Session 10: Group Work Flashcards
Give factors that may restrict fetal growth.
Malnutrition
Hypoxaemia
Alcohol
Smkoing
Infection
Hereditary
Names some USS measurements that are routinely taken to monitor fetal growth later in pregancy.
Abdo circumference
Biparietal diameter
Femur length
What is asymmetrical growth restriction?
When the head doesn’t stop growing (as well as other vital organs) but the rest of the body does.
If there is asymmetrical growth usually later in pregnancy when vital organs have developed.
Which organs are being assessed by each parameter.
Fetal movement
Fetal breathing movement
Fetal tone
Amniotic fluid volume
Fetal heart rate response to movement
FM - Nervous system , MSK
FBM - Resp/MSK
FT - MSK
Amniotic fluid volume - Urinary, GI, Resp
Fetal heart rate response to movement - Cardiovascular/nervous
In a non-stress test, 3 or more fetal movements should be
accompanied by a rise in fetal heart rate. Over a 30-minute period you record neither fetal movement nor- change in heart rate. Should you be concerned?
Not necessarily. The fetus could be sleeping during that time period. Usually the fetus only sleep for about 40 minutes so there might be concern to be raised.
Why is oligohydramnios associated with compromise of the uteroplacental circulation like pre-eclampsia.
Poor uteroplacental circulation like placental insufficiency due to less blood to placenta and fetus.
This leads to a redirection of the blood to the brain of the fetus.
Less blood goes to abdo and kidneys and this means less urine output -> less amniotic fluid.
Fetal urine contributes to the volume of amniotic fluid. At what stage is urine first produced?
9 weeks
Prior to this, how is amniotic fluid produced.
Maternal plasma through the placental membrane.
How might uteroplacental or fetoplactental circulations be investigated.
Doppler sonography (USS)
As the fetus swallows and digests amniotic fluid. Identify a fetal GI tract defect that might lead to excessive amniotic fluid volume.
Tracheo-oesophageal fistula
What is the aerage fetal heart rate at term?
110-160 bpm
What are the advantages of a scalp electrode in monitoring fetal heart rate?
Continuous monitoring
Nothing obstructive in the way as well.
What signs could suggest fetal distress?
Bradycardia
Meconium staining
Reduced movement
Which cells secrete surfactant?
Pneumocytes type 2
At what gestational age does surfactant production begin and how is this significant in prematurity?
Week 26-30
Not enough surfactant can lead to respiratory distress.
This can be treated with corticosteroids.
What is the difference between effacement and dilation of the cervix?
Effacement is the thinning of the cervix
Dilation - increased diameter
What feature of uterine smooth muscle contributes to the shortening of the cervix?
Brachystasis where when the myometrium contracts they won’t relax fully again.
What maternal and fetal landmarks are used to assess fetal head position in the birth canal?
Maternal - Ischial spine
Fetal - fontanelles
An epidural is a common procedure for analgesia during labour. What ligaments of the spine will the needle pass through in this procedure?
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
(Dura)
What neurological structure in the fetus is at risk of damage during delivery of a fetus in shoulder dystocia?
Brachial plexus
What would you exptect to see on examination if the upper part C5-C6 of the brachial plexus is damaged during delivery?
Erb’s palsy
Waiter’s tip where the arm is internally rotated
Elbow is extended
Wrist is flexed
What would you expect to see on examination of the lower part C8-T1 of the brachial plexus is damaged during delivery?
Klumpske’s palsy
Claw hand deformity
Hyperextension of MCPJs and flexion och PIPs and DIPs
Give a cause of shoulder dystocia.
Gestational diabetes
Define post-partum.
Excessive haemorrhage per vaginum after delivery til 6 weeks.
Primary - <24 hrs
Secondary >24 hrs to 6 weeks.
What is the most common cause of PPH?
Uterine atony
What effect does oxytocin have during delivery?
Causes increased uterine contraction frequency and amplitude
Therefore why can oxytocin sometimes be used to treat PPH?
More forceful contraction (or in case of generally weak contraction) leads to compression of the blood vessels and prevents bleeding.
What physiological mechanism exists?
Increased clotting
If the uterus is firm on palpation with continuous bleeding, what other cause should you consider?
Retained uterus
The patient has lost 1.5 l of blood. What state will likely result from this degree of blood loss?
Hypovolaemic shock (not necessarily the case since increased blood volume (mainly plasma))
What additional symptoms and/or signs might you expect to be present in this case?
Tachycardia
Pallor
Hypotension
Cold, clammy hands
Dizziness
Confusion
Tachypnoea
