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Questions And Answers
uterine blood supply - correct answer - uterine arteries deliver oxygenated blood to spiral arteries which bring oxygen rich blood to intervillous space of placenta that has fetal capillaries
- fetal capillaries carry the O2 rich blood to umbilical VEIN that goes to fetus -in contrast, the umbilical ARTERIES return waste products to that intervillous space that go into mother's venous system Potential issues that negatively affect fetal oxygenation - correct answer Maternal Oxygenation: asthma, hyper- or hypo- ventilation Maternal Circulation: decreased maternal cardiac output, hypotension, decreased Hgb Placental O2 and CO2 Exchange: postterm, abruption, HTN, hypotension, uterine tachysystole Fetal circulation: cord compression or occlusion
Questions And Answers
Fetal hypoxemia - correct answer - can occur d/t reduced fetal O2 reserves, excessive uterine activity, or reduced uteroplacental blood flow
- worsening fetal hypoxemia can lead to abnormal FHR patterns, mostly minimal or absent variability from acidemia (1) hypoxemia vs. (2) hypoxia - correct answer 1 - reduce O2 in blood 2 - reduced O2 delivery at tissue level Fetal anaerobic metabolism - correct answer - occurs when long term O2 delivery is insufficient to meet cellular needs of tissues
- results in production of lactic acid and other noncarbonic acids
- ACIDOSIS is the presence of excessive acids in tissues acidosis - correct answer pH below 7.
Questions And Answers
~ they are equivalent and terms are used interchangeably ~ fetal acidosis - correct answer - when O2 is decreased to fetus, tissue hypoxia results in acidosis, which then shows a drop in pH, a loss of bicarb, and increase in base deficit acidemia - correct answer assoc w/ widespread, deleterious effects on vital organ and body function fetal hypoxia during birth - correct answer assoc w/ neonatal depression, low apgars, neonatal encephalopathy, and cerebral palsy respiratory acidosis - correct answer low pH (< 7.10), high pCO2 (> 60), normal base deficit ( < 12)
- increase of pCO2 for fetus that lowers pH but doesn't affect base deficit
Questions And Answers
factors that contribute to resp acidosis - correct answer - sudden decrease in placental or cord perfusion
- uterine tachysystole
- maternal hypoventilation metabolic acidosis - correct answer ph < 7.10 , normal pCO2 (<60), high base deficit (>12)
- a higher base deficit (such as > 12) has been assoc w/higher risk for severe neonatal complications
- most common cause of metabolic acidosis in fetus is r/t inadequate O2 delivery
- prolonged hypoxic insult to fetus results in depletion of bicarb, which is a base buffer that normalizes pH levels mixed acidosis - correct answer pH < 7.10 , high pCO2 > 60, and high base deficit >12
- may develop when resp acidosis persists for a prolonged period of time
Questions And Answers
pH 7. pCO2 33- base excess -1 to - factors for neonatal encephalopathy or cerebral palsy - correct answer Data shows that intrapartum hypoxia- ischemia is rarely sole significant contributing factor for this Other contributing factors include:
- infection
- prolonged intermittent hypoxia assoc w/subcortical and cortical or preventricular damage
- acute total or near total hypoxia is assoc w/damage to midbrain and brainstem low pH in newborns - correct answer - no absolute fetal arterial pH threshold assoc w/harm in all newborns
Questions And Answers
- typically if pH is < 7.10 that is used to determine acidosis and if the pH is < 7 then that is associated w/ low apgars, early neonatal seizues, and neonatal deaths prolonged intermittent hypoxia is assoc w/ - correct answer subcortical and cortical (term) or perventricular (preterm) damage acute total or near total hypoxia is assoc w/damage to - correct answer midbrain and brainstem fetal hypoxemia can occur under the following conditions
correct answer - excessive uterine contractions
- prolonged contractions without adequate resting tone or duration between contractions
- abnormal uterine physiology or anatomy is present
- separation of placenta and uterus (recurrent late, variable, or prolonged decels suggest this) Risk factors for late decels - correct answer Uteroplacental factors:
- tachysystole
Questions And Answers
- umbilical cord prolapse or compression
- cord stretching w/ pushing or rapid descent
- preterm Maternal factors:
- positioning risk factors for prolonged decels - correct answer Uteroplacental:
- excessive activity
- uterine rupture
- abnormal placentation
- hypertonic/prolonged contractions
- hypoperfusion Fetal factors:
- OP position
- vagal stimulation d/t head compression and or rapid descent
- cord compression
- hypoxia
- acute fetal hemorrhage
Questions And Answers
Maternal:
- hypotension; acute hypoxia maternal factors for prolonged decels - correct answer - supine position
- hypotension
- resp or cardiac arrest
- seizures FHR features of normal fetal acid base status - correct answer presence of moderate variability and FHR accelerations are both strong indicators of absence of fetal acidemia moderate FHR variability - correct answer - amplitude 6 to 25 bpm
- represents well oxygenated, nonacidemic accelerations - correct answer for 32+ wks gestation it is a 15 by 15 accel
Questions And Answers
heart, manifested by a reduction (minimal) FHR varaibility and loss of accels
- if FHR transitions from moderate to minimal in presence of recurrent variable, late, or prolonged decels then hypoxia and evolving acidemia should be assumed hypoxic causes for minimal variability - correct answer - placental abruption
- excessive uterine activity
- fetal hypoxemia ^ less common and usually require immediate resolution or intervention nonhypoxic causes of minimal variability - correct answer - extreme preterm ( < 28 wks)
- fetal sleep cycle
- fetal tachycardia
- fetal anomalies (esp CNS) or previous neurologic insult
- meds ^causes are more common and less acute, immediate resolution is not always required
Questions And Answers
Fetal scalp electrode requires - correct answer - adequate cervical dilation
- rupture membranes
- presentation of appropriate fetal part (head) risks of FSE - correct answer - infection: maternal and fetal
- increased risk for fetal hemorrhage or injury FSE is contraindicated in these circumstances - correct answer - fetal presentation of face, fontanelles, genitalia
- presence of maternal blood borne infection (HIV, hep)
- placental previa
- undx vaginal bleeding FHR tachycardia definition - correct answer - bsl range >160 bpm
- variability often decreased or absent
- characteristic that falls into cat 2 pattern regardless of variability or accels
Questions And Answers
overview of early decels - correct answer - gradual onset to nadir (>30 sec) and nadir of decel coincides w/peak of contraction
- in most cases, decrease starts and ends w/contraction
- thought to be benign d/t head compression
- most commonly seen when cervix i 4 to 6 cm dilated, when transient, and resolve w/progession of labor
- may also be seen in early labor when fetus is in breech overview of late decels - correct answer - gradual onset to nadir (> 30 s) and shallow depth of decel
- onset, nadir, and recovery are delayed r/t time of contraction
- often assoc w/ fetal hypxoemia
- cat 2 strip
Questions And Answers
causes of late decels - correct answer - uterine tachysystole
- maternal hypotension
- placental abruption
- severe maternal anemia variable decels - correct answer - abrupt (< 30 s from onsent to nadir).
- depth usually greater than early or late decel
- 15 bpm or greater decel from bsl, lasts at least 15 sec but less than 2 min
- if recurrent then cat 2 tracing causes of variable decels - correct answer - cord compression may be d/t
oligo (in early labor or after ROM) during descent of presenting part d/t stretching of nuchal or short cord
Questions And Answers
- early decels ok cat 2 tracing - correct answer indeterminate patterns, includes:
- bsl rate abnormalities: tachy; brady w/out absent variability
- abnormalities in variability: minimal or absent without recurrent variable, late or prolonged decels
- presence of intermittent variable or late decels with any variability
- prolonged decel *tachysystole is not a consideration but may be a cause cat 3 tracing - correct answer patterns include:
- absent variability w/recurrent late decels
- recurrent variable decels
- bradycardia
Questions And Answers
- sinusoidal fhr minimal variability - correct answer - may be assoc w/fetal hypoxia although other more benign factors may be responsible such as sleep cyce or meds (terb, mag, parenteral narcotics) absent variability - correct answer - if there are recurrent or late decels w/absent variability that equals cat 3 strip
- if absent variability without recurrent variable or late decels that is a cat 2 tracing but does require prompt eval and surveillance management of late fhr decels - correct answer - maternal repositioning
- IV fluid bolus
- O
- tocolysis (in situations where decels persist, accels are absent, minimal or absent variability then immediate delivery should be considered)
