RNC NIC Review by Me/Maternal Hx & Risk Factors
Terms in this set (45)
Infants born to Mothers who receive no prenatal care are at increased risk of what?
Low Birth Weight
Maternal iron deficiency anemia
Explain in 5 steps why does an IDM presents with hypoglycemia at birth?
1. Glucose crosses the placenta whereas insulin doesn't.
2. When Mom has elevated insulin, the fetus also has elevated insulin
3. The fetus produces insulin starting at 20 weeks of Gestation
4. After 20 weeks the fetus produces high level of insulin in response to hyperglycemia.
5. Sudden glucose's withdrawal from glucose at birth paired with high insulin production results in HYPOglycemia
When does the fetus start producing insulin
At 20 weeks of gestation
Why does IDM are often LGA
The combo of elevated maternal glucose and elevated fetal insulin triggers rapid growth
6 Indications for routine blood glucose monitoring in the neonate
5. Congénital Cardiac Malformation
6. Endocrine Disorder
IDM often presents with these 8 issues
1. Birth trauma due to LGA
3. RDS because high insulin level inhibits surfactant production
4. Polycythemia because high insulin and glucose increase metabolic rate & O2 consumption, so the infant produces more RBCs to compensate
5. Iron deficiency due to Polycythemia
6. Hyperbili because increased RBC destruction after birth
7. Congenital Malformations
8. Electrolyte Imbalances (low ca and mg)
What is Oligohydramnious?
Decreased amount of amniotic fluid
How is the amniotic fluid produced
After 20 weeks the fluid is mainly made by the fetus' excreted urine
What is the amniotic fluid necessary for?
Cushion and lung development
What are the 7 conditions associated with Oligohydramnious?
1. Urinary tract anomalies
2. Pulmonary Hypoplasia
3. Cord Compression (Variable Decels.)
4. Meconium Staining
5. Post term gestation
6. Pressure Deformities (clubbed feet)
7. PROM which can lead to infections
What is Polyhydramnious?
Increased amount of amniotic fluid
What is the most common endocrine disorder affecting Pregnancy
How does sulfonylurea such as Glyburide and Metformin affect the fetus?
They can cross the placenta and may cause Neonatal jaundice, but they are considered safe during lactation.
How soon does the fetal thyroid gland synthesizes its own hormones
At 10 to 12 weeks' gestation
What is Phenylketonuria (PKU)?
An inherited disorder in which an enzyme defect makes impossible to convert the AA phenylalanine into tyrosine
What is the problem with PKU?
The accumulation of excessive amount of phenylalanine is toxic to the CNS
Maternal phenylalanine Level affects neonatal outcomes
When is PKU screened?
Within 24 hours of life
What are the 3 consequences of maternal renal diseases?
May Cause IUGR
and Perinatal Loss
What is Pre Eclampsia?
A pregnancy complication with Hypertension and increased protein in the urine
Early onset (prior to 32wks) is associated with increased mortality and morbidity
Give 3 Neonatal complications of Pre Eclampsia?
1. Increased risk of placenta abruption
2. Poor Growth
3. Prémature birth
What is eclampsia?
Convulsions that occurs with Pre Eclampsia
How does maternal seizure disorders affects the infant?
The mom is treated with Antiépileptic Rx (AED)
AED crosse the placenta and can cause congenital malformations such as neural tube defects, VSD, hypospadias and phalangeal hypoplasia
What are signs exhibited by infants born to mothers treated with barbiturates
Poor muscle tone
Symptoms of drug withdrawal
How does phenytoin, phenobarbital and primidone affects the fetus
Abnormal Clotting and severe Hemorrhage
(Give Vit K soon after birth)
5 Adverse Events of Maternal Hx of CHD
5. Neonatal CHD
What are 6 charactrisics of Fetal Alcohol Syndrome (FAS)
1. Smooth Philtrum
2. Short palpébral fissures
4. Intellectual impairment
5. Cognitive Dev. Delays
What is the consequence of maternal Thrombocytopenia?
Infants born to mothers with idiopathic thrombocytopenia purpura (ITP) may have a low platelet count
Chronic HTN vs. Gestational HTN
Chronic HTN is defined as HTN before pregnancy or 20 weeks of gestation
Gestational HTN is diagnosed after 20 weeks of gestation
What is HELLP Syndrome?
Severe Pregnancy Induced Hypertension (PIH)
EL-Elevated Liver enzymes
LP -Low Platelet count
What is the major cause of sepsis, menigitis nd death among newborns
Group B Streptococcus (GBS)
Cite 3 Side effects of Mag Sulfate on the Neonate
Decreased Calcium level
What is an Early Deceleration?
the deceleration (slowing of HR) that accompanies head compression during contraction
What happens during an Early Deceleration?
The fetal HR drops as contraction builds;
Reaches its lowest point as contraction peaks;
Returns to baseline as contraction subsides
**The result is a uniform dip that mirrors the shape of the contractions
What happens during a Late Deceleration?
In Late Deceleration, the HR also mirror the contractions but the fall in HR begins at or after the peak of contractions
The HR doesn't return to baseline right after the contraction
What is a Variable Deceleration?
Umbilical Cord Compression aggravated by contractions and fetal descend during labor.
The drops in HR is rapid and does not mirror the contraction
What is Placenta Previa?
The placenta lies low in the uterus and partially or totally covers the cervical os
What is Placenta Abruption?
The placenta detaches partially or totally from the the uterine wall
What is the most common cause of hemorrhage in late pregnancy?
Placenta Previa and Placenta Abruption
What is a Velamentous Cord Insertion?
The fetal umbilical cord inserts in the chorioamnionic membrane instead of the placenta
What is a Vasa Previa?
Placental abnormality that occurs when Fetal blood vessels are outside of the umbilical cord and cover the cervical os. Extremely rare, associated with high perinatal mortality
What are the 4 methods of assessing fetal well being?
1. Fetal Movement Count
2. Contraction Stress Test (CST)
3. Non-Stress Test (NST)
4. Fetal Biophysical Profile (BPP)
What does the BPP measures?
1. Fetal breathing
2. Fetal body movement
3. Fetal Tone
4. Non-Stress Test (NST)
5. Amniotic Fluid Volume
Explain Biophysical Profile scoring
Score range from 0-10
There are 5 variables. Normal is 2pts/Abnormal is 0
8-10 is normal
6 is equivocal (test must be repeated in 12-24hrs)
4 or less is abnormal
What is the CST and how does it work?
This test measures how well the fetus tolerates uterine contraction (uteroplacental reserve)
Contraction is stimulated with nipple stim or oxytocin
3 contractions of 4o sec duration in 10 min
Negative CST result = No late Decels (Good)
Positive CST results = >50 % late decels (Bad)
How is the Fetal movement survey (kick count) done?
Done between 26 and 32 weeks gestation
Counting at least 10 movements within 2 hours
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