CEFM – NCC Study Guide
What are some important factors (risks) to consider when evaluating a fetal heart rate strip? ANS: --
*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? ANS: *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? ANS: *VASOCONSTRICTION*
which adversely effects placental perfusion and can lead to:
--*IUGR*
--*Infarcts* (decreases functional area of the placenta & functional capacity)
Placental Infarcts ANS: - Necrosis of placental villi
- Anechoic or Hypoechoic areas in placenta
Placental infarcts will do what to the placental function? ANS: *DECREASE functional area* of placenta
*DECREASE functional capacity*
,What effect can *Diabetes* have on Placental perfusion? ANS: 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*? ANS: 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*? ANS:
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? ANS:
*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)? ANS:
*Secondary Heart BLOCK*
*Renal disease* (CKD, etc.) could cause what? ANS: *Maternal VASOCONSTRICTION*
= maternal *vasocontriction* which can lead to interruptions in placental & uterine blood flow
--'IUGR'
*Thyroid Disease* could cause what? ANS: *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? ANS: 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*? ANS: *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? ANS: 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? ANS: 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*? ANS:
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 ANS: UTERINE BLOOD FLOW:
-Nonpregnancy rate is usually 50ml/min, during *pregnancy = 700ml/min*!!
-*10-15%* of total *cardiac output*
What are some important factors (risks) to consider when evaluating a fetal heart rate strip? ANS: --
*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? ANS: *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? ANS: *VASOCONSTRICTION*
which adversely effects placental perfusion and can lead to:
--*IUGR*
--*Infarcts* (decreases functional area of the placenta & functional capacity)
Placental Infarcts ANS: - Necrosis of placental villi
- Anechoic or Hypoechoic areas in placenta
Placental infarcts will do what to the placental function? ANS: *DECREASE functional area* of placenta
*DECREASE functional capacity*
,What effect can *Diabetes* have on Placental perfusion? ANS: 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*? ANS: 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*? ANS:
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? ANS:
*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)? ANS:
*Secondary Heart BLOCK*
*Renal disease* (CKD, etc.) could cause what? ANS: *Maternal VASOCONSTRICTION*
= maternal *vasocontriction* which can lead to interruptions in placental & uterine blood flow
--'IUGR'
*Thyroid Disease* could cause what? ANS: *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? ANS: 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*? ANS: *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? ANS: 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? ANS: 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*? ANS:
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 ANS: UTERINE BLOOD FLOW:
-Nonpregnancy rate is usually 50ml/min, during *pregnancy = 700ml/min*!!
-*10-15%* of total *cardiac output*
