Maternal & Foetal Wellbeing Flashcards by frankiespeck@hotmail.co.uk Speck

When is the embryo most at risk?

When women dont know they are pregnant at 3-14 weeks when all major organ systems are developing

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What are the different types of abnormalities that occur in babies?

Structural: production of a congenital malformation by a teratogen causing problem with body parts i.e. cleft lip, NTD

Functional: direct toxic effect on cells of embryo either lethal or reduction in growth - how a body part or system works i.e. developmental disabilities

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What are the common causes of abnormalities?

Alcohol: FAS and heart defects
Folic acid deficiency: NTD
Anti-epileptic drugs: cleft lip and palate
Rubella: cataracts, heart defects and mental retardation
Foods: mould-riped soft cheese/ blue-veined cheese due to listeria bacterium - risks of miscarriage, still birth and sick neonate
Toxoplasmosis: in soil and cat litter - miscarriage

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What are the common symptoms in the first trimester in pregnancy?

Morning sickness due to rising hCG levels (hyperemesis gravidarum)

Frequency of micturition due to bladder vascularity and lasts until 16/40 when gravid uterus rises out of pelvic girdle

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What are the common symptoms later on in pregnancy?

Peridontal disease
Heartburn (by third trimester 80%)
Constipation (rising progesterone = reduced motility)
Haemorrhoids
Leucorrhoea (white/non-irritant/offensive)
Hyperpigmentation of skin of areola, nipples, vulva and perianal region
Backache (loosening of ligaments and altered maternal posture)
Symphysis pubis dysfunction
Leg cramp
CTS + oedema

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What should be included in an obstetric history?

Gravidity and parity

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Define gravidity.

The total no. of pregnancies including the current one if pregnancy (1 even if the women is having twins)

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Define parity.

The number of livebirths or stillbirths after 24 weeks gestation (twins = 1)

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What is stillbirth related to?

Mostly unexplained but there is a link to IUGR/foetal growth restriction (FGR, obesity and smoking

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How do you listen to the babies heart rate?

Pinnard stethoscopes

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What is a normal and abnormal birth weight?

Average = 3.2kg
Small = <2.5kg
Large = >4.5kg

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What is prematurity?

Baby born before 37 weeks

Extremely: < 28 weeks
Very: 28-32 weeks
Moderate-late: 32-37 weeks

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What can be done if there is a risk of prematurity?

Double dose 24 hours apart at 24-34 weeks and single dose at 34-27 weeks:

Magnesium sulphate: neuroprotectant to reduce cerebral palsy risk
Steroids e.g. Beclomethasone: stimulates surfactant synthesis to lubricate the lungs allowing air sacs to glide against eachother w/o sticking preventing bleeding in the brain and necrotizing enterocolitis

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What happens the higher the gestational age goes of a baby?

Increased risk of perinatal mortality

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What are biometric tests?

Designed to predict foetal size at a point in gestation - if performed periodically can indicate growth but not foetal well being

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What are biophysical tests?

Doppler/liquor assessment can predict foetal wellbeing but not growth

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What are the foetal biometric parameters in the 1st trimester?

CRL - used in early pregnancy due to little biological variability (6-13 weeks)

What are the foetal biometric parameters in the 2nd trimester?

Biparietal diameter (BPD)
Head circumference (HC)
Abdominal circumference (AC)
Femur length (FL)

What is intra-uterine growth restriction (IUGR)/foetal growth restriction (FGR)?

Small for gestational age of baby - below 10%

What are the risks of intra-uterine growth restriction (IUGR)/foetal growth restriction (FGR)?

Tachycardia in 50% of cases
Stillbirth
LBW
Decreased O2 levels
Hypoglycaemia
Hypothermia
Less resistant to infection
Difficulty handling vaginal delivery
Placental problems

What are the different types of intra-uterine growth restriction (IUGR)/foetal growth restriction (FGR)?

All foetal biometrics less than expected usually presenting early as a result of infection or chromosome abnormalities
Disproportion between diameters, AC is classically affected and there is foetal head sparing due to increased brain to liver ratio as a result of placental insufficiency or pre-eclampsia

What is a sign that intra-uterine growth restriction (IUGR)/foetal growth restriction (FGR) is really severe?

Foetal head circumference decreasing

What is biophysical profiling (BPP)?

Test in the 3rd trimester that combines a non-stress test with US to check the health of the foetus that measures:

HR in response to foetal movements
Breathing
Movements
Tone
Amniotic fluid volume

How is amniotic fluid volume regulated?

By swallowing at 10-12 weeks which causes the stomach and SI to produce HCL and digestive enzymes so there is movement of fluid in the GI which may enhance growth and development of the GI tract

What is polyhydramnios?

Excessive amniotic fluid as a result of baby swallowing high amounts

How is most foetal waste excreted?

By the placenta where urine enters the bladder and empties every 40-60 minutes into amniotic fluid - at 25 weeks the foetus produces ~100ml urine per day rising to about 500ml at term and the foetus swallows the amniotic fluid constantly absorbing water and electrolytes allowing debris to accumulate in foetal gut

What is the meconium?

Amniotic fluid and gut debris forming the babys 1st stool

How is the foetal urinary system monitored?

Foetal kidney number/size/structure Amniotic fluid volume Bladder activity

What is amniotic fluid?

Substance that surrounds the foetus giving it mechanical protection and a moist environment going for 10ml at 8 weeks, to 1L at 38 weeks then falling to 300ml at 42 weeks composed o foetal cells, amnion and proteins along with: 1. Early pregnancy: ultra-filtrate of maternal plasma 2. 2nd trimester: also ECF diffuses through foetal skin making up foetal plasma 3. After 20 weeks: addition of foetal urine

What is oligohydramnios?

Too little amniotic fluid

Why does the amniotic volume in the latter part of pregnancy contain a lot of foetal urine?

Reflects renal function, bladder, GI and foetal metabolism (placental supply)

What is the foetal circulation like?

Gas exchange occurs in placenta preferentially right to left blood flow due to presence of shunts: 1. Ductus venosus: left umbilical vein blood to IVC 2. Foramen ovale: between 2 atria 3. Ductus arteriosus: PA to descending aorta

What is the foeto-placental circulation?

Foetus relies on placenta for respiration, nutrition and excretion and this system requires: - Larger and more numerous RBCs - Modified Hb content to pick up max amount of O2 (active in slightly more acidic blood) - Foetal shunts (x3)

How does oxygen travel in the foetus?

1. O2 blood from placenta gets to foetus via umbilical vein (valveless) - 50% enters hepatic micro-circulation and later joins hepatic veins and IVC whilst remainder goes directly to IVC via DV 2. IVC also receives less-O2 blood from abdomen, pelvis and lower limbs 3. IVC bifurcates before heart into FO to L atrium and small inlet to R atrium 4. In L atrium, FO ends in 1 way valve permitting blood from R-L - maintained by higher pressures on R due to IVC 5. Lung tissue extracts O2 from low circulating BV entering from R ventricle and returns poorly O2 blood to L atrium 6. Blood leaving R ventricle perfuses lower body and placenta via DA 7. Blood bypasses lungs and directed to placenta

How is the foetal cardiovascular system monitored?

Rate (110-160bpm is normal with baseline variability of 5 beats) Responsiveness Timing Flow via umbilical a. flow doppler

What is deceleration?

Uterine contraction occurs and at the same time the foetal HR decreases - this is a sign of distress and should not happen

What can an increase respiratory rate in pregnancy lead to?

Substantial reduction in pCO2 in mum and baby

How is foetal baseline and acceleration along with foetal movements measured?

Cardiotocograpy (CTG)

How does the foetal circulation transition?

Between foetal and neonatal periods the low-resistance circulation of placenta is removed, breathing starts and there is reduction of pulmonary arterial resistance causing in utero shunts to close

What circulatory adaptations occur after birth?

1. Onset of breathing reducing pulmonary vascular resistance 2. Increased lung blood flow increasing volume of pulmonary venous blood returning to L atrium so L pressure goes up closing FO 3. As flow through pulmonary circulation increases and arterial O2 tensions rise the DA begins to constrict closing in a full-term infant within 1 day postnatally (permanent closure requires thrombosis/fibrosis = several weeks) 4. DV remains partially open but closes within 2-3 months after birth

When someone refers to a 'hole in the heart' what does this mean?

Patent ductus venosus