RCP 214 Test 1 B

Describe three different methods of measuring fetal heart rate.

external abdominal transducer, placement of electrodes on the abdomen, small spiral electrode into the fetal scalp

Average fetal heart rate.

early gestation if 140/min dropping to an average of 120/min near term

Identify factors that change the fetal heart rate.

fetal movement, fetal sleep cycles, maternal activity, maternal position, uterine contractions, medication, maternal oxygenation, maternal blood pressure, and changes in uteroplacental perfusion

Define fetal heart rate decelerations.

when the FHR drops below 120 bpm for less than two minutes

Early or type I deceleration

closely follow uterine contractions in onset and duration. HR may drop to 60-80 bpm during the contraction, rapidly returning to baseline following the contraction. Caused by compression of the fetal head against the cervix and are generally benign.

Late or type II deceleration

do not follow uterine contractions. Occur 10-30 sec. following the onset of the contraction, and HR does not return to baseline until after the contraction is over. Secondary to uteroplacental insufficiency during contractions, leading to fetal asphyxia.

Variable or type III deceleration

independent of uterine contractions. Random in their onset, duration, and severity. Usually secondary to compression of the umbilical cord leading to hypoxia. Cord may either be wrapped around the infant’s neck (nucal cord) or be pinched between the pelvis and the presenting body part. Alleviation of cord compression is accomplished by turning the mother side to side or assuming knee-chest position.

Identify normal scalp pH.

above 7.25

Explain how fetal scalp pH is used to assess fetal asphyxia.

pH of 7.20 - 7.24 shows slight asphyxia and a pH of less than 7.20 signifies severe asphyxia

Nagele’s Rule

most common method of determining EDC. 3 months are subtracted from the first day of the first day of the last menstrual period. 7 days ar Ethen added to the result to determine the EDC.

Fundus measuring

the opposite end of the cervix can be measured on abdominal wall as it grows with the fetus. Fairly reliable during first and second trimesters but unreliable during the last trimester.

Quickening

the first sensation of fetal movement experienced by the mother. Generally occurs between 16 and 22 week, but on average occurs near week 20. Very rough estimate of gestational age.

Fetal heartbeat

can be heard as early as week 16, but is nearly always heard no later than week 20. Use of doppler devices is required.

Non-stress test (NST)

evaluates fetal well-being by monitoring the fetal heart rate without inducing uterine contractions. Looks for normal increases in the fetal heart rate in response to fetal movement, which indicates adequate oxygenation and a healthy nervous system.

Contraction Stress Test (CST)

evaluates how fetus responds to the stress of uterine contractions, which may occur naturally or be induced with oxytocin or nipple stimulation

What is included in a biophysical profile?

fetal breathing, fetal movement, fetal limb tone, NST, and amniotic fluid volume

Identify and list 5 factors that indicate high risk pregnancy.

low income/poor housing, severe social problems, unwed status, minority status, and poor nutritional status

Stage I of Labor

onset of regular contractions to full dilation and effacement of the cervix

Stage II of Labor

full dilation and effacement of the cervix to delivery of the fetus

Stage III of Labor

delivery of the fetus to delivery of placenta

How many centimeters is a fully dilated cervix and what does this indicate?

10 cm; indicates end of stage I of labor

Identify the most common fetus presentation.

head-down (vertex) position

Define tocolysis.

process of stopping labor; either pharmacologically or non-pharmacologically

Define dystocia.

prolongation of labor; present when the first and second stages of labor exceeds 20 hours.

Causes of dystocia.

uterine dysfunction, abnormal fetus presentations, excessive fetal size, hydrocephalus, and abnormality in size or shape of birth canal

Complete breech

when the feet, legs, and buttocks all present together

Incomplete/Footling breech

occurs when one or both feet descend into the birth canal first

Frank breech

occurs when the legs are flexed against the body, the feet being near the face, and the buttocks being the presenting part

Face/brow presentation

the head enters the birth canal in such a way that the sutures cannot override. The result is that the head must pass through the pelvis and the birth canal at its full size.

Transverse lie

occurs when the fetus is lying perpendicular to the birth canal. Delivery of the fetus in this state is nearly impossible and requires a great deal of manipulation to straighten the fetus.

Prolapse of umbilical cord and occult cord compression

when the umbilical cord passes through the cervix into the birth canal ahead of the presenting part.

Placentae previa

when implantation occurs in the lower portion of the uterus

Low implantation

occupies the lower portion of the uterus but does not cover the cervical opening

Partial placentae previa

covers a portion of the cervical opening but does not cover it completely

Total placentae previa

completely covers the opening of the cervix

Abruption placentae

anytime a normally attached placenta separates prematurely from the uterine wall

Grade 1 abruption placentae

vaginal bleeding, no signs of maternal shock or fetal distress, tetany and tenderness of the uterus may be present

Grade 2 abruption placentae

external vaginal bleeding may be present, no signs of maternal shock, signs of fetal distress are present, tetany and tenderness of the uterus are present

Grade 3 abruption placentae

external vaginal bleeding may be present, maternal shock and persistent abdominal pain are present, fetal demise is present, marked uterine tetany resulting

Common cause of placental abruption

maternal hypertension which includes preeclampsia

Define preeclampsia

the development of hypertension with proteinuria, edema, or both; usually presents after week 20 of gestation

Define cesarean delivery

fetuses delivered by way of a surgical incision through the maternal abdomen and uterus

Indications for a cesarean birth

prior cesarean delivery, dystocia, breech presentation, and fetal distress

Explain why multiple gestation create high risk pregnancies.

high incidence of premature labor/delivery, increased incidence of congenital abnormalities, growth retardation, bacterial infection, and hypoglycemia

Factors responsible for the first breath

biochemical - increased PaCO2, decreased PaO2, and pH stimulate the chemoreceptors

physical - natural recoil of the thorax during birth creates a negative pressure in thoracic cavity causing air to enter the lungs

environmental - as fetus passes from an environment of darkness and warmth into a bright, loud, and cold environment, the abrupt change initiates a cry reflex

Explain in detail the change from fetal to adult circulation

the pressures found inside the fetal vasculature are the reverse of those found in the adult. Pressures in the right, or venous system, are higher than those in the left, or arterial system; referred to as transition

G, T, P, A, L

gravida

term births (>37 weeks)

premature births (<37 weeks)

abortions/miscarriages

living children

Primigravida

first time pregnancy

Multigravida

subsequent pregnancies

Nulligravida

never been pregnant

PARA

obstetrical history

State at least 10 anatomic and physiologic differences between an infant and adult.

smaller airways, larger tongue, higher anterior larynx, omega shaped epiglottis, obligate nose breathers, fewer alveoli, more compliant chest wall, diaphragm-dependent breathing, higher oxygen consumption, and lower FRC

Dubowitz scoring system

examines 11 physical criteria and 10 neurologic signs assigned a point value from 1-5. Usually accurate within two weeks and has consistent results when used in the first five days of life.

Ballard scoring system

scores six neurologic signs and six physical signs. Most reliable when examination is done before 42 hours of life with the ideal time being between 30 and 42 hours after delivery. Takes less time to perform.

Quiet examination

observing the infant without disturbing them to assess general appearance, posture, color, breathing pattern, activity level, and any signs of respiratory distress

Hands-on examination

physically assessing the infant through inspection, palpation, percussion, and auscultation to evaluate areas such as the airway, lungs, heart, abdomen, skin, and extremities

Neurologic examination

evaluates the infant’s neurological maturity and function by assessing muscle tone, reflexes, posture, and responses to stimuli