OB and Fetal Monitoring Flashcards
What’s this?
Three Stages of Woman
by Gustav Klimt
At what gestational age does CO reach its peak?
When does it normalize?
30 weeks
~44 weeks
When does MAP peak in the pregnant pt?
about 40 weeks
When does total peripheral resistance reach its nadir in the OB patient?
around 20 continuing to 35 weeks
What happens to SVR and PVR in a pregnant woman?
both decrease
What are the changes in % to:
platelets
erythrocytes
blood volume
plasma
0 %
20
35
45
What occurs to Hct and plasma volume in the pregnant pt?
Hct decreases and plasma volume increases
What occurs to MV, alveolar ventilation, TV, RR in the OB pt?
all increase
Alveolar (70%)
MV (50%)
TV
RR
What remains unchanged in the OB pt? (4)
pH
Vital capacity
Inspiratory lung capacity
Total lung capacity
What decreases in the OB pt?
FRC
Expiratory reserve volume
Residual volume
To prevent supine hypotensive syndrome, what do you do?
Right uterine displacement
What is normal FHR?
120 - 160
What defines fetal stress?
Decreased perfusion→hypoxia→low pH⇒low FHR
What is NST?
Nonstress Test
uses vibroacoustic stimulation
want to see variability and accelerations = (-) NST
What is a test that measures FHR over 10 minutes with 3 contractions?
Contraction Stress Test
What does the biophysical profile (BPP) measure?
Fetal breathing
Body movements
Tone
Amniotic fluid
HR
Reactivity
How common is fetal blood sampling?
Now uncommon
How is O2 sat measured on the fetus?
Fetal Oxygen Saturation (FSpO2) is measured on the scalp of the fetus.
What SaO2 is a concern for the well being of the fetus?
< 30%
What is a normal pH for a fetus?
7.25 - 7.35
pH of umbilical = 7.26
What is the blood gas SO2 for the fetus?
30 - 50%
What is the normal PO2 and PCO2 for the fetus?
PO2 = 18 - 22 mmHg
PCO2 = 40 - 50 mmHg
How can scalp pH be related to APGAR scores?
The higher the pH, the higher the Apgar score.
64.4% probability or correlation
Label:
What does increased SpO2 tell us?
increased pH, healthier baby
What occurs during birth?
SpO2 decreases from stress, thus pH decreases.
Which ECG electrode is the reference electrode?
Where is it placed?
What is the name of this electrode?
black one on left
uterine wall
Hon scalp ECG electrode
Label
Top: fetal ECG
Bottom: ultrasound
What is an external fetal monitoring system called?
Tocogram
What are the classes of FHR variability? (4)
None
Reduced variability (0 - < 5 beats/min)
Normal variability (5 - 10 beats/min)
Increased variability (> 15 beats/min)
What is this graph called?
What is enclosed in the red box?
Tocograph
Normal FHR pattern
What are patterns of FHR changes? (4)
Accelerations (normal)
Early decelerations
Late decelerations
Variable decelerations
Which FHR pattern is coincident with contraction?
Early decelerations possibly from compression of the head
What FHR patterns will result in decreased uterine blood flow beyond the capacity of the fetus to extract sufficient oxygen?
Late decelerations
What will occur to FHR with vagal firing in response to cord compression or sustained head compression?
Variable decelerations
What’s depicted?
Normal fetal oxygenation
Accelerations with contractions
What’s depicted?
Early deceleration, head compression
What’s depicted?
Late deceleration, Uteroplacental insufficiency
What’s depicted?
Variable deceleration, umbilical cord compression
What’s depicted?
Early deceleration, head compression
What’s depicted?
Late deceleration, hypoxia
What is depicted?
Variable decelerations and absence of HR variability
What does the lack of HR variability indicate?
decreased cerebral oxygenation
What does APGAR represent?
What is it?
What is a good score?
Activity
Pulse
Grimace
Appearance of skin color
Respiration
Backronym named after Dr. Apgar.
10
What emergency equipment is needed in the delivery room? (5)
Radiant warmer
Suction
Suction catheters
Infant aw materials including ambu
Meds: 1:10,000 epi, narcan, sodium bicarb, volume expanders
