopment (NST, CST, BPP)
If the infant is close to term, administer steroids and induce labor after 48 hours.
If there are signs of nonreassuring fetal status;or deterioration of maternal vital signs (e.g., pre-eclampsia), induce labor or perform immediate cesarean section.
