Week 2 Fetal & Neonatal Assessment (everything) Flashcards
1
Q
Fetal growth restriction results from suboptimal uteroplacental perfusion and fetal nutrition caused by different conditions that can be divided into:
(3 answers)
A
Maternal
Fetal
Placental
(bold in PPT)
2
Q
Fetal growth restriction results from? (two answers)
A
suboptimal uteroplacental perfusion and fetal nutrition.
3
Q
Maternal disorders associated with fetal growth restriction include any condition that can potentially result in vascular disease, such as ? (multiple answers)
A
pregestational diabetes, hypertension, antiphospholipid antibody syndrome, autoimmune diseases and renal insufficiency, malnutrition, and substance abuse.
4
Q
Fetal conditions that may result in growth restriction include?
A
teratogen exposure, including certain medications; intrauterine infection; aneuploidy, most often trisomy 13 and trisomy 18; and some structural malformations, such as abdominal wall defects and congenital heart disease.
5
Q
Placental pathology resulting in poor WHAT can lead to fetal growth restriction.
A
placental perfusion
6
Q
Umbilical cord abnormalities, such as what and what have also been implicated in cases of fetal growth restriction.
A
velamentous or marginal cord insertion.
7
Q
In more than HOW MANY of cases of growth restriction, the etiology may be unclear even after a thorough investigation
A
In more than HALF
8
Q
Fetal growth restriction is associated with an increased risk for WHAT? (Bold in the PPT)
A
Stillbirth
9
Q
The risk for stillbirth is further increased when WHAT occurs in the context of oligohydramnios or abnormal diastolic blood flow in the umbilical artery. (bold in the ppt)
A
fetal growth restrictions
10
Q
What two issues further increases risk for stillbirth when fetal growth restrictions are also present? (bold in ppt)
A
oligohydramnios or abnormal diastolic blood flow in the umbilical artery.
11
Q
If EFW measures less than the 10th percentile, the risk for stillbirth is what percentage? (the percentage is twice the risk for appropriately grown fetuses)
A
1.5%
12
Q
The risk for stillbirth increases to what percentage when the EFW is less than the 5th percentile?
A
2.5%
13
Q
What two things can occur which will lead to an improvement in perinatal outcomes? (think in relation to fetal growth restrictions) (bold in ppt)
A
Early and accurate diagnosis of fetal growth restriction coupled with appropriate intervention leads to an improvement in perinatal outcome.
14
Q
If fetal growth restriction is suspected clinically and on the basis of ultrasonography, then what should follow in relation to mother and fetus? (bold in ppt)
A
a thorough evaluation of the mother and fetus is indicated.
15
Q
True or false
Every effort should be made to identify the cause of the fetal growth restriction and to modify or eliminate contributing factors.
A
True
16
Q
Monitoring of a fetus who may have fetal growth restrictions should include what all? (multiple answers) (bold in ppt)
A
Monitoring should include serial ultrasonographic examinations for growth and amniotic fluid volume, and antenatal surveillance with umbilical artery velocimetry and antepartum testing (nonstress tests or biophysical profiles).
17
Q
What do you base timing of delivery on? (multiple factors) (bold in ppt)
A
based on gestational age,
the underlying etiology if known, results of antepartum testing and interval growth scans, and any additional risk factors for an adverse outcome, including maternal co-morbidities.
18
Q
What is the definition of Fetal macrosomia?
A
growth beyond an absolute birth weight of 4000 g or 4500 g regardless of gestational age. (bold in ppt)
19
Q
Tell me the difference between fetal macrosomia and large for gestational age?
A
Fetal macrosomia, defined as growth beyond an absolute birth weight of 4000 g or 4500 g regardless of gestational age,
should be differentiated from the term large for gestational age (LGA), which implies a birth weight greater than or equal to the 90th percentile for a given gestational age.
20
Q
what percentage of fetuses born in the US are LGA?
A
10%
8% of all live-born infants weigh 4000 g or more, and 1.1% weigh more than 4500 g
21
Q
Vibroacoustic Stimulation- how is this done
A
Fetal vibroacoustic stimulation (VAS) refers to the response of the FHR to a vibroacoustic stimulus (82 to 95 dB) applied to the maternal abdomen for 1 to 2 seconds in the region of the fetal head (BOLD)
22
Q
positive result of fetal vibroacoustic stimulation
A
An FHR acceleration in response to VAS represents a positive result and is suggestive of fetal health. (BOLD)
23
Q
What injuries are associated with shoulder dystocia?
A
The fetal injuries associated with shoulder dystocia include fracture of the clavicle and damage to the nerves of the brachial plexus, resulting in Erb-Duchenne paralysis, of which the vast majority resolve by 1 year of age.
24
Q
An NST alone may not be sufficient to confirm fetal well-being. In such cases, a biophysical profile (BPP) may be performed.
A
The BPP combines an NST with an ultrasonographic scoring system performed over a 30-minute period
25
the Biophysical profile is used in what two situations?
| what situation is it not used in?
term and preterm fetuses
not during active labor
26
what are the 5 variables described in the original BPP
The five variables described in the original BPP were
(1) gross fetal body movements,
(2) fetal tone (i.e., flexion and extension of limbs),
(3) amniotic fluid volume,
(4) fetal breathing movements, and
(5) the NST (Table 6.4).75 More recently, the BPP has been interpreted without the NST.
(BOLD)
27
contraction stress test, also known as the oxytocin challenge test (OCT) how and why is it done
assesses the response of the FHR to uterine contractions induced by either intravenous oxytocin administration or nipple stimulation (which causes release of endogenous oxytocin from the maternal neurohypophysis). (BOLD)
28
what are the results of a contraction stress test
A minimum of three contractions for at least 40 seconds in a 10-minute period is required to interpret the test. A negative CST (no late or severe late decelerations with contractions) is reassuring and suggestive of a healthy, well-oxygenated fetus
min of 3 ctx for at least 40s in a 10min period is req to interpret the test. a negative CST (no late or severe late decels) is reassuring and suggestive of a healthy well oxygenated fetus.
(BOLD)
29
Doppler Velocimetry what does it measure? where does it measure it?
Doppler velocimetry can be used for the noninvasive measurement of fetal circulation,
(BOLD)
including the umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV).
30
which artery is frequently evaluated during pregnancy
the umbilical artery as it is one of the few arteries that normally has diastolic flow.
(BOLD)
31
Normally, UA resistance to blood flow from the fetus to the placenta falls progressively throughout pregnancy, reflecting an increase in the number of tertiary stem vessels. Factors that affect placental vascular resistance include
gestational age, placental location, pregnancy complications (e.g., placental abruption, preeclampsia), and underlying maternal disease (chronic hypertension).
(BOLD)
32
doppler velocimetry is used to evaluate
growth restricted fetuses or growth discordance in twin gestations
33
before in utero surgery can be recommended what must happen
a thorough evaluation must be performed (BOLD)
34
a thorough evaluation must be performed prior to utero surgery to evaluated
(1) precisely characterize the defect,
(2) exclude associated malformations,
(3) perform a fetal karyotype analysis, and
(4) eliminate the possibility that the condition can be treated using less aggressive technologies. Detailed counseling about the risks and benefits of the proposed procedure is required, and written informed consent is mandatory. Such a discussion must include a detailed review of the risks to both the fetus and the mother, including preterm PROM (28% to 100%), preterm labor and delivery (> 50%), maternal pulmonary edema (20% to 30%), placental abruption (5% to 10%), chorioamnionitis and sepsis (< 5%), and maternal death (rare).
35
the ideal case for fetal surgery consists of
a singleton pregnancy before fetal viability (before 23-24 weeks gestation)
in which the fetus has a normal karyotype and an isolated malformation that, if untreated, will result in fetal or neonatal demise.
36
what did the two randomized control trials publish
one on tracheal occlusion for the management of congenital diaphragmatic hernia
the other on rental versus postnatal repair of myelomeningocele
found little benefit to in utero surgery. although pediatric benefit with open maternal fetal surgery for myelomeningocele repair has been observed, there are significant risks including need for C section delivery with all future pregnancies- similar to that for women with a history of a classical c section delivery (BOLD)
37
when should repair of lesions such as cleft lip and palate be preformed
after delivery to minimize risk to the mother
38
Intrauterine fetal demise (IUFD)- known as
also known as stillbirth,
| -defined as demise of the fetus after 20 weeks’ gestation and before delivery.
39
still birth rate in US
5.96 per 1000 live births in 2013- half occurring before 28 weeks.
40
Risk factors for still births include
```
extremes of maternal age,
chromosomal disorders,
congenital malformations,
antenatal infection,
multiple pregnancy,
prior unexplained IUFD,
postterm pregnancy,
fetal macrosomia,
MALE FETUS,
umbilical cord and placental abnormalities, and
```
underlying maternal medical conditions (e.g., chronic hypertension, pregestational or gestational diabetes mellitus, autoimmune disorders, inherited or acquired thrombophilia).
(BOLD)
41
Hydrops Fetalis is?
Hydrops fetalis (“edema of the fetus”) is a rare pathologic condition that complicates approximately 0.05% of all pregnancies.
42
Hydrops Fetalis US diagnosis requires...
abnormal accumulation of fluid in more than one fetal extravascular compartment, including ascites, pericardial effusion, pleural effusion, subcutaneous edema, and/or placental edema. (BOLD)
43
overall perinatal mortality rate in the setting of hydros fetalis exceeds what percent
50%
prognosis depends on the underlying cause, severity and gestation age
44
in 50-75% of hydros fetalis what is seen
polyhydramnios
45
90% of hydros fetalis cases are a result of
non immune causes such as maternal infection (e.g., with parvovirus B19, cytomegalovirus, syphilis), massive fetal-maternal hemorrhage, and fetal abnormalities (e.g., congenital cardiac defects, fetal thalassemia, twin-to-twin transfusion syndrome).
46
hydros fetalis can be classically seen in fetuses with severe anemia - resulting form what
Rh isoimmunization, the introduction of Rh0(D) immune globulin has led to a substantial decrease in the incidence of immune hydrops
47
CHORIONIC VILLUS SAMPLING
Like that of amniocentesis, the goal of CVS is to provide fetal cells for genetic analysis, although in this case the cells are trophectoderm (placental) cells rather than amniocytes.
48
when is CVS best performed
10 and 12 weeks’ gestation. CVS performed before 10 weeks’ gestation has been associated with limb reduction defects
49
what is the most common complication of CVS
vaginal spotting, 10-25% of patients within the first few days after the procedure
50
is pregnancy loss associated with CVS
CVS appears to be associated with a higher risk for pregnancy loss than late amniocentesis
(BOLD)
51
what is the most serious complication of CVS
spontaneous abortion (BOLD)
52
one complication unique to CVS involves
interpretation of the genetic test results (BOLD)
53
AMNIOCENTESIS
Amniotic fluid is composed of fetal urine, lung fluid, skin transudate, and water that is filtered across the amniotic membranes. It contains electrolytes, proteins, and desquamated fetal cells (amniocytes). Sampling of amniotic fluid (amniocentesis) can be used to measure various substances such as lecithin and sphingomyelin for assessing fetal lung maturity, to look for pathogenic bacteria for confirmation of an intra-amniotic infection, and to obtain fetal cells for determination of fetal karyotype or performance of specific genetic analyses.
(BOLD)
54
amniocentesis
The most common indication for second-trimester
amniocentesis is cytogenetic analysis of fetal cells, although on occasion it is performed to determine amniotic fluid AFP levels and acetylcholinesterase activity for the diagnosis of fetal open neural tube defects. Amniocentesis later in pregnancy is usually performed for nongenetic indications, such as (1) documentation of fetal pulmonary maturity before elective delivery before 39 weeks’ gestation, (2) amnioreduction in pregnancies complicated by severe polyhydramnios, (3) to confirm preterm premature rupture of membranes (PROM) (amniodye test), or (4) to exclude intra-amniotic infection.
(BOLD)
55
Screening for Fetal Chromosomal Abnormalities
Fetal chromosomal abnormalities are a major cause of perinatal morbidity and mortality, accounting for 50% of first-trimester spontaneous abortions, 6% to 12% of all stillbirths and neonatal deaths, and 10% to 15% of structural anomalies in live-born infants. The most common aneuploidy (presence of an abnormal number of chromosomes instead of usual 46) encountered during pregnancy (autosomal trisomy) results primarily from nondisjunction during meiosis
56
women greater than 35 years are at higher risk for what
having a pregnancy complicated by fetal aneuploidy and are routinely offered noninvasive prenatal screening and an invasive diagnostic procedure (either amniocentesis or chorionic villus sampling [CVS]). (BOLD)
57
screening for fetal chromosomal abnormalities continued- random states-
which is the most common disorder
should all women be offered anurploidy?
However, because only 8% to 12% of all births occur in women 35 years of age and older, at most 20% to 25% of all cases of trisomy 21 (Down syndrome) would be identified if all women of advanced maternal age agreed to amniocentesis.101 Klinefelter syndrome (47, XXY) is the most common sex chromosome aneuploidy with a prevalence of 1 : 500 males, and Turner syndrome (45, X) is the only viable monosomy. Many older women are now opting for serum analyte screening for fetal aneuploidy, which is equally accurate in older women. All women, regardless of age, should be offered aneuploidy screening during early gestation.
58
Perinatal Ultrasonography-uses
high-frequency sound waves that are directed into the body by a transducer, reflected by maternal and fetal tissue, detected receiver, processed and displayed on a screen
59
Standard evaluation with perinatal US
involves determination of fetal number, presentation, amniotic fluid volume, cardiac activity, placental position, fetal biometry, and an anatomic survey.
60
Specialized examination-
include fetal Doppler assessments, BPP, fetal echocardiogram and additional biometric measurements, evaluate fetal structures in detail and define characterize fetal malformation.
61
most patients undergo a detailed fetal anatomic surgery at 18-22 weeks gestation to assess?
assess fetal growth and screen for structural defects.
62
indications for US at 14 weeks gestation
are different from second trimester and third trimester
63
What is the definition of Fetal macrosomia?
growth beyond an absolute birth weight of 4000 g or 4500 g regardless of gestational age.
64
Tell me the difference between fetal macrosomia and large for gestational age?
Fetal macrosomia, defined as growth beyond an absolute birth weight of 4000 g or 4500 g regardless of gestational age,44 should be differentiated from the term large for gestational age (LGA), which implies a birth weight greater than or equal to the 90th percentile for a given gestational age.
65
what percentage of fetuses born in the US are LGA?
10%
66
What birth weights are associated with risks for labor abnormalities? (bold in ppt)
(three diff. weight classes)
the risk for labor abnormalities increases with birth weights between 4000 and 4499 g
newborn and maternal morbidity increases significantly with birth weights between 4500 and 4999 g
and perinatal mortality (e.g., stillbirth and neonatal mortality) increase with birth weights greater than 5000 g
67
What is the most serious consequence of fetal macrosomia? (bold in ppt)
Shoulder dystocia, defined as a failure of delivery of the fetal shoulder(s) after initial attempts at downward traction, is the most serious consequence of fetal macrosomia, and requires additional maneuvers to effect delivery.
68
obstetric providers have two patients
mother and fetus
69
Of the two patients (mother/fetus), who will take priority ?
mother
70
Some tests are recommended for all pregnancies; like?
Ultrasound
71
Some tests are recommended for women with pregnancy complications; like?
middle cerebral artery doppler velocimetry
72
Fetal interventions are employed to improve
fetal outcome
- such as maternal corticosteroid administration
- Intrauterine fetal procedures
73
Around what year did neonatal concern/study begin by Dr. Little?
1861
74
** Barcroft wrongly concluded that
the term infant faced either asphyxia in utero or escape through the initiation of labor
75
Who proved Barcroft wrong? He concluded?
his student, D. Barron.
| -concluded no deterioration environment until onset of labor
76
Who's data has had the greatest impact on clinical practice?
Barcroft
- all current methods of fetal monitoring grew out of the belief that oxygen availability is the single most important factor influencing the well-being of newborns
77
*** Mean duration of a singlton pregnancy
280 days / 40 weeks
78
singleton pregancy
birth of only one child during a single delivery w/a gestation of 20 weeks or more
79
*** Term is defined as
ultimate time for delivery
** 37-42 weeks
80
The optimal time for delivery:
37-42 weeks
81
**preterm births =
delivery before 37 weeks
82
**delivery after 42 weeks =
post term birth
83
**what are associated with increased perinatal and neonatal morbidity and mortality:;
Preterm and post term births
| <37 weeks and >42 weeks
84
**Early Term:
37-38 wks
85
**Full Term:
39-40 wks
86
**Late Term:
41-42 wks
87
1. The American College of Obstetricians and Gynecologists
2. The Society of Maternal-Fetal Medicine
3. The American Institute of Ultrasound in Medicine
Have established:
recommendations for determining the gestational age (measure ot eh age of a preganancy) and EDD (est. due date)
88
** Gestational age is most accurate when US measurement of the fetus or embryo is performed
in the first trimester (< or = 14 weeks)
** assisted reproductive tech; EDD should be assigned based on the age of the embryo and the date of transfer
89
Criteria commonly used to confirm gestational age:
- Reported date of LMP
- size of uterus on bimanual exam in first trimester should be consistent w/dates
- Perception of fetal movement
- Fetal heart activity
- US to determine fetal crown to rump length during first trimester
90
Naegele's Rule
EDD calculated by subtracting 3 mos and adding 7 days to the first day of the last normal menstrual period
91
*** Fetal heart activity can be detected with doppler US by
10-12 weeks
| -18-20 wks w/ fetal stethoscope
92
**Fundal height at 20 weeks (in a singleton pregnancy) should be approx.
20cm above the pubic symphysis (usually corresponding to the umbilicus)
93
"Quickening" occurs at
18-20 weeks (nulliparous )
| 16-18 weeks (parous)
94
Nulliparous woman is
a woman who has never carried a pregnancy
95
Parous woman is
a woman who has carried a pregnancy
96
***Routine US is recommended for all pregnancies given its ability to:
- accurately determine gest. age
- viability
- fetal number
- placental location
- screen for fetal structural abnormalities (in second trimester)
97
Perinatal outcomes have been shown in some studies to have an improvement b/c of the use of
US
98
**perinatal period is defined as
20-28th week of gestation and ends 1 to 4 weeks after birth
99
What did the RADIUS study conclude?
that screening US did NOT improve perinatal outcomes and had no impact on the mgmt of the anomalous (normal) fetus
100
Normal fetal growth is a critical component of a healthy pregnancy and the subsequent
the subsequent health of the child.
101
An increased risk for delivering a small-for-gestational age baby and/or having a preterm delivery is associated
with low maternal gestational weight gain.
102
Higher risk for delivering a large-for-gestational age baby and/or cesarean delivery is associated with
excessive gestational weight gain.
103
*** Leopold Maneuvers/ abdominal examination has several limitations - especially in the setting of
- a small fetus **
- maternal obesity,
- multiple pregnancy,
- uterine fibroids, or
- polyhydramnios,
104
what exam technique is safe, is well tolerated, and may add valuable information to assist in antepartum management
abdominal examination
| Leopold maneuvers
105
Leopold Maneuvers (fig 6.1);
Each maneuver is is designed to identify specific fetal landmarks or to reveal a specific relationship between the fetus and the mother.
-First maneuver: fundal height
106
uterus can be palpated above the pelvic brim at approximately
12 weeks’ gestation
107
the uterus should increase at what rate/week? reaching what Landmark when?
1 cm per week, reaching the umbilicus at 20-22 weeks
108
Fundal height between 20 and 32 weeks gestation (in cm) is approximately equal to
the gestational age ( in weeks)
in a healthy women of average weight with an appropriately growing fetus
109
Maximal fundal height occurs at
approximately 36 weeks’ gestation,
110
after 36 weeks gestation, fundal ht drops as a result of
the fetus drops into the pelvis in preparation for labor
111
Fundal height measurements alone fail to identify 50% of these:
fetuses with fetal growth restriction
112
Fetal Growth Restriction is associated with a number of significant adverse perinatal outcomes:
1. Intrauterine Demise
2. Neonatal Morbidity
3. Neonatal Mortality
4. Cognitive Delay in Childhood
5. Chronic Diseases (Obesity, Type II Diabetes, CAD, Stroke in Adulthood
113
The definition of fetal growth restriction is
an EFW less than the 10th percentile for gestational age
114
the term small for gestational age (SGA) is reserved for newborns with
a birth weight less than the 10th percentile for gestational age.
115
a birth weight less than the 10th percentile for gestational age
small for gestational age (SGA)
116
EFW (est fetal weight) less than the 10th % for gestational age is called
fetal growth restriction
117
1. Intrauterine Demise
2. Neonatal Morbidity
3. Neonatal Mortality
4. Cognitive Delay in Childhood
5. Chronic Diseases (Obesity, Type II Diabetes, CAD, Stroke in Adulthood
these are perinatal outcomes associated with
fetal growth restriction
118
*** The fetal injuries associated with shoulder dystocia include which two issues? (one results in Erb-Duchenne paralysis)
fracture of the clavicle and damage to the nerves of the brachial plexus, resulting in Erb-Duchenne paralysis.
**exam
119
Of the fetal injuries associated with shoulder dystocia, a vast majority will resolve by what age?
1 year of age
**specifically erb-duchene paralysis mentioned
120
Shoulder dystocia of vaginal births is 0.2-0.3%, the risk for shoulder dystocia goes up to 9-14% if the baby is?
and then increases even higher to 20-50% if the momma has what issue?
birth weights of 4500 grams or more = 9-14% shoulder dystocia.
If momma has maternal diabetes shoulder dystocia at birth is 25-50%
(maternal diabetes babies are big!)
121
What two techniques can be used to determine fetal macrosomia and are equally accurate?
abdominal palpation (Leopold maneuvers)
and
ultrasonography
122
What is Macrosomia?
Macrosomia is a term that describes a baby who is born much larger than average for their gestational age, which is the number of weeks in the uterus.
123
The ability to predict fetal macrosomia is poor no matter the method used, what factors compound the inaccuracies? (four things)
low amniotic fluid volume, advancing gestational age, maternal obesity, and fetal position.
(bold in ppt)
124
What "extra" and investigational techniques have been used to "try" and more accurately predict fetal macrosomia? (bold in ppt)
(I cant blv we actually have to know these?)
fetal abdominal circumference alone, umbilical cord circumference, cheek-to-cheek diameter, and subcutaneous fat in the mid humerus, thigh, abdominal wall, and shoulder. However, these measurements remain investigational.
125
Despite the inaccuracy in the prediction of fetal macrosomia, an EFW should be documented by either clinical estimation or ultrasonography in WHAT group of pregnant women and What week?
in all high risk women at apprx. 38 weeks gestation.
126
Why is Suspected fetal macrosomia not an indication for induction of labor? (bold in ppt)
because induction does not improve maternal or fetal outcomes and may increase the risk for cesarean delivery.
127
at what weight does the American College of Obstetricians and Gynecologists (ACOG) recommends performance of an elective cesarean delivery?
4500g in a diabetic women and 5000g in a nondiabetic women.
128
at what weight in a non diabetic women would it be suggested by the ACOG to have an elective C section?
5000g fetus weight (suspected birth weight technically)
129
What situation can cause an otherwise expected vaginal delivery to turn into a C-section? (recommended to do C section)
a cesarean delivery is recommended in laboring women when the suspected birth weight exceeds 4500 g in the setting of a prolonged second stage of labor or arrest of descent in the second stage (bold in ppt)
130
What in the heck does arrest of descent mean? (talking about delivering a baby)
In an “arrest of descent”, the head of the fetus is in the same place in the birth canal during the first and second examinations, which your doctor performs one hour apart. This signifies that the baby hasn't moved farther down the birth canal within the last hour.
131
Does every pregnant women have regular antenatal care throughout their pregnancy?
NOPE
132
What would be considered a low FHR and what is it associated with?
A low FHR (< 100 bpm) is associated with an increased risk for pregnancy loss, although congenital complete heart block should be excluded. (bold in ppt)
133
what should be excluded when a fetus has a low FHR?
CONGENITAL COMPLETE HEART BLOCK
134
What does nulliparous and parous women mean?
```
nulliparous = has not given birth
Parous = has given birth (even if to stillborn)
```
135
what week of gestation is quickening (fetal movements) reported typically by nulliparous women vs parous women? (bold in ppt)
```
nulliparous = 18-20 weeks
parous = 16-18 weeks
```
(just think it takes longer to feel the baby move if you have never had a baby before)
136
The presence of fetal movements is strongly correlated with what?
fetal health
137
on average how many gross body movements per hour does the fetus exhibit? (bold in ppt)
20-50
| range of 0-130 (seems like a big weird range
138
When is fetal activity (that you can feel) fewer and increased? (think times of days) (bold in ppt)
with fewer movements during the day and increased activity between 9:00 PM and 1:00 AM
139
Maternal factors that make someone a high risk pregnancy? (7 things listed, think pre-existing dz or dz process that can take place in pregnancy)
Preeclampsia(gestational proteinuric hypertension)
Chronic Hypertension
Diabetes mellitus (including gestational diabetes)
Maternal cardiac disease
Chronic Renal Disease
Chronic pulmonary disease
Active thromboembolic disease
140
High risk pregnancy do to fetal factors would be? (all the things that could be wrong with the fetus or bad signs)
Nonreassuring fetal testing (fetal compromise)
Fetal growth restriction
Isoimmunization (development of antibodies against
the antigens of another individual of the same species)
Intra-amniotic infection
Known fetal structural anomaly
Prior unexplained stillbirth
Multiple pregnancy
141
*** EXAM**
What is the most common Isoimmunization when talking about mom and fetus?
rh factor incompatibility
142
What are Uteroplacental factors that make for a high risk pregnancy?
Premature rupture of fetal membranes
Unexplained oligohydramnios
Prior classic (high vertical hysterotomy) (hysterotomy is incision in the uterus) -- always a weak spot
Placenta previa
Placental abruption
Vasa previa
143
What is placenta previa?
occurs when a baby's placenta partially or totally covers the mother's cervix — the outlet for the uterus. Placenta previa can cause severe bleeding during pregnancy and delivery.
144
What is placenta abruption?
Placental abruption occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery. This can decrease or block the baby's supply of oxygen and nutrients and cause heavy bleeding in the mother.
145
What is Vasa previa?
a condition which arises when fetal blood vessels implant into the placenta in a way that covers the internal os of the uterus.
(internal os is the opening into the cervix)
146
labor abnormalities increase with what?
birth weights b/w 4000 and 4499 g.
147
newborn and maternal morbidity increases significantly with ?
birth weights b/w 4500 and 4999 g
148
perinatal mortality increase w/birth weights greater than
5000g
149
shoulder dystocia is defined as
a failure of delivery of the fetal shoulder(s) after initial attempts at downward traction, is the most serious consequence of fetal macrosomia
and requires additional maneuvers to effect delivery.
150
is the most serious consequence of fetal macrosomia
shoulder dystocia
151
Amniotic fluid is composed of
fetal urine, lung fluid, skin transudate, and water that is filtered across the amniotic membranes. It contains electrolytes, proteins, and desquamated fetal cells (amniocytes
