INTRAPARTUM Flashcards
Understand and recall the physiological, anatomical changes in pregnancies and associated diseases, outcomes, and general know hows of pregnancies
In high income countries, what are the major causes of antepartum intrauterine fetal demise (AIFP)?
For high income countries: chromosomal abnormalities, uteroplacental insufficiency, and maternal medical diseases (GDM, preeclampsia, htn, etc)
In low income countries, what are the major causes of antepartum intrauterine fetal demise?
In low income counties, maternal infection, preeclampsia, or obstructed labor are the most common causes of antepartum intrauterine fetal demise
What are the signs/clinical presentation of an intrauterine fetal demise?
Decreased fetal movement, lack of fetal heart tones on exam. Is confirmed via US.
What is the following fetal heart tracing consistent with?
These are consistent with fetal head compression with each uterine contraction as it decends through the birth canal which triggers autonomic response that decreases fetal heart rate. Early decelerations seen here are a benign finding and not a sign of fetal distress.
DETAILS:
The upper blue tracing shows the fetal heart rate (FHR) in beats per minute (bpm) with a baseline of approx. 130 bpm (green dashed line overlay). The FHR baseline lies within the normal range (green shading overlay) and shows moderate variability (~10 bpm; normal range 6–25 bpm). The lower blue tracing shows the maternal uterine contractions (in mm Hg).
Contractions and decelerations begin and end together (red dashed line overlay), with the peaks of the contractions coinciding with the nadirs of the decelerations (red arrow overlay). The decelerations are gradual, with ≥ 30 s from onset to nadir. These findings are characteristic of early decelerations.
What is the following fetal heart tracing consistent with?
Cardiotocogram (CTG) showing recurrent variable decelerations
This is consistent with umbilical cord compression.
The upper blue tracing shows the fetal heart rate (FHR) in beats per minute (bpm), with a baseline of approx. 136 bpm (dashed green line overlay). The FHR baseline lies within the normal range (green shading overlay) and shows moderate variability (∼ 10 bpm; normal range 6–25/minute). The lower blue tracing shows the maternal uterine contractions (in mm Hg).
The three decelerations visible are abrupt, with < 30 s from onset to nadir (red arrow overlay), and vary in their shape and their temporal relation to the uterine contractions (dashed red line overlay). These findings are characteristic of variable decelerations. As the decelerations here occur with ≥ 50% of uterine contractions over a 20-minute time period, they are termed “recurrent variable decelerations.” This pattern is concerning for umbilical cord compression/prolapse. If persistent, it may prompt considering emergency cesarean delivery.
What signs are consistent with fetal blood loss rather than maternal blood loss ?
The absence of maternal tachycardia despite significant vaginal bleeding, together with fetal distress (indicated by fetal bradycardia), suggests that fetal blood rather than maternal blood is being lost.
defined as the expulsion of the cervical mucus plug mixed with blood at the onset of labor.
Bloody Show
The onset of vaginal bleeding with the rupture of membranes (not found to be bloody show) suggests what?
Ruptured vasa previa
What are the risk factors for vasa previa?
Risk factors for vasa previa include
-multiparity
-placental anomalies (e.g., bilobate or succenturiate placenta, velamentous umbilical cord insertion)
-placenta previa
-in-vitro fertilization
Diagnosis is confirmed by transvaginal or transabdominal ultrasonography, which shows fetal vessels overlying the internal os and decreased blood flow within fetal vessels.
combination of maternal fever, tachycardia, uterine tenderness, malodorous and purulent amniotic fluid, vaginal discharge, and fetal tachycardia is consistent with……
chorioamnionitis
What is the major risk factor for chorioamnionitis?
PPROM (preterm premature ROM)
