NCC EFM Brain Storming Revised QUIZ Test Bank FINAL Exam with Complete Solution 2023 VERIFIED 100%

What are some important factors (risks) to consider when evaluating a fetal heart rate strip? correct answers --*PNLs* (abnormal?) --weight gain/loss --Maternal age --*Gestational age* --*MATERNAL vital signs* --*Membrane status* --*Cervical exam* What are the easiest ways for assessment of maternal oxygenation status? correct answers *Pulse Ox* (& other vital signs, RR) *Blood gas* (if indicated, asthma exacerbation) *Lung soungs* (pneumonia, pulmonary edema?) What effect can *HTN/Preeclampsia* have on the Placenta? correct answers *VASOCONSTRICTION* which adversely effects placental perfusion and can lead to: --*IUGR* --*Infarcts* (decreases functional area of the placenta & functional capacity) Placental Infarcts correct answers - Necrosis of placental villi - Anechoic or Hypoechoic areas in placenta Placental infarcts will do what to the placental function? correct answers *DECREASE functional area* of placenta *DECREASE functional capacity* What effect can *Diabetes* have on Placental perfusion? correct answers Secondary to *Maternal Vasculopathy* & HYPERglycemia* this can lead to: *reduced utero-placental perfusion* = *IUGR* What can change for fetal energy demands when you have a "DIABETIC mother" uncontrolled and there is *Fetal HYPERglycemia & HYPERinsulinemia*? correct answers Fetal hyperglycemia & hyperinsulinemia can cause: *Increased fetal O2 consumption* which may induce *fetal hypoxemia & acidosis* if the O2 needs of the fetus are not met by the placenta. What are some common conditions which could lead to a *POOR maternal Oxygenation status*? correct answers Respiratory DEPRESSION (*Meds or Seizure*) *Pulmonary EMBOLISM* *Pneumonia* *Asthma* *Atelectasis* ARDS *Smoking* *ANEMIA* What are some examples of *collagen-vascular diseases*? HOw does these effect pregnancy? correct answers *Rheumatoid arthritis* *Scleroderma* *SLE* (lupus) = maternal *vasocontriction* which can lead to interruptions in placental & uterine blood flow --'IUGR' What fetal cardiac condition may you see in a mother with *SLE* (systemic lupus erythematosis)? correct answers *Secondary Heart BLOCK* *Renal disease* (CKD, etc.) could cause what? correct answers *Maternal VASOCONSTRICTION* = maternal *vasocontriction* which can lead to interruptions in placental & uterine blood flow --'IUGR' *Thyroid Disease* could cause what? correct answers *Maternal VASOCONSTRICTION* = maternal *vasocontriction* which can lead to interruptions in placental & uterine blood flow --'IUGR' What is the concern with *cardiac disease* in expectant mothers? correct answers Cardiac disease ----> impaired cardiac function or even cardiac failure ---> *Decrease cardiac output* ----> decreased blood flow/oxygen flow through placenta IUGR, etc. What are some common causes of *Maternal HYPOTENSION*? correct answers *Supine hypotension* of pregnancy *VASODILATION* 2/2 epidural This will *DECREASE O2 & blood flow through the placenta*. What are the *Maternal* 'EXTRINSIC factors' which effect delivery of bloos & availability of blood/O2 through placenta? correct answers 1. *Maternal Oxygen status* --fetus relies on the ability of mother to be well-oxygenated Anything that interferes with maternal oxygenation has the potential to compromise the fetus. 2. *Maternal HEMOGLOBIN levels* O2 is released from the maternal Hgb & attaches to fetal Hgb (*O2 carrying capacity*) 3. *Cardiac OUTPUT* -- decreased CO affects blood flow to the uterus & placenta. In terms of Maternal Oxygen Status, in order for there to be *adequate arterial oxygen tension (PaO2)* -- there needs to be what? correct answers PaO2 = immediately available O2 for exchange Needs adequate *maternal ventilation & pulmonary function* What are the *'Placental factors'* which can effect the efficiency of *Uteroplacental perfusion*? correct answers 1. '*UTERINE Blood flow* 2. Damaged chorionic vessels* (leaking into the intervillouos space) 3. *Decrease in SIZE or functioning area* of the *Placenta* 4. *Placental Reserve* There can be Acute vs. Chronic decreases in uteroplacental function. Describe *Uterine BLOOD flow* changes during pregnancy. --rate, % of CO, % to placenta vs. uterus correct answers UTERINE BLOOD FLOW: -Nonpregnancy rate is usually 50ml/min, during *pregnancy = 700ml/min*!! -*10-15%* of total *cardiac output* *70-90%* of this blood flow goes to *PLACENTA/intervillous space* = intervillous space perfusion is dependent on adequate uterine blood flow. Compare Acute vs. Chronic changes in uteroplacental perfusion/function. correct answers *ACUTE*: sudden drop in placental function limits O2 & CO2 exchange which can lead to *fetal asphyxia* *CHRONIC*: if there is a chronic decrease in placental function this may be more likely to limit *carbohydrate transfer* & can lead to fetal growth restriction. Due to high rate of uterin blood flow in pregnancy - what level of decrease can be tolerated prior to severe effects on fetal status? correct answers Uterine blood flow can *decrease by 50%* befoer SEVERE acidosis develops. What are some common causes of *damage to the chorionic vessels* which causes leakage of blood into the intervillous space (fetal-maternal hemorrhage)? correct answers Damaged chorionic vessels: *abdominal trauma* *'spontaneous' placental abruption* (or secondary to cocaine, HTN disorders, etc) *Invasive procedures* (amniocentesis, CVS) *Ruptured vasa previa* What are four main ways that the *size or functional area* of the *placenta* can be compromised? correct answers 1. *ABRUPTION*: decreases the functional AREA of placenta (spontaneous, trauma, procedures) 2. *MATERNAL DISEASE* (HTN) -disease processes can cause smaller placenta -smaller placenta decreases gas exchange results in FGR, asphyxia & malnourishment. 3. *INFECTION* 4. *CONGENITAL DEFECTS* What is the *placental reserve*? correct answers *OXYGEN in the placenta DURING a CONTRACTION* when there is *NO other blood flow entering the placenta* This is the O2 reserve that continues oxygenating the fetus until the contraction ends!!! ----Anything that reduced the size of the placent or the functioning of the placenta decreases the reserve available to the fetus. What are common risk factors for decreased placental perfusion/function? correct answers >> *EXCESSIVE UTERINE ACTIVITY*: *Tachysystole, hypertonus* or leading to Placental abruption. >> ABRUPTION >> *Maternal HYPOTENSION*; when supine or with epidural >> *Maternal HYPERTENSION* >> *Placental changes* --decreased durface area (abruption) --edema (erythroblastosis fetalis) --degenerative changes (HTN, diabetes, post due, IUGR) --Calcifications (smoking, tobacco use) --Infarcts (post due) --Infection (Chorio) >> *Vasocontriction* exogenous mostly sympathomimetics (EXCEPT EPHEDRINE) Why do we give *EPHEDRINE* to expectant mothers who experience *Hypotension* after placement of *Epidural? correct answers HYPOTENSION can lead to decreased placental perfusion (fetal asphyxia/acidosis) *Ephedrine* will cause vasoconstriction to increase blood pressure without further compromise the placental perfusion. erythroblastosis fetalis is what? What can this do to the placenta? correct answers hemolytic disease in the newborn (HDN) caused by a blood group (Rh factor) incompatibility between the mother and the fetus -remember this can cause *EDEMA in the placenta* (thereby compromising plcental perfusion/function) *post-due dates*: will cause what kinds of changes to the placenta? correct answers 'DEGENERATIVE Lesions' > *Calcifications* > *Infarcts* Additionally post-dates is associated with: *Decreased Amniotic fluid* (Oligohydramnios)