CEFM - NCC with correct answers

CEFM – NCC What are some important factors (risks) to consider when evaluating a fetal heart rate strip? -correct answer --*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 answer *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 answer *VASOCONSTRICTION* which adversely effects placental perfusion and can lead to: --*IUGR* --*Infarcts* (decreases functional area of the placenta & functional capacity) Placental Infarcts -correct answer - Necrosis of placental villi - Anechoic or Hypoechoic areas in placenta Placental infarcts will do what to the placental function? -correct answer *DECREASE functional area* of placenta *DECREASE functional capacity* What effect can *Diabetes* have on Placental perfusion? -correct answer 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 answer 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 answer 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 answer *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 answer *Secondary Heart BLOCK* *Renal disease* (CKD, etc.) could cause what? -correct answer *Maternal VASOCONSTRICTION* = maternal *vasocontriction* which can lead to interruptions in placental & uterine blood flow --'IUGR' *Thyroid Disease* could cause what? -correct answer *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 answer 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 answer *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 answer 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 answer 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 answer 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 answer 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 answer *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 answer 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 answer Damaged chorionic vessels: *abdominal trauma* *'spontaneous' placental abruption* (or secondary to cocaine, HTN disorders, etc) *Invasive procedures* (amniocentesis, CVS) *Ruptured vasa previa*