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OBGYN Intrapartum Fetal Surveillance and Delivery
KYCOM Block 13
56
Medical
Graduate
01/17/2014

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Cards

Term
how often is there non-reassuring fetal status
Definition
5-10% of pregnancies
Term
define fetal distress
Definition
obselete term
less percise
neonata often shows no sign of intrauterine compormis as measured by APGAR score and blood gas studies
Term
3 causes of non reassuring fetal status
Definition
uteroplacental insufficiency
umbilical cord compression
fetal conditions/anomalies
Term
5 causes of uteroplacemtal insufficiency
Definition
placental edema: maternal DM, fetal hydrops
placental accidents: abruption placentae, placental previa
postdatism
intrauterine growth restriction
uterine hyerstimulation
Term
2 causes of umbilical cord compression
Definition
umbilical cord accidents: prolapse, enlargement, knot abnormal insertion, anomalous cord

oligohydramnios: less fluid pushes baby on cord causing compression
Term
5 causes of fetal conditions/anomalies
Definition
sepsis
fetal congenital anomalies
intrauterine growth restrictions
prematurity
postdatism
Term
methods of intrapartum monitoring
Definition
intermittent ascultation
electronic fetal monitoring
fetal heart rate
fetal heart rate variability
fetal heart rate pattern
Term
intermittent ascultation: how often
Definition
Q15-30 min post contraction 1st stage

Q5-15 min 2nd stage
Term
what are the typs of electric fetal monitoring
Definition
external
internal
Term
what does internal electronic fetal monitoring show
Definition
spiral electrode records fetal ECG
sagittal section showing attachment of fetal scalp and wires transversing cervix and agina
Term
what is a normal, fast, slow, causes of fetal HR
Definition
normal 120-160 BPM (slightly high pre term)

tachy: >160 (usually chorioamnionitis)

brady: <120 (fetal anemia)
Term
define fetal heart rate variability
Definition
fluctuations in FHR from beat to beat
single most reliable EFM indicator of fetal well being
Term
what does variability reflext
Definition
adequate fetal CNS oxygenation
Term
what is decreased variability associated with
Definition
fetal hypoxia
acidemia
drugs
fetal CNS and cardiac anomalies
uterine hypertonus (not enough time between contractions for baby to rest)
prematurity: less CNS developed decreases variability
fetal sleep
Term
what are the levels of variability, which is ideal
Definition
absent: no change from midline
minimal: <6 units change
moderate: 6-12 units change IDEAL
marked: >25 units change
Term
what acceleration is good <32 wks
Definition
2 accelerations per strip that increase by 10 bpm and last 10 sec
Term
what acceleration is good >32 wks
Definition
2 accelerations per strip that increase by 15 bpm and last for 15 sec
Term
define sinusoidal fetal heart rate pattern
Definition
fetal anemia
Rh immunization
newborns with significant compormise GET BABY OUT
Term
why does fetal heart rate vary
Definition
uterine contractions slow and accelerate it
Term
why are fetal accelerations good
Definition
intact fetal mechanism is reassuring
Term
how can you test for acceleration if you dont see it (2)
Definition
fetal scalp stimulation
external vibroacoustic stimulation
Term
define decelerations of fetal heart rate changes
Definition
visually apparent and gradual onset to nadir 30sec or more
Term
cause of early decelerations
Definition
pressure on fetal head as baby moves into pelvis mediated by vagus nerve
this is normal
Term
deceleration timeline
Definition
30 sec to peak
30sec to normal
Term
cause of variable decelerations
Definition
anything compressing the cord causes
no relation to contraction
Term
cause of late decelerations
Definition
uteroplacental insufficiency
after a contraction with prolonged recovery
BAD sign
Term
what is the best evaluation of health of fetus
Definition
beat to beat variability
Term
what causes poor beat to beat variability
Definition
narcotics, intolerance ot labor
Term
what do you do if baby has poor beat to beat stimulation
Definition
scalp stimulation
acoustic stimulation
pH sampling (<7 is significant hypoxia)
Term
what can compormise fetal variability
Definition
severe bradycardia
repetitive late decelerations
undulating baseline
non-reassuring pattern with poor beat to beat
Term
when is a variable deceleration not reassuring
Definition
>45-60 sec
repetitive
rising fetal hR baseline
tend towards tachycardia
loss of variability
delay of return to baseline
Term
late decelerations: marker for, when to be concerned
Definition
marker for fetal hypoxia and uteroplacental insufficiency

repetative lates are clear warning that fetus is in trouble
Term
define prolonged deceleration
Definition
decel 15 beats/min or more lasting 2min - 10 min
Term
causes of prolonged deceleration
Definition
tetanic contractions
prolapse unbolical cord
vaginal exam
application of internal electrode
paracervical block
epidural bloick
supine hypotensive event
rapid descent of fetal head during delivery
Term
causes of cerebral paysl
Definition
70% of neonatal encephalopathy is caused by factors present befoe labor
1/1000 are classified as encephalopathy are associated with acute intrapartum event
Term
parts of intrauterine recussitation
Definition
check maternal BP
increase IV fluids
DC ocytocin (consider iv tocolytic)
change moms position
administer O2
check cord prolapse
check cervix babys head may be ready to deliver
amnioinfusion
Term
what position should mom be in when she delivers
Definition
dorsal lithotomy
Term
when do you do episiotomy, how, why
Definition
only when you need to get baby out fast

midline: could tear into rectum
mediolateral: more painful, heals slow
Term
what is ritgen maneuver:
Definition
finger in rectum used to adjust babys head
Term
what do you do right after the baby's head is delivered
Definition
check for nucal cord
downward traction to assist in delivery of anterior shoulder
Term
when should you suction the baby's airway
Definition
some say after head but before shoulder out
some say all the way out
Term
what are the events and complications of the third stages of labor
Definition
collection of cord blood
delivery of placenta
inversion of uterus
manual removal of placenta in OR if it dosent remove in 30 min
inspection of cord
inspection of vagina
Term
what do you inspect the vagina for after delivery
Definition
tears, lacerations, extensions of episiotomy
Term
what should the contents of the cord be, what is a common abnormality
Definition
2 arteries
1 vein

1A/1V associated with renal anomolit
Term
cause of inversion of the uterus
Definition
excessive traction force on placenta
Term
signs of delivery of placenta
Definition
uterus rises in abdomen and becomes globular
gush of blood #1 sign
lengthening of umbilical cord
Term
what are the degree of obstretic laceration and their descriptions
Definition
1: skid marks: vaginal mucosa and perineal skin but not underlying tissue

2: most common. involves underlying SC tissue but not rectal sphincter or rectal mucosa
3: extends through the rectal sphincter but not the rectal mucosa
4: extends into rectal mucosa
Term
[image]
Definition
sinusoidal fetal HR
Term
[image]
Definition
sinusoidal HR
Term
[image]
Definition
prolonged fetal bradycardia
Term
[image]
Definition
normal
Term
[image]
Definition
normal likes contractions
Term
[image]
Definition
normal labor with pushing
Term
[image]
Definition
late deceleration
Term
[image]
Definition
early deceleration
Term
[image]
Definition
absent variability
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