Mod 1 fetal development & Maternal problems Flashcards
1.1 Fetal Development, Prenatal Assessment and Pregnancy 2.2 Maternal Health & Prenatal Complications
1
Q
what’s the age range for a neonate?
A
First 28 days of life
2
Q
What is age of viability?
A
- 22-23 weeks
- Age fetus can be resuscitated at delivery and survive w/o significant morbidity
3
Q
Extremely preterm or extremely low birth weight can be expected to be at what range of term?
A
< 28 weeks
4
Q
What is a very preterm baby?
A
Less than 28-32 weeks
5
Q
What is a moderate to late preterm range for a fetus?
A
32-37 weeks
6
Q
Range for baby at term?
A
37-42
7
Q
Define Post term range for a baby?
A
> 43 weeks
8
Q
What are the ranges of each trimester?
A
1st trimester = 0-13 weeks
2nd trimester = 14-27 weeks
3rd trimester = 28 weeks-delivery
9
Q
what are the 3 embryonic germ layers?
A
Ectoderm (outer)
Endoderm (inner)
Mesoderm (middle)
10
Q
5 phases of fetal lung development
A
Embryonic
Pseudoglandular
Canalicular
Saccular
Alveolar
11
Q
What is the estimated date of arrival (EDD) taken from?
A
From date of last menstrual cycle
12
Q
What is viability of the fetus dependent on?
A
Generally speaking, Gestational age bc it determines how much of the babe has developed. That being said:
- Stability and maturity of CNS (and protective mechs)
- Circulatory system
- Respiratory system
- musculoskeletal system
- Integrity of the skin
13
Q
What develops in the ectoderm?
A
- CNS and PNS
- Sensory epithelia of eyes, inner ears, nose
- Skin (epidermal layer)
- Teeth (enamel)
14
Q
What develops in the ectoderm phase from the CNS and PNS?
A
CNS: Brain and spinal chord
PNS: Cranial + spinal nerves
15
Q
What develops from the mesoderm layer?
A
Cardiovascular system
lymphatic system vessels
All connective tissue and muscle tissue
- skin
- kidneys and ureters
- reproductive tissue
- the 3 major body cavities
- serious lining of organs
- Teeth
16
Q
What develops from the endoderm layer?
A
Digestive system
Respiratory system
Urinary system
Liver and pancreas
Tonsils etc.
epithelial lining of auditory tube and tympanic cavity
17
Q
what are the 3 stages of development (for pregnancy)?
A
- Conception
- Embryonic stage
- Fetal development
18
Q
What happens during the conception stage of development?
- What is the range?
A
The ovum and sperm unite
- Occurs during the First 2 weeks of pregnancy
19
Q
What happens during the embryonic stage of development?
What is the range?
A
- Embryo development
- major organs (heart + CNS begin to develop)
- Occurs during weeks 3-8, but can continue to week 12
20
Q
What happens during fetal development?
When does it occur?
A
Most lung development occurs during this stage
occurs @ weeks 13-40
21
Q
what happens 5 days after fertilization of a egg?
(5 things happens)
A
- blastocyst combines w/tissue in the endometrium to form the chorionic membrane
- outer tissue envelops the embryonic structure and forms the amniotic sac
- Amniotic sac surrounds the entire embryo
- Embryo attaches via umbilical stalk -> turns into umbilical cord
- umbilical cord vili (where gas exchange occurs) connects to outer lining of the chorion
22
Q
During Fetal development, in what order do the following develop?
- Alveolar sac
- Bronchi
- Terminal Bronchioles
- Respiratory bronchioles
- Bronchioles
- Alveolar ducts
A
- Bronchi
- Bronchioles
- Terminal Bronchioles
- Respiratory bronchioles
- Alveolar ducts
- Alveolar sacs
23
Q
Why is age of viability important?
A
- Babe can be resuscitated (wks 22-23)
- Surfactant typically developments in weeks (24-28)
- Surfactant is immature at week 26 and matures around weeks 28+
- Surfactant is crucial to gentle ventilation
24
Q
When does the Embryonic phase generally occur?
- and what is most notable about this phase?
A
- conception to around week 8
25
What are some complications during the Embryonic phase of development?
1. When the trachea forms, there can congenital defects (tracheoesophageal atresia, trachea stenosis).
2. Diaphragmatic Hernia
26
What is most notable about the embryonic phase?
- **The respiratory epithelium begins to grow**
- pharynx forms from endoderm
- **Lung buds form** (left and right)
- **Diaphragm forms**
- Pulmonary interstitial, smooth muscle, and blood vessels begin to form
27
When does the pseudoglandular phase occur?
Arounds week 8-16
28
What is most notable about the pseudoglandular phase?
Formation of conduction airways (complete) and development of Terminal bronchioles (immature)
- lobes complete ( 3 right, 2 left)
- cartilage beings to form around airways
- Cilia develop
- presence of mucus, goblet cells, and bronchial glands
- Pulmonary vasculature develops
- **Larynx** begins developing
- **Oropharynx and nasopharyngeal** develop
29
what are some complications that occur during the pseudogalndular phase?
Congenital disorder can development in the oropharynx/nasopharyngeal
- Choanal atresia
30
When does the Canalicular phase occur?
Weeks 16-26
31
What is most notable about the Canalicular phase?
- **surfactant becomes to form.**
- they’re viable because we can provide it for them
they also have the framework for that (systems)
- can start to test at this range *aka can sample amniotic fluid to gauge condition*
32
What develops in the canalicular phase?
- Immature surfactant (begin to differentiate between type I and type II cells)
- Capillary network forms
- Airway complete branching
- Acinar units appear
- Fetal lung fluid
33
When does gas exchange become possible in a developing fetus?
During the Canalicular phase, around weeks 22-24
34
What is apart of the Acinar?
- Respiratory bronchiole
- alveolar ducts
- alveolar sacs
35
What are premature neonates susceptible to during the canalicular phase?
RDS
36
when does the saccular phase occur?
Weeks 26-36
37
what is notable about the saccular phase in fetal development?
Last gen of growth in airways
- Immature alveoli (saccules) form
- **Surfactant Matures @ week 35**
38
When does the alveolar phase occur?
Week 36 to term
39
What is notable about the alveolar phase of fetal development
- Immature alveolar saccules mature to alveolar sacs
- O2 uptake increases
- Alveoli proliferate into millions by full term birth (continues till ages 8-10)
40
When would you provide glucoticoidsteroids?
Given systemically to moms to help **accelerate lung maturation** of baby
- its a type II pneumocytes
41
what is pulmonary hypoplasia
When there is a growth limitation in lung development
42
what are 3 tests for examining fetal lung maturity?
1. L/S Ratio
2. PG presence
3. S/A ratio
43
In a fetus what is hypoxic pulmonary vasoconstriction and why does it occur?
Hypoxic pulmonary vasoconstriction occurs when there is low O2 in the lungs, causing the arteries to all constrict, increasing resistance in the pulmonary arteries.
44
What conditions would you expect to increase lung maturation of a fetus?
- Giving birth to multiples
- Glucocorticoid steroids (Type II pneumocytes)
45
In a fetus, what conditions would slow down lung development?
- Maternal diabetes
- Chest wall compression (diaphragmatic hernia)
- Oligohydramnios
- Diminished respirations in utero
- Other hormonal/metabolic abnormalities
46
what is Oligohydramnios?
Decreased amniotic fluid
47
Immature surfactant production begins in which phase?
Canalicular phase
48
when does immature surfactant mature?
at 35 weeks gestation
49
What does mature surfactant gain when it reaches full maturation?
**lipids and glycoproteins**
- phosphatidylcholine
- and Phosphatidylglycerol (PG)
50
What phases does surfactant mature?
Saccular, but potentially Alveolar phase as well.
51
What are characteristics/traits of Type I pneumocytes (Surfactant)?
Type 1 pneumocytes facilitate gas exchange
- structure of the alveoli
- Gas permeable membrane area
- flat
52
What are characteristics/traits of Type II pneumocytes (Surfactant)?
Cuboidal in shape, they produces:
- Type I cells,
- surfactant
- fetal lung fluid
53
Infants born before mature surfactant is present are at risk of what?
- what is the treatment?
At risk of RDS
- admin surfactant within 1 hour after birth
54
What is the golden hour?
Time frame to admin surfactant to a baby lacking mature surfactant
- basically supportive management in the first hour that determines if a babe lives.
55
Factors that affect surfactant
- Aspiration syndromes
- Meconium
- Severe bleeding (pulmonary hemorrhage)
- Amniotic fluid
- PDA
56
How is fetal lung fluid different from amniotic fluid?
- Lower pH, HCO3, and protein levels
- Higher sodium and chloride concentrations.
57
How much fluid do fetal lungs secrete a day?
250-300 mL
58
What do we analyze to determine if fetal lungs are at full maturity?
Fetal lung fluid
59
How is fetal lung fluid removed from a baby at birth?
- Decreased production in late gestation
- Contractions during vaginal delivery
- Lymphatic absorption after birth
60
Fetal Lung Maturity Testing: What is the L/S ratio and what do we ideally want?
Tests the ratio of Lethicin to sphingomyelin
- Week 31-32 = 1:1
- **Week 35 gestation 2:1 (only 2% chance of RDS @ this ratio)**
- we want a ratio of 2:1 or greater at week 35
61
What does the ratio 2:1 mean from the L/S ratio?
The lecithin to sphingomyelin ratio of 2:1 or greater is characteristic of **mature fetal lungs** (around wk 35)
- Fetuses delivered prior to this gestational age are at increased risk of neonatal respiratory distress syndrome. (before week 35)
62
Fetal Lung Maturity Testing: what is PG presence?
- why is it important?
- when does it appear
- It indicates surfactant maturity
- Appears around week 35
- Good predictor of lung maturity, but not maturity
- full name of PG is Phosphatidylglycerol/Phosphatidylcholine
63
Fetal Lung Maturity Testing: What is the S/A Ratio?
- what does it tell us?
- why is it important?
Measures concentration of albumin and surfactant.
- only requires a small amount of amniotic fluid
- > 55 mg of surfactant per 1 g of albumin indicates maturity
- < 40 mg surfactant per 1 g of albumin indicates immature
64
What is the primary function of amniotic fluid?
- Protects the fetus from injury (cushions)
- Control thermal environment
- Assists in effacement and dilation of the cervix during labour
65
What is amniotic fluid composed of?
- Maternal blood products
- Amniotic cells
- fetal skin, hair, & urine
66
How much amniotic fluid is produced in the period of a term?
1.5L by term
- Begins production at week 10, 30mLs are produced a day.
67
How much fluid does a fetus swallow a day?
500 mLs, it also excretes the same amount of hypotonic urine back into the mix
68
Fetal Heart Development: Label the following structures
69
How does fetal circulation differ from adult circulation?
Blood is mostly shunted around the lungs
70
Fetal circulation: Describe how vascular resistance differs from adults
Fetus have high vascular resistance in pulmonary circulation and low vascular resistance in the systemic circulation.
71
Why do fetus's have low systemic vascular resistance?
The placenta
- It has a large volume (surface area) and has a very low resistance.
72
In adults, pulmonary vascular resistance is usually low and systemic high.
- Why do fetus's have high vascular resistance in pulmonary circulation?
- Vasoconstriction is response to low PO2's
- Fluid filled lungs pressing on vasculature
73
Fetal Circulation:
1. What are SaO2 saturations throughout normal fetal circulation?
2. What SaO2 is blood throughout fetal circulation from umbilical vein to mom and back to the placenta?
Umbilical vein = SaO2 80%
Right Atrium (RA) = 40%
Left Ventricle (LV) = 65%
74
what does the placenta develop from?
**The Chorionic villi**
- where gas exchange occurs
- Turns into the embryonic blastocyst
- The blastocyte expands and grows into the placenta
75
what are the parts make up the chorionic villi?
- The maternal compartment
- The fetal compartment
76
What is the function of the Chorionic Villi?
Site of maternal and fetal passive exchange of nutrients and waste.
- A structural anchor
- exchange of gases, nutrients, & metabolic wastes
77
What are some precautions for the mother that involve the Chorionic Villi/Placenta?
Toxic substances (alcohol, nicotine, opiates, cocaine, caffeine) and some infectious organisms (rubella) and viruses (HIV) can pass to the fetus
78
Describe the role of the Umbilical Vein in fetal circulation
**Returns *oxygenated blood* from the placenta.**
- Enters the fetal body through the umbilicus
- Connects to fetal circulation under the liver
- Diverts with 50% of blood going through liver, the rest diverting to become the ductus venosus
79
Describe the role of the Ductus Venosus in fetal circulation
- Shunt that allows about 50% of blood returning from placenta
- Drains into the inferior vena cava, then the right atrium
80
Describe the role of the Foreman Ovale in fetal circulation
- Once in the right atrium, this second shunt is encountered
- **Foramen Ovale is a one way valve allowing for blood to pass through the atrial septa into left atrium**
- Right side pressures in the heart are greater than the left, keeping the foramen ovale open until after birth
81
Why is pressure higher on the right side of the heart?
- Low resistance in placenta (little back pressure on left side of heart)
- High Pulmonary Vascular Resistance
82
Describe the role of the Ductus Arteriosus in fetal circulation
- Small vessel connecting the pulmonary artery with the descending (thoracic) aorta
- Blood from right ventricle is diverted into either the pulmonary circulation or the ductus arteriosus
- Allows more blood to detour into the systemic circulation without going through the fetal lungs
83
Describe the role of the Umbilical Arteries in fetal circulation
Carry *deoxygenated* fetal blood to the placenta
- Extensions of the internal iliac arteries
84
What prevents the umbilical cord from being bent or squished?
Whartons Jelly
85
What is the umbilical cord composed of?
3 vessels and gelatinous material.
- 2 small arteries
- 1 large vein
- Wharton's Jelly
86
For a developing fetus, where does gas exchange occur?
The placenta.
87
Why does maternal blood have high PO2 w/a low pH?
The oxyhemoglobin curve shifts right.
- Decreases the affinity of Hgb for o2 = easy offloading of O2 to fetal blood
88
Why does fetal blood have low PO2?
Fetal lungs do not participate in gas exchange in utero.
- The fetal pulmonary vascular resistance is very high, and the pulmonary circulation only receives 16–21% of the combined ventricular cardiac output
- Oxyhemoglobin shifts left, allowing easy uptake of O2 by fetal blood.
- Fetal Hgb also has the ability to combine with O2 to a greater extent than adult Hgb
89
When is immature Hgb in a fetus mature?
Replaced by adult hemoglobin about 6 months postnatal
90
Does fetal blood have low or high PO2?
Low
91
Does maternal blood have:
- high or low PO2?
- High or low pH
High PO2 w/low pH
92
What is a baby at risk of if the mother has maternal diabetes?
RDS
93
Why is compression a issue in lung development?
Left lung can be underdeveloped (hyperplasticity) as a result of chest wall compression
- the same applies w/amniotic fluid
94
Type II pneumocystis are made up of lipids and proteins, which protein is important for testing lung growth?
Phosphatidylglyercol (PG)
95
Respiratory exchange for a fetus happens in the placenta, what structure does gas exchange occur in?
Coronic Villa
96
Which duct is important to shunt blood back into the IVC?
**need to confirm**
Ductus venous
97
How can nurses deliver fluids to the baby?
Through the Umbilical cord via cannulation.
98
What are the risks of maternal smoking?
Increased risk of:
- preterm birth & low birth weight
- SIDS (smoking before/after birth)
- Nicotine can damage developing brain and lungs
- hypoxic ischemic injury
99
Opioid use during pregnancy can result in what?
- neonatal abstinence syndrome (NAS)
- Maternal overdose/death
- preterm birth & low birth weight
100
What are treatment plans for a mother w/opioid use?
Methadone and buprenorphine programs
- used to help wean bc they have weak affects
101
What tests can be done to assess the fetus?
Antenatal Assesments:
- Ultrasound
- Nuchal translucency
- Amniocentesis (guided via ultrasound)
- Nonstress test
- Contraction stress test
- Biphysical profiles (BPP)
102
what do ultrasounds assess?
Estimated gestational age & view of baby development.
- Fetal viability & activity
- Reveals potential defects, i.e CNS defects, cardiac defects, renal defects
103
When are dating ultrasounds performed?
8 Weeks
104
When are Nuchal scans performed?
11-12 weeks
105
When are anatomy scans performed?
18-20 weeks
106
What are hallmark of Nuchal translucency scans?
They look at the nuchal fold in the neck of the fetus
- A wider fold = chromosome defect
- 70% detection rate of down syndrome with 91% accuracy.
107
When should prenatal care begin?
- why is it important?
6-8 weeks of pregnancy
- Purpose is to identify any potential problems so that interventions can be done asap
108
What changes can be expected to occur to moms.to prepare for pregnancy?
- Frequent urination
- Nausea and vomiting onset at 4-6 weeks gestation
- Increased Relaxin (skin/cartilage stretch & relax)
- Uterine enlargement (fundal height) @ 36 weeks, the uterus should be a few cm under the rib cage
109
How early can fetal movement be expected?
16 weeks
110
What changes can be expected to occur to mom to prepare for pregnancy?
Effacement and dilation
- Breast development for milk production
- Increased estrogen, progesterone, and prostaglandins
- Increased RR and Vt (restrictive pattern)
- Blood volume increases by 40-50%
- Cardiac output can double or triple by 33 weeks gestation
111
What are maternal risk factors for the age demographic of < 18?
Risk of spontaneous abortion or prenatal care
112
What are maternal risk factors for the age demographic of > 35
Risk of genetic disorders
- down syndrome
- Age 20 = 1/1500 chance
- age 45 = 1/30 chance
113
What are maternal risk factors that would effect the fetus/newborn?
- Preterm
- lifestyle considerations
- Hypertension & diabetes
- Infectious diseases
- Fetal membranes, umbilical cord, & placenta
- Disorders of amniotic fluid volume
- mode of delivery
114
Asthma severity varies in pregnancies, what are physiological changes that effect asthma?
- Diaphragm rises 4cm (**reduces ERV and RV**)
- 20% **increase in O2 consumption**
- 15% **increase in maternal metabolic rate**
- Congestion of upper respiratory tract
- GERD
115
Complications and Risks of asthma during pregnancy?
- Potential loss of control of asthma during pregnancy
- Medications used to treat asthma
- Hypoxia (Mom and fetus)
- Respiratory Tract Infections
- Smoking during pregnancy
- Postpartum control
116
what risks are associated with tobacco during pregnancy?
- Preterm birth & low birth weight
- SIDS (Sudden increase death syndrome)
- hypoxic ischemic injury
- Nicotine can damage developing lung + brain
117
Opioid use during pregnancy can result in?
- Neonatal abstinence syndrome (NAS)
- maternal overdose/death
- Preterm birth & low birth weight
118
What is neonatal abstinence syndrome (NAS)?
Conditions caused when a baby withdraws from certain drugs he's exposed to in the womb before birth.
- linked to fentanyl crisis
119
Treatment for neonatal abstinence syndrome (NAS)
- how would timeline of treatment change?
During pregnancy:
- Med assisted with methadone or buprenorphine
- post term baby would be slowly weaned w/methadone
120
What is amniocentesis?
A needle is used to pierce & obtain amniotic fluid sample.
- **Tests lung maturity**
- **Guided/in conjunction w/ultrasound** around 15-18 weeks
- May be tested for gender, Rh isoimmunization, chromosomal abnormalities [trisomy 21], fetal enzyme deficiencies, certain genetic mutations, spina bifida, bleeding disorders
121
What are the indications for amniocentesis?
Indicated for moms over 40 w/previous children w/abnormalities
122
What is a Nonstress Test (NST)?
Measure's fetal heart rate by assessing spontaneous movement
- **When the fetus moves, the heart rate increases**
- Reflects normal uteroplacental function and predicts normal fetal survival
123
What is a Contraction Stress Test (CST)
Used to assess viability of the uterus/placenta
- Done when lack of movement is noted later in pregnancy
- Monitors fetal heart during induced contractions (oxytocin) to put stress on the fetus and assess response
124
What does a positive Contraction Stress Test (CST) indicate?
More than 50% of the contractions results in late decelerations
- **indicates poor fetal outcome**
125
What is spontaneous abortion and what does it occur most often?
Miscarriage.
- It occurs most during the first trimester.
- Second trimesters are usually a maternal factor
126
Why does spontaneous abortion occur?
Faulty development where placental fragmentation occurs or there are malformations.
- Or the fetus is absent entirely
127
What is a ectopic pregnancy?
- what are the involved risks?
- Implantation occurs outside the uterus in the cervix, pelvic cavity, fallopian tubes [most common]
- May lead to tubule rupture and if so there is the possibility of massive hemorrhage
128
What is Maternal Diabetes Mellitus?
Gestational Diabetes is abnormal glucose intolerance resulting from the stress of pregnancy
- Women with good prenatal care + glycemic control (through lifestyle, metformin or insulin) can expect normal pregnancy outcomes
- Mom is at increased risk for developing Type 2 diabetes and gestational diabetes in other pregnancies
129
What are the risks associated w/ Maternal Diabetes Mellitus
Uncontrolled diabetes = maternal hypertension = can lead to uteroplacental insufficiency and polyhydraminos
- Infants of any type of diabetic mother have a greater risk of congenital anomalies, respiratory distress (Respiratory Distress Syndrome), and electrolyte disorders (especially Glucose-infant sugars are monitored post birth)
130
When does preeclampsia occur?
20 weeks of gestation?
131
What the key signs/symptoms normally associated w/Preeclampsia?
Unknown etiology; characterized by a sudden increase in blood pressure
The triad of:
- hypertension
- proteinuria (excess protein in urine) -> kidney problem?
- Edema
132
How is mild preeclampsia treated?
Mild can be treated with:
- Best rest
- low dose of aspirin
- Salt restrictions
- frequent monitoring
- Delivery should be managed quickly with antihypertensive agents in place
133
How is severe preeclampsia treated?
MgSO4 to lessen risk of seizures.
- MgSO4 is a smooth muscle relaxant
- Delivery should be managed quickly with antihypertensive agents in place
134
What are major complications of preeclampsia?
Abruption (placental separation from uterine wall) and HELLP syndrome (high BP).
- hemolysis
- elevated liver enzymes
- low platelets
135
What is HELLP syndrome?
A severe form of preeclampsia characterized by high blood pressure and damage to organs like the liver and kidneys.
HELLP stands for:
- Hemolysis (breakdown of red blood cells)
- Elevated Liver enzymes (indicating liver dysfunction),
- Low Platelet count (indicating problems with blood clotting).
136
What is Eclampsia?
- when does it occur?
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
137
What is the treatment for Eclampsia?
- The routine for preeclampsia
- Quick delivery of the fetus
- Treatment of symptoms
138
What is Oligohydramnios?
An abnormally small amount of amniotic fluid, meaning less room for the fetus to grow.
- Cause is usually unknown
139
What does Oligohydramnios lead to?
- IUGR
- Compression of structures as they grow as well the cord
- Fetal demise
- Anomalies (limb deformities, pulmonary hypoplasia, renal and urinary defects or agenesis)
140
How is Oligohydramnios treated?
Amnioinfusion if fetus at risk.
- AKA adding amniotic fluid to the uterus.
- It's most commonly performed during labor when a fetus shows signs of a slow or irregular heart rate due to low amniotic fluid.
141
What is Polyhydramnios?
Too much amniotic fluid [>2L]
- Can over distend the uterus, leading to premature rupture of membranes [PROM]
- Cause is unknown
- Associated w/ multiples, hydrops fetalis, & Maternal diabetes
142
What is IUGR?
IUGR stands for "Intrauterine Growth Restriction"
- A condition in which a developing fetus fails to grow at the expected rate for its gestational age.
- TLDR: Inadequate growth of the fetus while it is still in the womb. Also referred to as Fetal Growth Restriction
143
What anoamlies are usually associated w/Polyhydramnios?
anencephaly, esophageal atresia, TE fistula, neural tube defects
144
What is Abruptio Placentae?
Premature separation [from a minor separation to complete detachment] of a normally implanted placenta from the uterus
- baby or mom can hemorrhage
- C section may be considered
145
What is Placenta Previa?
Placental **implantation over or near** the internal os
From partial occlusion/covering to complete obstruction of the os (bottom, **opening of the vagina** basically)
- C-section always performed
146
What is Placental Insufficiency?
The placenta fails to meet demands of the fetus as it ages.
- delivered infant is considered as small for gestational age or intrauterine growth retardation
147
which term is affected by placental aging?
Third trimester or post term growth [> 42 weeks’ gestation]
148
What are outcomes of IUGR?
Outcomes are based on severity:
- Birth asphyxia
- Hypoglycemia
- Polycythemia
- Thermal instability
- Persistent fetal circulation
- Malformations
149
What is considered large for gestational age?
- Complications?
Any infants whose weight is above the 90th percentile for gestational age
- Complications can include RDS, electrolyte imbalances
- Due to their size these infants are at greater risk of birth trauma
- Usually associated with infants of diabetic mothers but can be seen in infants with anomalies, large infants from large parents, or infants with hydrops
150
How is Rh(D) Isoimmnization detected?
Amniocentesis
151
What is Rh(D) Isoimmunization?
- What is a primary complication?
The mom creates antibodies to the fetus.
- Mom is exposed to fetal RBCs which leak across the placenta, stimulating antibody production.
152
What conditions are needed to cause Rh(D) Isoimmunization?
when an Rh(D)– mom is impregnated by an Rh(D)+ man
153
What is hemolytic anemia?
A disorder in which red blood cells are destroyed faster than they can be made.
- The destruction of red blood cells is called hemolysis.
154
Why compilations can be expected after subsequent pregnancies following Rh(D) Isoimmunization?
Moms antibodies will lyse (kill) fetal RBC's leading to life-threatening anemia in the fetus.
- Fetal bone marrow is releases erythroblasts into circulation
155
What is Erythroblastosis?
When bone marrow is stimulated in releasing erythroblasts into circulation
156
How is Rh(D) Isoimmunization managed/treated?
The mom can be treated with Rh(D) immune globulin (D Ig): Rhogam or WinRho immunoglobulin
- usually given at 28 weeks
157
If Rh levels rise are found, what is done to monitor and manage Rh levels?
- Amniocentesis will be done continually to monitor bilirubin levels.
- Intrauterine transfusions will be given q2weeks
158
What do high Rh levels indicate?
High levels indicate impending fetal death
159
Newborns w/Erythroblastosis fetalis will usually have what done after birth?
Transfusions
- Severe Erythroblastosis fetalis in a newborn results in hyperinsulinism, edema and fluid overload, heart + liver + kidney failure, RDS
160
What complications can be expected from a baby w/erythroblastosis fetalis
Severe Erythroblastosis fetalis in a newborn results in:
- hyperinsulinism
- edema
- and fluid overload, heart + liver + kidney failure, RDS
161
Generally, what is Hydrops Fetalis?
- Why does it develop?
- What categories are involved with it?
Abnormal & severe accumulation of fluid (edema).
- Hydrops develops when too much fluid leaves the baby's bloodstream and goes into the tissues.
- 2 groups: Immune and non-immune
- Severe problem w/50% survival prognosis
162
What is immune hydrops fetalis?
Complication of blood group incompatibility between the mother and baby.
- Uncommon type, b/c of the widespread use of Rh immunoglobulin treatment for Rh negative women.
163
What is Nonimmune Hydrops Fetalis?
*common type*
It can result when diseases or complications interfere with the baby's ability to manage fluid, such as:
- Severe anemias
- Congenital infections (infections present at birth)
- Heart or lung defects
-Chromosomal abnormalities and birth defects
- Liver disease
164
What are conditions are typically associated w/hydrops fetalis?
- *hint* which areas are affected in the body?
Fluids where they shouldn't be.
- Associated with polyhydramnios and placental edema
- Abnormal accumulation of fluid
- Abdomen (ascites)
- Thorax (pleural effusions)
- Pericardiac sac (pleural effusion)
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What managements plan is typically initiated for Hydrops Fetalis?
- Intentional premature delivery for babies safety
- Percutaneous chest tube insertion after birth to optimize chest expansion, lung recruitment, and optimize resuscitation success
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Symptoms of Hydrops Fetalis during pregnancy?
- Large amounts of amniotic fluid
- Thickened placenta
- Ultrasound of fetus shows enlarged liver, spleen, heart, or fluid buildup surrounding fetus abdomen, hearts, and lungs
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Symptoms of Hydrops Fetalis after birth?
- Pale coloring
- Severe swelling overall, notably in babies abdomen
- Enlarged liver and spleen
- RDS (trouble breathing)
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What is Premature/Prelabour Rupture of the Membranes [PROM]?
Membranes rupture w/o going into labor
- If fetus is mature enough labor is induced.
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What period of time is Premature/Prelabour Rupture of the Membranes [PROM] a risk?
Prolonged PROM > 24hrs leads to risk of intrauterine infection and sepsis
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How is Premature/Prelabour Rupture of the Membranes [PROM] diagnosed?
Confirmed if amniotic fluid is observed outside the cervix in conjunction with maternal history:
- Fever
- Malaise
- Reported ROM
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What treatments should be initiated If Premature/Prelabour Rupture of the Membranes [PROM] is confirmed and fetus is not mature enoug?
- Best rest
- MgSO4 to prevent contractions (tocolytics)
- Steroids to improve lung growth as well as antibiotics
- amnioinfusions may be necessary
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What is shoulder dystocia?
When babes shoulder is caught and compressed in the birth canal (head already delivered)
- Collar bones and broken arms @ risk during extraction
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What is a Amniotomy?
The physician ruptures the amniotic sac during a vaginal exam.
- Once the membranes are broken and the cervix is ready, labor starts in a matter of hours
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How is induction of labor started?
Prostaglandin or oxytocin are given to start/progress uterine contractions.
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What is prostaglandin?
Hormone that aids in ripening of the cervix
- A gel inserted inserted into vagina or tablet give PO
- may be used w/oxytocin
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What is Oxytocin?
Hormone given to stimulate contractions.
- Usually used to encourage a labor that is stalling
- Admin'd continuously via IV
- Low dose, increases as needed until labor is progressing well.
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What are some increased risks due to multiple gestations to the fetus?
- *Premature labor*
- Abnormalities
- growth problems
- Problems w/placenta or cord
- mortality increased
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What is the difference between fraternal and identical twins?
2/3 are dizygotic (fraternal)
- multiple ova, 2 different sperm = 2 zygotes
- 2 placentas
- 2 umbilical's
1/3 are monozygotic (identical)
- single ova, 1 sperm = 1 zygote that will split at the 2 cell stage into 2
- 1 placenta
- 2 umbilical's
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What are some increased risks due to multiple gestations to the mother?
- Preterm labor
- Hypertension
- Placental abruption
- Anemia
- UTI
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How are multiple gesations detected?
Ultra sound.
- Some twin pregnancies will only produce one child, a phenomenon termed as vanishing twin
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With multiples in gestation, how early can prematury be?
Can be accelerated to weeks 31 and 32.
- Intrauterine growth retardation is also a complication with an incidence of approximately 50-60%
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What are 2 abnormalities unique to multiple pregancies?
Conjoined twins and acardia (absecence of heart)
- mostly in monozygotic twins that developed from a single zygote
- 1 twin may also get more blood flow (1 big baby and one small)
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What is abnormality is common w/invitro fertilization
triplets, quads, and quints
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What is considered a premature baby?
Any infant less than 37 weeks gestation.
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What are signs of premature labor?
- Contractions that are regular (unlike Braxton-Hicks)
- Discharge
- Pressure or cramping
- Backache
- Severe cramping
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What is bronchopulmonary dysplasia?
Lungs and the airways (bronchi) are damaged, causing tissue destruction (dysplasia) in the tiny air sacs of the lung.
- chronic lung disease that affects newborns, most often those who are born prematurely and need oxygen therapy.
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What is Respiratory Distress Syndrome (RDS)?
A condition in newborns caused by a lack of surfactant causing lung collapse.
Symptoms include:
- rapid and shallow breathing
- **grunting**
- nasal flaring
- chest retractions
- cyanosis
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Treatments for respiratory distress syndrome (RDS)?
- Providing artificial surfactant
- mech. ventilation w/PPV
- Warm and humified environment
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What are complications associated w/prematurity?
**Respiratory Distress Syndrome [RDS] due to immaturity of the lung, then Bronchopulmonary Dysplasia [BPD]**
- Infections due to immaturity of the skin and immune response
- Jaundice & anemia
- Retinopathy of Prematurity [ROP]
- Inappropriate feeding responses and apneic spells due to immaturity of the CNS
- Thermal instability
- NEC, liver, and kidney function problems
- IVH and neurological deficits due to an immature CNS
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Survival statistics of premature babies?
- 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
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What is the best preventive measugre against premature labor?
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
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What are Tocolytics?
Anti-contraction meds (labor represents)
- used to suppress premature labor or when delivery would result in premature birth.
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What is the treatment of premature labor called and what does it do?
- *hint* there are 3 objectives
Tocolysis.
1. **Stop contractions** via Tocolytic agents (MgSO4, progesterone's, nitrates, and salbutamol)
2. **Delay infections via antibiotics**
3. **Encourage lung maturity via glucocorticoids** (dexamethasone's or betamethasone) to promote surfactant production and decrease RDS.
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What is considered postmaturity
Infants born after 42 weeks.
- Infants will have loose hanging skin on the extremities which can be dry and peeling.
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Why would a postmature baby have loose & dry skin?
Decreasing amniotic fluid levels and efficiency of the placenta as the normal term date passes
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What is a severe risk factor of post maturity
- Placental insufficiency can lead to asphyxia of the fetus during labor.
- Higher risk for meconium aspiration syndrome and hypoglycemia
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What is the Biophysical Profile [BPP]
Helps practitioners observe the fetus's heart rate, breathing, movement, muscle tone, and the **amount of amniotic fluid surrounding the fetus** in the uterus.
- performed in the 3rd trimester, around wks 32-34
- **guided by ultrasound to assess components**
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For babes at risk of RDS, what should you do to manage them after birth?
**BLES**
- Goal is to administer surfactant within 1 hour after birth **(Golden Hour)**
