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Repro > Perinatal Adaption > Flashcards

Perinatal Adaption Flashcards

1
Q

What is the function of the placenta?

A 
Fetal homeostasis
Gas exchange
Nutrient transport to fetus
Waste products transport from fetus
Acid base balance
Hormone production
Transport of IgG
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2
Q

What are the 3 fetal shunts?

A

Ductus venosus
Foramen ovale
Ductus arteriosus

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3
Q

How much of the fetal output goes via the lungs?

A

7%

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4
Q

What happens in the 3rd trimester to prepare the fetus for birth?

A

Surfactant production
Accumulation of glycogen - liver, muscle and heart
Accumulation of brown fat - between scapulae and around internal organs
Accumulation of subcut fat
Swallowing of amniotic fluid

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5
Q

What preparation occurs for labour and delivery?

A

At onset of labour - Increased cetacholamines and cortisol
Synthesis of lung fluid stops
vaginal delivery - squeezes lungs

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6
Q

What happens in the first few seconds following birth?

A 
Baby is blue
Starts to breathe
Cries
gradually goes pink
Cord is cut
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7
Q

What transitions occur regarding the circulatory system?

A 
Pulmonary vascular resistance drops
Systemic vascular resistance rises
Oxygen tension rises
Circulating prostaglandins drop
Duct constricts
Foramen ovale closes
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8
Q

What happens to the foramen ovale?

A

Closes or persists as PFO (10%)

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9
Q

What happens to the ductus arteriosus?

A

Becomes ligamentum arteriosus

Persistent ductus arteriosus

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10
Q

What happens to the ductus venosus?

A

Becomes ligamentum teres

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11
Q

What failure of cardiorespiratory adaptation can occur?

A

Persistent pulminary hypertension of the newborn (PPNH)

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12
Q

How do you manage PPHN?

A 
Ventilation
Oxygen
Nitric oxide
Sedation
Inotropes
ECLS
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13
Q

What is altered in the first few hours after birth?

A

Thermoregulation
Glucose homeostasis
Nutrition

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14
Q

What helps change thermoregulation?

A

Large surface area

Wet when born

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15
Q

What 4 methods help heat loss?

A

No shivering
Non-shivering thermogenesis
Peripheral vasoconstriction
Help via external factors e.g. parents

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16
Q

What is Non-shivering thermogenesis?

A

Heat produced by breakdown of stored brown adipose tissue in response to catecholamines
Not efficient in first 12 hours of life

17
Q

What problems in preterm babies can lead to hypothermia?

A

Low stores of brown fat
Little subcut fat
Larger surface area: volume

18
Q

What is glucose homeostasis?

A

interruption of glucose supply from placenta
Very little oral intake of milk
Drop in insulin, rise in glycogen
Mobilisation of hepatic glycogen stores for gluconeogenesis
Ability to use ketones as brain fuel

19
Q

What can cause hypoglycaemia?

A

Increase in energy demand (unwell, hypothermia)
Low glycogen stores (small, premature)
Inappropriate insulin:glucose ratio (Maternal diabetes, hyperinsulinism)
Some drugs

20
Q

What reflex(es) help babies breastfeed?

A

Rooting and Suck

21
Q

What does breastmilk contain?

A

Colostrum

22
Q

What happens to fetal haemoglobin?

A

Becomes disadvantageous

Increase in 2,3 DPG shifts curve to the right

23
Q

Where does Haematopoiesis move to?

A

Bone marrow

24
Q

What is synthesised quicker, adult or fetal haemoglobin?

A

Fetal

25
Q

What does the breakdown of fetal Hb cause and when is Nadir reached?

A

Physiological anaemia

8-10 weeks

26
Q

What causes physiological jaundice?

A

Breakdown of fetal haemoglobin
Conjugating pathways immature
Rise in circulating unconjugated biliruben
Generally not harmful unless very high levels

27
Q

When may jaundice be physiological?

A

In the first week

28
Q

When may jaundice be pathological?

A

In the first 24 hours

After the first week

29
Q

What are risk factors for adaptation issues?

A 
Hypoxia/Asphyxia at delivery
Particularly small or large babies
premature babies
Small maternal illnesses and medications
Ill babies, sepsis, congenital anomalies

Repro (46 decks)

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