UPDATED MOTHER BABY EXAM 1

Describe attitude:

relation of fetal body parts to each other

Describe flexion:

Is the optimum attitude, Any extension presents a problem

Describe fetal lie:

• Relation of long axis (spine) of the fetus to the long axis (spine) of the mother • Longitudinal / vertical (parallel) ll • Transverse / horizontal (perpendicular) +

What is the smallest AP diameter of the skull:

Suboccipitobregmatic 9.5 cm (flexion)

What is the largest AP diameter of the skull:

Occipitomental 13.5 cm (extension)

What is the largest transverse diameter of the skull:

Biparietal 9.25 cm.

Describe occiput presentation:

Occiput present first

Describe vertex presentation:

Also known as military straight down

Describe bregma presentation:

Brow presenting first

Describe mentum presentation:

Chin delivered first

Describe complete breech presentation:

Baby's buttocks are positioned to come out first during delivery, with the legs folded at the knees and the feet near the buttocks.

Describe incomplete breech presentation:

Baby's buttocks are positioned to be delivered first, but one or both of the baby's legs are extended instead of being flexed at the hips.

Describe frank breech presentation:

When the babys legs are folded flat up against his head and his bottom is closest to the birth cana

Describe shoulder presentation:

Baby is in a transverse lie, thus the leading part is an arm, a shoulder, or the trunk.

Describe anterior occiput presentation (OA):

The best position for the baby to be in to pass through the pelvis is with the head down and the body facing towards the mother's back.

Describe posterior occiput presentation (OP):

In occiput posterior position, your baby's head is down, but it is facing the mother's front instead of her back.

Describe transverse occiput presentation (OT):

fetal cephalic malposition in which the sagittal suture and fontanels align

List the steps in Leopold's Maneuvers:

1. of fetuses

2. Presenting part

3. Fetal lie

4. Fetal attitude

5. Descent

6. Location of PMI of FHT

What is dilation of the cervix and how is it measured:

Dilitation - opening of cervix is measured in 0cm-10cm

What does effacement of the cervix mean and how is it measured:

Effacement - gradual thinning of cervix Is measured 0 %-100%

How is station determined:

Progress of presenting part through the pelvis Measured by "station" 0 station when presenting part is at the level of ischial spines (engagement) • -1 = 1 cm. above • 0 = at ischial spines • +1 = 1 cm. below

List the 7 cardinal movements of labor:

• Engagement • Descent • Flexion • Internal Rotation • Extension • External Rotation (Restitution) • Expulsion

How are contractions measured:

• Time between the beginning of one contraction and the beginning of the next contraction. • Measured in minutes or a range of minutes

What are the four stages of labor:

• Dilitation ; Effacement • Early/Latent • Active • Transition • Expulsion • Placental Expulsion

What is fetal monitoring:

Monitoring the heart rate and other vital signs of a fetus during pregnancy or labor.

Why do we use fetal monitoring:

• Prevent Maternal and Fetal Morbidity and Mortality • Surveillance tool to detect the fetal heart rate and maternal uterine activity • Assess fetal well being; 99% accurate in predicting a well oxygenated fetus • Provides a permanent record • Records events that cannot be heard or measured by auscultation alone

What is a toco and where is it placed:

-tocodynamometer measures the length, frequency, and strength of uterine contractions. -is placed on the mothers abdomen over the area of strongest contractions to

What is ultrasound use for and where is it placed:

An ultrasound is a procedure that uses soundwaves to create images of your baby while it's in the uterus (womb). During the scan, gel is placed on your abdomen (tummy) and a probe called a transducer is placed against your skin.

What is a FSE (ISE) and when is it used:

An internal fetal heart monitor that is used during labor to listen for fetal heart sounds

What is an IUPC and when is it used:

An internal contraction monitor. a device placed into the amniotic space during labor in order to measure the strength of uterine contractions.

What is the purpose of the upper channel and how is it counted:

• For recording fetal heart rate. Vertically scaled in beats • Measured in bpm

What is the purpose of the lower channel and how is it counted:

• Lower grid for recording uterine activity. Vertically scaled in millimeters of mercury • Measured in mm Hg

What is the role of the autonomic nervous system in fetal monitoring:

• Sympathetic- cardioaccelerator • Parasympathetic- Cardiodecelerator; present after the 28 th week of gestation

When does each part of the autonomic nervous system develop:

• Sympathetic- 4 th week of gestation • Parasympathetic- 28 th week of gestation

Describe normal fetal heart rate:

110-160s/min

Describe tachycardia and reasons why it may occur:

• Tachycardia is FHR <160s/min for >10 minutes • Fetal hypoxia, • Maternal fever, maternal dehydration, amnionitis, drugs (e.g., cocaine, amphetamines, nicotine), maternal hyperthyroidism, maternal anxiety, • fetal anemia, prematurity, fetal infection, chronic hypoxemia, congenital anomalies, • fetal heart failure, and fetal arrhythmias.

Describe bradycardia and reasons why it may occur:

• Bradycardia is FHR <110/min for >10 minutes

• It can be the initial response to asphyxia.

• Causes of fetal bradycardia might include fetal hypoxia,

• prolonged maternal hypoglycemia, fetal acidosis, administration of analgesic

• drugs to the mother, hypothermia, anesthetic agents (epidural), maternal hypotension, fetal hypothermia, prolonged umbilical cord compression, and fetal

• congenital heart block

What is variability:

• How much the heart rate is "bouncing around" the baseline.

• And shows that the baby has good oxygen supplies and is neurologically intact a reliable indicator of fetal well- being

Describe normal variability:

6-25 beats variation.

Describe minimal variability:

1-5 beats variation.

Describe and acceleration:

1 BPM

Describe an early deceleration:

• Decreased FHR that coincide with uterine contractions • Nadir of deceleration meets the apex of the uterine contraction • Fetal head compression causes vagus nerve stimulation and reflex bradycardia

Describe a late deceleration:

• Begins after unterine contraction has started • Associated with uteroplacental insufficiency (placental abruption, diabetes, anemia, sepsis, postterm pregnancy, hyperstimulated uterus) • Potentially dangerous and requires intervention

Describe absent variability:

Absent is less than 1 BPM

Describe exaggerated variability:

• Marked variability is 26+ beats variation

Describe a variable deceleration:

• May NOT coincide with uterine contractions. • Rapid decrease in FHR with variable recovery • Reflex mechanism due to umbilical cord compression

Describe a prolonged deceleration:

a visually apparent decrease of 15 or more beats per minute below the baseline. This decrease lasts at least 2 minutes but less than 10 minutes from onset to the return to baseline

What are maternal factor which may affect 02/C02 transport:

• Medical conditions such as HIP, diabetes, seizures

• Maternal substance abuse

• Maternal medication

What are placental factors which may affect 02/C02 transport:

• Anomalies: Tumors, calcifications

What are umbilical factors which may affect 02/C02 transport:

• Anomalies

• Compression: True knot; nucal cord, prolapse

What are fetal factors which may affect 02/C02 transport:

• Anomalies: Anencehphaly, neural tube defects

• Infection

• ABO incompatibilities; RH sensitization

List the steps in the Fetal Stress Protocol:

Where is the ovum released

Ovarian Follicle

What role do fallopian tubes play:

channels for oocyte transport and fertilization.

The ova is fertile for how long?

24 hours

How long are the sperm viable:

2-5 days

How many days are available for fertilization:

3-6

Where does fertilization occur

Outer third of fallopian tube

How many chromosomes are there:

46

When does life/cell division begin:

Conception/formation of zygote

Once cell division begins what are the group of cells called:

Zygote

How many days does a zygote last

14 days

When does implantation last?:

6-10days after conception

What implants into the uterus:

Chroni0nic villi

What is the purpose of HCG?

Softens the lining of the endometrium

How long does the embryonic period last?

4 weeks

What are each of the two layers of the amniotic membranes called

Chorion (outer), Amnion (inner)

What is the function of the amniotic fluid:

• a. Maintain constant temperature • Source of oral fluid • Repository for waste • Cushions fetus • Allows freedom of movement

What is oligohydramnios:

Too little amniotic fluid Associated with fetal renal abnormalities

What is polyhydramnios:

Too much amniotic fluid Associated with GI and other malformations

How many arteries in the umbilical chord and what are their purposes

2 arteries carry unoxygenated blood from fetus to placenta.

How many veins in the umbilical chord and what are their purposes

1 vein returns oxygenated blood to fetus.

When does maternal-placental-embryonic circulation begin:

Day 17

What is the size of the placenta by 20 weeks:

Covers ½ of uterine surface

What is the intervillous space:

a part of the fetal-maternal interface, where maternal blood enters to provide nutrients and gas exchange.

Describe the appearance of the placenta:

a disc of bumpy tissue rich in blood vessels, making it appear dark red at term.

What are the functions of the placenta:

• Respiration • Nutrition • Excretion • Storage • Hormone production • hCG (maintains function of corpus luteum) • hCS (growth hormone) • Estrogen • Progesterone

When does the fatal period begin

8 weeks

When does the heart begin to beat:

3 weeks

How is lung maturity measured:

Amniotic fluid is tested. L/S ratio 2:1 = indicates felt lung maturity and Absent Phosphatidylglycerol (PG) - indicates respiratory distress

What accelerates/decelerates lung maturity:

Accelerate lung maturity Maternal hypertension Placental dysfunction Infection Corticosteriods Retard lung maturity Gestational diabetes Chronic glomerulonephritis

When is fetal movement felt by the mother:

16-20 weeks

How does fetal circulation differ from maternal

Fetal structures shunt blood away from lungs:

What are the three shunts from the lungs:

• Ductus arteriosus (pulmonary artery - aorta) • Ductus venosus (umbilical vein - inferior vena cava) • Foramen ovale • (R - L atrium)

Describe fetal hemoglobin:

• Fetal Hgb carries 20-30% more oxygen • Fetal Hgb concentration is 50% greater • Cardiac output greater because of heart rate of 110-160 bpm

When is a fetus considered viable:

20-37 weeks

When is a fetus considered term:

38-42

What are the reasons for Therapeutic abortions

Rape or incest Threats to life or health of the mother Fetal anomalies High likelihood of intrauterine or neonatal death Significant mental or physical defects of the fetus

What are the reasons for Elective abortions

not ready for a baby

When should the "emergency contraception" (Morning after pill, Plan B) be taken:

taken within 72 hours of intercourse and again 12 hours later

When should the Abortion Pill (RU-4940 be taken:

Can be used up to 70 days or 10 weeks after the first day of last period.

What is required of this medication:

Requires 3 medical visits and takes 2-4 weeks. 16 weeks:

Describe instillation abortion:

Injection of drugs or chemicals through the abdomen & uterus into the amniotic sac to cause death and expulsion of the fetus.

When is this form of abortion used:

Late term abortion

What is the process of instillation abortion

Mother goes into labor about 33-35 hours after instillation. Most deliver within 72 hours

What is Selective Reduction:

Mother elects to abort or reduce the number of fetuses

Describe surgical abortion:

The cervix is dilated using metal rods and insert a tube into the uterus and the suction removes the fetus. Afterwards the uterus is scraped

How is late term abortion performed:

Induction Abortion (combination of saline abortion and induction of labor

What other names for late term abortion:

D&X Intrauterine Cranial Decompression Partial Birth Abortion

What is cranial decompression:

Incision and suction of the brain or by using forceps to collapse the skull.