Fetal Development Flashcards

Question

Factors Affecting Lung Development Maternal Diabetes

Answer 1

Slows lung tissue maturation

Answer 2

Amniotic fluid can be analyzed for pneumocytes

Answer 3

Lays out the structure Squamous cells Thin flat membrane that is permeable to gas 97% of alveolar surface area

Answer 4

Surfactant production Can differentiate and become type I cells Cuboidal Will appear ~22-24 weeks gestation

Answer 5

Surfactant is composed of phospholipids, neutral lipids, and proteins

Answer 6

* 90-95% Lipids * 80-85% phospholipids * Phophatidylcholine is the most abundant phospholipid (75-80%) * Dipalmitoylphosphatidlychoine (50%) * 1-palmitoyl-2-oleoyl-phosphatidylcholine * 5-10 % proteins Bovine-- BLES- very similar to human surfactant

Answer 7

The presence of fetal lung fluid is essential for normal lung development Fetal lung fluid will p**romote lung growth and maintain the shape of airwa**ys through keeping them filled with fluid. Allows the **patency of potential spaces and the development of FRC.** Fetal airways are not collapsed but **filled with fluid from the canalicular period until the delivery** and the initation of breathing air The lungs will have breathing like movements, but there is no function until the first breath of air

Answer 8

The lungs will secrete fluid from the lower respiratory tract (terminal respiratory units) up the conducting airways into the oropharynx where it will be swallowed or join with the amniotic fluid The baby will produce ~250-350 mL/day At tern fetal lung fluid levels will peak at 30 mL/kg which is the equivalence of the volume of FRC

Answer 9

The lungs will secrete fluid from the lower respiratory tract (terminal respiratory units) up the conducting airways into the oropharynx where it will be swallowed or join with the amniotic fluid This is why we can test the amniotic fluid for information about fetal lung fluid The concentration of phosphatidylglyceroland phosphatidylcholine in amniotic fluid is a sensitive indicator for the state of fetal lung maturity The fetal lung fluid will have a lower pH than amniotic fluid The baby will produce ~250-350 mL/day At tern fetal lung fluid levels will peak at 30 mL/kg which is the equivalence of the volume of FRC Lung fluid is removed from the lung via decreased production prior to birth (hormones), contractions during labor, and lymphatic absorption after birth If there is lung fluid retention it can lead to respiratory issues such as transient tachypnea of the newborn Fluid retention problems can be seen with c-sections The treatment of TTHN is CPAP and O2 therapy (24 hours)

Answer 10

* Lung fluid is removed from the lung via decreased production prior to birth (hormones), contractions during labor, and lymphatic absorption after birth * If there is lung fluid retention it can lead to respiratory issues such as transient tachypnea of the newborn * The treatment of TTHN is CPAP and O2 therapy (24 hours) * Fluid retention problems can be seen with c-sections

Answer 11

**Aspiration Syndrome** Ex. Meconium, blood, amniotic fluid Meconium can inactivate surfactant as well as decrease the production of surfactant **Pulmonary Hemmorrhage or Edema** Deactivation of surfactant

Answer 12

PDA is a risk factor Large differences in systemic to pulmonary vascular pressure between the descending aorta and pulmonary vasculature

Answer 13

Looks at the componenets of surfactant The levels of **spingomyelin** will remain constant in th eamniotic fluid, whereas the levels of **lecithin** will **increase** as the fetal lung matures and produces surfactant This test will be done through amniocentesis or when mom's membrane is ruptured

Answer 14

The lecithin/sphingomyelin ration (L:S Ration) is usually 1:1 by week 31-32 and 2:1 by 35 week gestations * L:S 2:1 or greater * Lungs are mature * L:S 1.5-1.9 : 1 * 50% chance of RDS * L:S less than 1.5 : 1 * High risk of RDS

Answer 15

The heart will begin to beat regularly early the fourth week after fertilization Will be from the mesoderm The heart is the first organ that will be fully formed At week 8 the heart will be fully developed At 21 days there will be the fusion of the tubes

Answer 16

* Fetal circulation will be very different from adult circulation as the blood is mostly shunted around the lungs * There is highly vascularized resistance in pulmonary circulation in the fetus * One of the reason there is high PVR is because of the vasoconstriction in response to PaO2 * The other reason for high PVR is the fluid in the lungs will be pressing down on the vasculature * The pressures will be high in the pulmonary system that blood will back up into the right side of the heart increasing pressures in both the right ventricle and atrium * The right ventricle is unable to pump through this resistance so it will go through the foreman ovale

Answer 17

There is a low vascular resistance in systemic circulation The placenta is a large surface area/volume with a low resistance

Answer 18

Return oxygenation blood from the placenta Enters the fetal body through the umbilicus to the undersurface of the liver then to the branches (2 or 3) to the liver Continues on to the ductus venosus

Answer 19

Allows blood (30-50%) returning from the placenta to bypass the liver Drains into the inferior vena cava which goes into the right atrium

Answer 20

* An opening in the septum between the two atriums * Blood from the inferior vena cava will be deflected from the right atrium into the left atrium * Some of the blood will not be shunted through the foramen ovale and rather will go to the right ventricle then into the pulmonary artery * But most blood will not flow into the lungs and will be diverted into the ductus arteriosus

Answer 21

A small vessel that connects the pulmonary artery with the descending (thoracic) aorta It allows more blood to detour into the systemic circulation without going through the fetal lungs

Answer 22

There are two umbilical arteries Extensions of the internal iliac arteries Will carry deoxygenated fetal blood into the placenta

Answer 23

The placenta is the only source of oxygen and nutrient rich blood for the baby. It is also the only way for the baby to remove deoxygenated blood This occurs via finger like projections in the placenta pool

Answer 24

* Placenta * Umbilical Vein * Will branch into two * One branch to the liver (venous admixture) and then to the IVC * The other branch goes directly to IVC (shortcut via ductus venous) (oxygen rich blood) * IVC (venous admixture from legs and PaO2decreases also from the liver) * RA

Answer 25

The SVC bring deoxygenated blood from the head and arms to the right atrium adding more venous blood into the right atrium and decreasing PaO2

Answer 26

Contains 3 vessels (2 small arteries and 1 large vein) which will be surrounded by a tough gelatinous material (Wharton’s Jelly) This jelly will prevent the cord from being squished or bent

Answer 27

* Contains hemtopaotic stem cells, which can be frozen and used to treat infant cancers * The RTs will run cord blood * Respiratory acidosis indicates distress of the fetus and an assessment of the baby is required

Answer 28

There is a two layered wall in the atrial septum which is composed of the septum secondum and the septum primum Both walls will have holes in them s when pressure is increase a flap will be created between the holes (Foramen ovale) connecting the two atriums

Answer 29

Placenta (~SaO290%) - Umbilical vein (~SaO280%) - Ductus venosus (~ SaO270%) âIVC - RA (~SaO255% to 65%) - FO - LA - LV - aorta with some blood, between 13 to 25%, going into pulmonary circulation via RA - RV - pulmonary trunk - Ductus arteriosus - aorta

Answer 30

Will be continuously produced, used, absorbed, and exchanged throughout pregnancy A term fetus will swallow about 500 mL of amniotic fluid a day and excretes the same amount of hypotonic urine back into the mis each day There will be ~30mL of amniotic fluid at 10 weeks At term there will be 1.5 L

Answer 31

Protect the fetus from injury by acting as a cushion Controls the thermal environment Assists in the effacement and dilation of the cervix during labor

Answer 32

Maternal blood products Amniotic cells Fetal skin, hair, and urine

Answer 33

the placenta

Answer 34

Maternal blood will have a high PO2 and a low pH Shifts in the oxyhemoglobin curve to the right decreasing the affinity of maternal Hgb for O2 This allow for easy offloading of oxygen to the fetal blood The low pH is due to extra CO2and the fact that mom has a big belly and it become harder to breathe (pregnancy is a restrictive lung process)

Answer 35

Fetal blood has a low PaO2 Shifts the oxyhemoglobin curve to the left allowing easy uploading of O2 by fetal blood Fetal hemoglobin has the ability to combine with oxygen to a greater extent than adult hemoglobin

Answer 36

Also known as antenatal care, and is medical care recommened for women during pregnancy Should begin at 6-8 weeks of pregnancy Purpose: To identify any potential problems [normal/low risk or high risk] and to intervene in a timely manner

Answer 37

Maternal history & risk factors: Genetic disorders, infectious disease, etc. Antenatal assessment Intrapartum monitoringàex: ultrasound

Answer 38

Too young = risk of spontaneous abortion or poor prenatal care Too old = risk of genetic disorders (ex. Down syndrome)

Answer 39

* Tobacco cessation counselling * Asthma * Due to the hormonal changes during pregnancy women will tend to lose control of their asthma and fear being on corticosteroids thinking it will hurt the baby but research shows it is safe for the baby * Acute Care for in case mom gets sick * Every mother should have the flu shot * Maternal diabetes * Drug use

Answer 40

* Will be dependent upon the stability and maturity of * CNS * Including protective mechanisms * Circulatory system * Respiratory system * Musculoskeletal system * Integrity of the skin will help determine how susceptible the infant is to infections

Answer 41

The first ultrasound will be done around the 11-14 week mark and used to predict a due date 2^ndultrasound will be done at 18-20 mark and can determine sex of the baby as well as look for any anatomical concerns, viability, and estimate gestational age

Answer 42

Ultrasound that looks at the nuchal folds in the neck of the fetus Done at 11-14 week of pregnancy when there is an increase risk in the pregnancy A wider fold = chromosomal defect Will have a 70% detection rate of Down Syndrome

Answer 43

Invasive test where a needle will pierce the amniotic sac to obtain an amniotic fluid sample done in conjunction with an ultrasound at ~15-18 week Done when there is something that will make the fetus not viable in order to give mom time to plan if they have to do a late abortion Can have false positives Will use a needle to pierce and obtain amniotic fluid sample

Answer 44

Lung Maturity Gender Rh isoimmunization Chromosomal abnormalities [trisomy 21] Fetal enzyme deficiencies Certain genetic mutations Spina bifida Bleeding disorders

Answer 45

Assess for spontaneous movement by measuring fetal heart rate When the fetus move the heart rate will increase In a 20-30 minute period a reactive (good) test means that the heart rate will increase twice for at least 15 BPM for 15 seconds with maternal perception of fetal movement Reflect normal uteroplacental function and predicts normal fetal survival

Answer 46

Assess viability of uterus and placenta Monitors fetal HR during an induced contraction (oxytocin). The contraction is used in order to put stress on the fetus and assess a response Indicated when there is a lack of movement noted late in the pregnancy A positive test indicated that more the 50% of contractions result in late decelerations (poor outcomes)

Answer 47

* Done at the 26-28 mark * Indications: Maternal diabetes, hypertension, low fetal movement * Scores * 8-10 Normal * 6= Uncertain repeat test * 0-4= Abnormal

Answer 48

* Fetal Breathing: 1 episode of 30 seconds during a 30 minute time * Normal: Positive * Abnormal:Absent * Gross Body Movement: 3 during a 30 minute time * Normal: 3 or more * Abnormal:2 or less * Tone: 1 episode of extension/flexion during a 30 minute time * Normal: Positive * Abnormal:Absent * Reactive NST: 2 episodes of +15 bpm increased in 30 minutes * Normal: Yes * Abnormal:No * Amniotic Fluid: 1 pocket of 1 x 1 cm * Normal: Positive * Abnormal:Absent

Answer 49

* Nausea and vomiting at 4-6 weeks gestation * Frequent urination * Cartilage/joint relaxation and stretching * Pregnancy will release relaxin * More flexible but more prone to injury * Skin changes (acne) * Fetal movements as early as 16 weeks * Uterine Enlargement (fundal height) * Will be determined from ultrasound * Effacement and dilation * Breast development for milk production * Hormonal changes * Increased respiratory rate and tidal volume (restrive pattern) * Blood volume increase (40-50%) * Cardiac output can double or triple by 33 weeks gestation

Answer 50

Severe nausea and vomitting durign preganancy

Answer 51

Fundal height measured from pelvis to rib cage At 36 weeks the uterus should be a few cm under the rib cage

Answer 52

Increased estrogen progesterone and prostaglandins Prostaglandin will be used to keep PDA open

Answer 53

If occurs in 1st semester * fetal in origin due to faulty development If occurs in 2nd semester * maternal factor (ex. trauma, drugs, cervix not supporting fetus, etc)

Answer 54

* Implantation outside uterus * Most common in fallopian tubes * May lead to tubule ruptue which causes a massive hemmorrhage * If it is an ectopic pregancy will have to have an abortion

Answer 55

Gestational diabetes is abnormal glucose intolerance in pregnancy Results in greater risk for congenital anomalies, respiratory distress, and electrolyte disorders With good prenatal care and glycemic control you can expect normal pregnancy outcome The infant of diabetic mother (IDM) is classically a large plethoric infant (\> 4000 gms at birth)

Answer 56

Uncontrolled diabetes = maternal hypertension = can lead to uteroplacental insufficiency and polyhydraminos

Answer 57

Drink glucose drink, test blood glucose Higher than 9mmol = indicates gestastional diabtetes

Answer 58

Occur after 20 week gestation when \>140/90 mmHg or a systolic change \>30 mmHg or diastolic \>15 mmHg Unknown etiology Asmatic women have a higher risk The ultimate treatment will be the delivery of the baby

Answer 59

Hypertension Proteinuria-Frequent urination Edema

Answer 60

systolic change greater 30 mmHg Dys change of 15 mmHg Bp greater than 140/90 mmHg= preeclampsia

Answer 61

Mild preeclampsia may be treated with bed rest, low dose aspirin, salt restrictions, and frequent monitoring

Answer 62

If severe, MgSO4 is added to lessen risk of seizures and as a smooth muscle relaxant

Answer 63

Abruption and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) Delivery should be managed quickly with antihypertensive agents in place

Answer 64

Eclampsia is a sudden progression of preeclampsia where the patient goes into a coma or convulsive seizures Can occur post-partum if patient had preeclampsia

Answer 65

* The routine for preeclampsia * Quick delivery of the fetus * Treatment of symptoms

Answer 66

* An abnormally small amount of amniotic fluid * Cause is usually unknown * Less room for the fetus to grow * Growth retardation/restriction * Pul hypoplasia– diaphragmatic hernia * Agenesis= malformation of organs

Answer 67

Compression of structures as they are growing Anomalies (limb deformities, pulmonary hypoplasia, renal and urinary defects or agenesis) IUGR Compression of the cord Fetal demise

Answer 68

* Too much amniotic fluid [\>2L] * Can over distend the uterus, leading to premature rupture of membranes [PROM] * Associated with anomalies like anencephaly (part of skull missing), esophageal atresia, TE fistula, neural tube defects * Also associated with multiples, hydrops fetalis, maternal diabetes * Cause is usually unknown

Answer 69

abnormal accumulation of fluid in 2 or more units– acites, pl.effusions, pericardial effusions, and skin

Answer 70

Premature separation [from a minor separation to complete detachment] of a normally implanted placenta from the uterus Fetal well being can be seriously compromised Baby or mom can hemorrhage C Section may be considered for prompt delivery Etiology is mostly unknown, with a high correlation to preeclampsia

Answer 71

Placental implantation over or near the internal os From partial occlusion/covering to complete obstruction of the os If the fetus or maternal condition is endangered then a cesarean section [C-sec] is almost always performed to deliver the fetus If deemed minor with no compromise àbed rest A C-sec will be done in a total previa

Answer 72

* Usually in the post term baby as they have grown so big that the placenta can no longer meets it needs * Placental aging usually only affects third trimester or post term growth [\> 42 weeks’ gestation] * The delivered infant is considered as small for gestational age or intrauterine growth retardation * Even though they are post term it is because the placenta cant handle it * The younger the babe, the smaller the babe!!

Answer 73

These can give clues for what is happening with the baby Small for gestational age [SGA] : Birthweight \< 10% percentile Large for gestational age [LGA]: Birth weight \> 90% percentile

Answer 74

Small for gestational age or intrauterine growth restriction(IUGR) is defined as an infant whose weight is below the 10thpercentile or more than 2 standard deviations below the mean for its’ gestational age

Answer 75

* Birth asphyxia * More prone to be breech * Hypoglycemia * Polycythemia * Not developing as they should * Thermal instability * Because they are smaller * Persistent fetal circulation * This includes PDA, foramen ovale, etc * Malformations * Outcomes are based on severity

Answer 76

* Any infants whose weight for is above the 90th percentile for gestational age * Usually associated with infants of diabetic mothers but can be seen in infants with anomalies, large infants from large parents, or infants with hydrops * Due to their size these infants are at greater risk of birth trauma * Harder to come out of birth cannal * HIE more common * Umbilical cord around neck more common * Complications can include RDS electrolyte imbalances * Both are mostly in moms with gestational diabetes

Answer 77

Normal presentation Ideal position Head facing posteriorly

Answer 78

Coming out feet first due to a failure to turn Normally this will be identified as a problem before labor May or may not require c section

Answer 79

Frank: butt first, feet near head Complete: knees are bent, feet near butt Incomplete or Footling: one or both feet stretched out below butt

Answer 80

The chin presents first in this position with the neck hyper-extended If the chin is posterior, vaginal delivery is not possible

Answer 81

Brow presentation usually corrects during pregnancy Less severe than face presentation If not, vaginal delivery is not possible

Answer 82

When the fetus presents with the long axis of it’s body not parallel to the mother’s They could present as should fisrt and if they can be manipulates so that mom can still give birth vaginally May present shoulder first or may turn as they proceed down the birth canal If the fetus can be manipulated, vaginal delivery can be accomplished BUT if not, caesarean is the only option

Answer 83

An Rh(D) Negative mom is impregnated by a Rh(D) + man The mom will become exposed to fetal RBC which can leak across the placenta and stimulate antibody production Will not affect the first pregnancy but will affect subsequent pregnancies

Answer 84

May be detected on amniocentesis through hyperbilirium

Answer 85

* After the 1stsensitization mom’s antibodies will lyse (kill) fetal RBC leading to life threatening anemia in the fetus * This hemolytic anemia trigger fetal bone marrow to release erythroblasts into circulation * Erythroblastosis

Answer 86

* Mom can be given Rh(D) immunoglobin (Id D): Rhogam or WinRho immunoglobin * Usually given at 28 weeks * This is if we identify the problem before the RBC begin to lace * Intrauterine transfusions will be given through the umbilicus every 2 weeks

Answer 87

If there is a suspected isoimmunization, the mom is continually tested for Rh levels If they rise, amniocentesis will be done to monitor bilirubin levels – high levels indicate impending fetal death

Answer 88

Newborns with Erythroblastosis fetalis will usually have exchange transfusion done after birth Severe Erythroblastosis fetalis in a newborn results in hyperinsulinism, edema and fluid overload, heart + liver + kidney failure, RDS

Answer 89

Abnormal accumulation of fluid which can lead to severe life threatening swelling and edema due to blood incompatibility of mom and baby Abdomen (ascites) Thorax (pleural effusions) Pericardiac sac (pleural effusion) Associated with polyhydramnios (too much amniotic fluid) and placental edema 2 types immune and nonimmune

Answer 90

Complication of blood group incompatibility between the mother and baby. This type of hydrops is uncommon, however, because of the widespread use of Rh immunoglobulin treatment for Rh negative women.

Answer 91

This is the more common type. It can result when diseases or complications interfere with the baby's ability to manage fluid. Severe anemias Congenital infections (infections present at birth) Heart or lung defects Chromosomal abnormalities and birth defects Liver disease

Answer 92

Large amounts of amniotic fluid Thickened placenta Ultrasound of the fetus shows enlarged liver, spleen, or heart, and fluid buildup surrounding the fetus' abdomen, heart, and lungs

Answer 93

Pale coloring Severe swelling overall, especially in the baby's abdomen Enlarged liver and spleen Respiratory distress (difficulty breathing) Usualy from the huge abdomine but there are also reason affecting bretahing

Answer 94

Membrane has ruptured prior term Preterm baby where the water has broke before the baby is ready to come out Prolonged rupture of membrane (ROM) for more than 24 hours can lead to a greater risk of infection and sepsis Diagnosis is confirmed if amniotic fluid is observed outside the cervix in conjunction with the maternal history: Fever, Malaise, reported ROM

Answer 95

* If the fetus is mature enough (36-38 week), labor will be induced * If not, the mom will be restricted to bed rest, given MgSO4 to prevent contractions (tocolytic)and steroids to improve lung growth as well as antibiotics, amnioinfusion may be necessary * If they know what they are treating they wll use a specific antibiotic if not it will be a broad spectrum one

Answer 96

Prolonged difficult labor and delivery which is secondary to uterine, pelvic, or fetal factors When the 1stand 2ndstages of labor exceed 20 hours

Answer 97

* Dysfunction of the uterus * Contractions are too weak or too strong (obstructing baby from getting out) * Abnormal fetal presentation * Breech, brow position, face position * Fetal head is too large for maternal pelvic opening * Hydrocephalus * Abnormalities in size or shape of the birth canal * Labor that is too long increases mortality of the fetus due to asphyxia, stress, infection * So we will try to quick fix the underlying problem or do an emergency c section

Answer 98

Can occur in larger infants when the anterior shoulder impinges on the pubic bone (Head is popping out but shoulder is stuck) Uncommon Once the head is delivered, the babe is caught by the shoulder and is compressed in the birth canal Speedy manipulationof the infant and delivery are necessary to prevent further infant stress Broken collar bones and broken arms are a risk during extraction

Answer 99

An amniotomy: The doctor ruptures the amniotic sac during a vaginal exam Once the membranes are broken, and if the cervix is ready, labor starts in a matter of hours.

Answer 100

Whenlabor is artificially started with either Prostoglandin or Oxytocin– synthetic hormones that start and progress uterine contractions Indomethathin can also be used Usually given orally but can also be given vagially

Answer 101

Hormone that aids in ripening [soft, thinned out] of the cervix. A gel inserted into the vagina or a tablet given by mouth. May be used alone or with oxytocin. To start the labor

Answer 102

Hormone given to stimulate contractions. Administered continuously via an IV Start low dose and increase as needed until labour is progressing well Usually used to encourage a labour that is stalling.

Answer 103

Premature labor Abnormalities Growth problems Because they are sharing that space Problems with the placenta or cord Mortality increase

Answer 104

But reemmeber not all mom get care duing pregency Can be diagnosed at the 8-11 week ultrasound

Answer 105

Some twin pregnancies will only produce one child, a phenomenon termed as vanishing twin The fetal compartement is absorbed by the other compartment and mom

Answer 106

Increased maternal risk factors include: preterm labor, hypertension, placental abruption, anemia, and urinary tract infections

Answer 107

Prematurity with the average delivery at 32 weeks Lung maturity is accelerated in multiples 31-32 week gestation twins have the same pulmonary function as average 34-35 week singleton infant

Answer 108

Twins weighing less than 2500g also have lower mortality rates than comparable singleton infants Intrauterine growth retardation is also a complication with an incidence of approximately 50-60% Congenital anomalies are also more common in multiples than with singletons, mostly in monozygotic twins that developed from a single zygote Anomalies such as conjoined twins and acardia (absence of a heart) are unique to multiple pregnancies

Answer 109

Twin to twin transfusion is also unique to monozygotic pregnancies: a vascular anastomosis occurs via the shared placenta, with 1 twin receiving most of the blood flow Clinically a twin to twin transfusion is diagnosed via US when there is a size and amniotic fluid level difference between twins

Answer 110

2/3 are dizygotic (fraternal) multiple ova, 2 different sperm = 2 zygotes 2 placentas 2 umbilicals So each baby has its own space

Answer 111

1/3 are monozygotic (identical) single ova, 1 sperm = 1 zygote that will split at the 2 cell stage into 2 1 placenta 2 umbilicals So the babies are sharing space

Answer 112

Any infant less than 37 weeks gestation In most cases the causes of premature labor or premature rupture of the membranes followed by labor is unknown It is important to differentiate the preterm infant from the growth retarded Unknown why one pregnancy ends early and another goes to term

Answer 113

–Low socioeconomic status –Prior prem birth –Multiple gestation –Underlying illness –Maternal age –Uterine or vaginal infections –Stress –Lifestyles: smoking –Fertility enhancement

Answer 114

* Contractions that are regular (unlike Braxton-Hicks-fake contractions) * Discharge * Pressure or cramping * Can also be mistaked for BH * Backache * Severe cramping

Answer 115

Infections due to immaturity of the skin and immune response Jaundice, anemia Retinopathy of Prematurity [ROP] Respiratory Distress Syndrome [RDS] due to immaturity of the lung, then BronchopulmonaryDysplasia [BPD] Inappropriate feeding responses and apneicspells due to immaturity of the CNS Thermal instability NEC, liver, and kidney function problems IVH and neurological deficits due to an immature CNS

Answer 116

32 + weeks: 98% survival 31 – 28 weeks: 90% survival, high risk of deficits 26 – 23 weeks: 40 – 80% survival dependent on gestational age and birth weight, 50% of survivors have serious debilitating deficits Less that 5% of all premature births are in this category, but these babes have the most complications and require the most intensive care Long term chronic issues with survivors include (cerebral palsy (CP), ventilator dependence and CLD, neurodevelopmental challenges

Answer 117

The best preventive measure against premature labor is good prenatal care Preterm labor can be stopped in approximately 50% of patients with bed rest and the use of drugs to decrease uterine activity **Tocolytics** (also called anti-contraction medications or labor repressants) are medications used to suppress premature labor (from the Greek tokos, childbirth, and lytic, capable of dissolving). They are given when delivery would result in premature birth

Answer 118

The process of stopping labor is called Tocolysis Objective * Stop contractions via tocolyticagents like Magnesium Sulfate, Progesterone, Nitrates, and Salbutamol (given via IV) * Delay infection via antibiotics * Labor \> 40 hours( PROM) * Encourage lung maturity if labor is not arrested via corticosteroids(Dexamethasoneor Betamethasone) to promote surfactant production and decrease the severity of neonatal respiratory distress

Answer 119

* Any infant born after 42 weeks gestation is postmature * The causes of postmaturity are generally unknown * Infants will have loose hanging skin on the extremities which can be dry and peeling – caused by decreasing amniotic fluid levels and efficiency of the placenta * Placental insufficiency can lead to asphyxia of the fetus during labor * Postmature infants are at higher risk for meconium aspiration syndrome (because of the spinctertone they can poop in utero) and hypoglycemia (gestational diabetes)

Fetal Development Flashcards

(144 cards)