VALUES and HOTSPOT Flashcards
Head compression, usually during______(what stage) What is the Corrective maneuvers_______
2nd stage
Women should be Pushing only with alternate contractions (return Umbilical BF toward normal)
Causes : Prolonged asphyxia Corrective maneuvers
Change in maternal position, supplemental O2
Causes: Transient umbilical cord compression Corrective maneuvers
Change in maternal position, amniotransfusion (Return of Umbilical BF toward normal)
Excessive Uterine contraction Corrective maneuveres
Decrease in oxytocin, lateral position, tocolysis
Head compression you see of FHR strip
variable decelerations
Transient umbilical cord compression
variable decelerations
Excessive Uterine contraction and HYPOTENSION FHR strip
Bradycardia, Late decelerations
Hypotension (supine hypotension, regional anesthesia) Corrective measure
IV fluids, position change, Ephedrine
Decreased FHR variability
prolonged Asphyxia
Decreased uterine blood flow associated with uterine contractions, below limits of fetal O2 needs FHR___ Corrective maneuvers
FHR : Late decelerations Change in maternal position, supplemental O2, Tocolysis
Identify dermatomes
Identify the dermatomes
Refer to Slide
O2 consumption and CO2 production during pregnancy
Increase up to 60% due to fetus, uterus and placenta
secondary to cardiac/respiratory work
Basal temperature in pregnancy
Rises
MV in pregnancy
TV and RR
Rise close to 50%
TV increase (45%)
RR unchanged
Cardiac output and pregnancy
HR and SV
increase 50%
HR 25%
SV 35%
Diaphragm changes
Flatter and higher
Inspiration at term
Diaphragmatic
Dependent on phrenic nerve function
No effect on
FEV, FEV1/FVC , closing capacity.
FRC and pregnancy
80% of pre-preg value by term
There is 20% reduction in FRC, accounted for 25% in ERV
and 15% RV
IRV and pregnancy
+ 5%
TV in pregnancy
+45%
ERV change
-25%
RV change
-15%
IC change
+15%
FRC
-20%
VC change
no change
TLC change
-5%
Dead Space change
+45%
RR change
No change
Ventilation : change: MV
+45%
Alveolar ventilation change 45%
Term changes: CO
+50%
Term SV
+25%
Term HR
+25%
LVEDV
Increased
LVESV
no change
EF
increased
PCWP/ PA diastolic pressure
CVP
No change
SVR at term
-20%
Hemodynamics labor when is CO higher
Immediatly postpartum 75%
Hemodynamics of labor when is SV the highest
Immediately postpartum 75%
Early 1st stage CO and SV
10%
Hemodynamics during labor: Late 1st, SV and CO
25%
Hemodynamics during labor 2nd stage: CO and SV
40%
Hemodynamics during Puerperium
CO
1 hour post 30%
hemodynamics during Puerperium
CO - 48 hours
-5%
Hemodynamics during puerperium
2 weeks CO
-40%
Identify all components
Face vs Brow presentation
FACE
Face vs Brow
Brow
Identify position
Occiput posterior
Identify position
LOP
Identify position of the fetus
LOT
Identify position of the fetus
LOA
Identify position of the fetus
Occiput Anterior
Identify position of the fetus
ROA
Identify position of the fetus
ROT
Identify position of the fetus
ROP
Identify this rhythm strip A, B, C and interpret rhythm and fill in the blanks
Baseline FHR is 120-160, preserved beat to beat and long term variability
Accelerations lasts for 15 or more seconds above baseline and peak to 15 or more bpm
A- Health Acceleration
B: Fetal Heart rate
C. Contractions
Interpretation is reassuring pattern
Explain rhythm
Severe Variable Decelerations
Interpretation is SEVERE VARIABLE DECELRATIONS
Severe deceleration below 70bpm
Persistent variable deceleration may lead to hypoxia and fetal distress
Identify the strip and all missing components
Late deceleration with PRESERVED VARIABILITY
A- Deceleration lag behind contractions
Fetal Heart rate return to baseline after the contractionhas ended
Uteroplacental insufficiency or decreased blood flow
Identify all components and fill in the blanks
A- Acceleration
B- Deceleration
C- Acceleration
D- “w” or “v” shape pattern
Interpretation is VARIABLE DECELERATIONS
Variable decelerations are varible in duration, intensity and timing
acceleration-deceleration- acceleration is due to compression and decompression of cord
Associated with fetal conditions that results in either ___________ or __________ with _______
4 conditions
Sinusoidal FHR pattern (resemble A-flutter)
Associated with fetal conditions that results in either
SEVERE FETAL ANEMIA or SEVERE/PROLONGED Fetal hypoxia with acidosis
CAFI
Chronic FETAL anemia associated with Erythroblastosis fetalis from RH sensitization
Acute Intrapartum Asphyxia
Fetal-maternal Hemorrhage
In-utero, Fetal HEMORRHAGE
Identify rhythm and possible causes
Saltatory FHR Pattern : resemble Torsade de pointes
Due to Excessive swings in variability
ACUTE FETAL HYPOXIA
Autonomic Nervous system identify all parts
A-O
A- midbrain
B- Medulla
C- Vagus nerve
D- C1
E: Superior Cervical Ganglion
F- T1
G- Celiac Ganglion
H- Superior Mesenteric Ganglion
I - L1
J- Inferior Mesenteric Ganglion
K- S1
L- Pelvic nerves
M- S2
N- S3
O- S4
Identify rhythm strip
Variable Decelerations
most common
Umbilical cord compression
Baroreceptor chemoreceptor medicatied vagal activity
Identify rhythm strip
Uteroplacental insufficiency
Identify stage
Stage 1
Initial (latent) phase
Identify phase
Active Phase of Stage I
Identify stage
Transition stage of Phase 1
Identify all components
Identify position
LOP
LOT
Identify position
LOA
Identify position
ROA
Identify position
ROT
Identify position
ROP
Explain chart with plasma volume
Blue: plasma volume
Green: Blood Volume
Red: TOTAL RED CELL VOLUME
Explain hormone chart
A- Estrogen increase 100%
B- Sympathetic input
C- Renin released by juxtaglomerula cells of neprhone cleave ANGIOTENSINOGEN
D- ANGIOTENSINOGEN
E- ANGIOTENSIN I
F- ANGIOTENSIN CONVERTING ENZYME IN LUNGS
H- ANGITONSIN II
I- INCREASE ALDOSTERONE LEVELS
J- Increase sodium and water Reabsorption by nephron collecting duct
K- Increased effective blood volume to correct initial stimulus to the system
L- Progesterone increase 100%
Which represent compression
Supine Aortacaval compression vs Lateral
Identify all structures
A- intervillus space
B- Chorionic villi
C- Placenta
Identify each element of graph ; PREGNANCY
Blue: Thoracic compliance
Green: Total compliance
Red: Lung compliance
Is this normal or pregnancy graph
Normal FRC
A- Thoracic compliance
B- Lung compliance
C- Total compliance
Identify types of breech
Frank Breech presentation
Identify Breech
Complete breech presentation
What breech presentation is this position?
Complete footing
What type of breech presentation is this?
Incomplete footing
Identify stage and phase
Stage 2 Phase 1 Presentation of head
Identify stage and phase
Stage 2 phase 2 Rotation and delivery of anterior shoulder
Identify stage and phase
Delivery of Posterior shoulder
Stage 2 phase 3
Identify Phase and Stage
Stage 2 Phase 4
Delivery of lower body and UMBILICAL CORD
Identify Breech position
Complete breech
Identify breech
Incomplete Breech
Identify Breech position
Frank breech
Identify presentation
Transverse lie shoulder presentation
Identify A
Ligamentum Arteriosum
Remnant of Ductus Arteriosus
What is this presentation
Shoulder distocia
What is this presentation
Compound VERTEX
Identify all components
1 12 o’ clock
A - ROP
B- OP
C- LOP
D- LOT
E - LOA
F - OA
G - ROA
H- ROT
Identify all missing components of fetal circulation
A- Pulmonary trunk
B- Supevior Vena Cava
C- Foramen Ovale
D- Ductus VENOUS
E- UMBILICAL VEIN
F: UMBILICAL ARTERIES
G- AORTA
H- DUCTUS ARTERIOSUS
I- LEFT pulmonary artery
J- LEFT PULMONARY VEIN
K Inferior VENA CAVA
L AORTA
M CELIAC TRUNK
Identify MARKED part of Fetal circulation
Identify A and what is it the remnant of ?
Identify B and what is it the remnant of ?
Identify C and what is it the remnant of ?
Identify D and what is the remant of ?
Identify E and what is the remant of ?
A- Ligamentum Arteriosum / remant of ductus arteriosus
B- Fossa Ovalis - Remnant of Foramen ovale
C- Ligamentum Venosum - Remnant of ductus venosus
D- Ligmentum Teres - remnant of umbilical vein
E- Medial umbilical Ligament - Remnant of umbilical arteries
What are the conditions for area labels A and B
A- PDA
B- Patent Foramen Ovale
Identify Breech presentation
Identify Breech
ROA
Identify breech presentation
Left Mentum anterior
Identify breech
Left Occiput Transverse
Identify this breech
Right Occiput Transverse
Identify breech
Right Mentum Anterior
Identify this breech
Left occiput posterior
Identify this breech
Right Occiput Posterior
Identify breech
Right Mentum Posterior
Identify Breech
Brow presentation
Identify This Breech
shoulder presentation
transverse lie
Identify breech
Left Sacral Anterior
Identify this breech
Left SACRUM POSTERIOR
Identify the Intervillous space
Pinkish area
