OB, Pediatric & Neonatal Critical Care
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Questions and Answers

What is the priority action for a patient on a mag drip at 4g/hr?

  • Plan for ground transport
  • Increase mag drip to 6g/hr
  • Load and go (by rotor) (correct)
  • Administer calcium gluconate

    • When referring to a neonate, which of the following definitions is correct?

  • An infant within the first few hours of birth
  • An infant within the first 28 days of birth (correct)
  • An infant delivered in the 37th to 42nd week of gestation
  • An infant delivered prior to the 37th week of gestation

    • At what week of gestation is a newborn considered term?

  • Between 30 and 35 weeks
  • Before the 37th week
  • After the 42nd week
  • Between the 37th and 42nd week (correct)

    • For a 39w2d pregnant female being transported, what should be monitored on the toco?

    <p>Fetal heart rate and contractions</p> Signup and view all the answers

    What is the normal arterial pH level at which lung development sustains life?

    <p>7.40</p> Signup and view all the answers

    Which of the following statements best describes a pre-term newborn?

    <p>An infant delivered prior to the 37th week of gestation</p> Signup and view all the answers

    What should be anticipated when delivering a neonate with reported back pain?

    <p>Potential for breech delivery</p> Signup and view all the answers

    What is a critical complication of pregnancy associated with the third trimester that is important to consider during transport?

    <p>Placental abruption</p> Signup and view all the answers

    What is one risk associated with the administration of magnesium sulfate?

    <p>Respiratory depression</p> Signup and view all the answers

    What physiological change occurs in the heart during pregnancy?

    <p>Increase in cardiac output by 20-30%</p> Signup and view all the answers

    What is the effect of suppressing the inferior vena cava (IVC) when a pregnant woman is laying flat?

    <p>Decreased venous return to the heart</p> Signup and view all the answers

    How much does the circulatory volume increase during pregnancy?

    <p>40-45%</p> Signup and view all the answers

    What complication is indicated by severe abdominal pain and hypovolemic shock in pregnant patients?

    <p>Ectopic pregnancy</p> Signup and view all the answers

    What is the recommended treatment for umbilical cord prolapse?

    <p>Positioning to relieve pressure on the cord</p> Signup and view all the answers

    What does a late deceleration in fetal heart rate typically indicate?

    <p>Placental insufficiency</p> Signup and view all the answers

    What is the normal fetal heart rate range?

    <p>110-160 bpm</p> Signup and view all the answers

    In cases of breech presentation, what should NOT be done?

    <p>Use traction on the presenting part</p> Signup and view all the answers

    When assessing a pregnant patient for fetal heart monitoring, which assessment is NOT relevant?

    <p>Respiratory rate</p> Signup and view all the answers

    What is the immediate management for post-partum hemorrhage?

    <p>Consider resuscitation fluids and transfusions</p> Signup and view all the answers

    What are the potential effects of the gravid uterus on adjacent structures during pregnancy?

    <p>Encroaches on various organs</p> Signup and view all the answers

    Which statement most accurately reflects the changes in blood pressure during pregnancy?

    <p>Blood pressure decreases by approximately 10 mmHg</p> Signup and view all the answers

    What is the typical increase in cardiac output by 10 weeks gestation?

    <p>20-30%</p> Signup and view all the answers

    What characteristic of variable decelerations in fetal heart rate is indicative of cord compression?

    <p>Abrupt decrease characterized by V or W shapes</p> Signup and view all the answers

    Which of the following is a typical physiological adaptation in the respiratory system during pregnancy?

    <p>Increased minute ventilation</p> Signup and view all the answers

    What clinical indicator suggests the presence of Rh incompatibility in pregnancy?

    <p>The mother is Rh negative and the fetus is Rh positive</p> Signup and view all the answers

    What does a sinusoidal pattern in fetal heart rate monitoring typically indicate?

    <p>Imminent fetal demise</p> Signup and view all the answers

    What is the significance of assessing cervical dilation during labor?

    <p>Measures progression towards delivery</p> Signup and view all the answers

    What should be monitored closely to prevent complications due to supine hypotension during pregnancy?

    <p>Pelvic tilt of the mother</p> Signup and view all the answers

    What is a primary treatment for post-partum hemorrhage?

    <p>Direct pressure and suture repair for lacerations</p> Signup and view all the answers

    What is the most critical intervention for a patient on a magnesium drip who has had a magnesium bolus?

    <p>Administer calcium gluconate</p> Signup and view all the answers

    What complication should be prioritized if there is a risk of delivering a neonate during transport?

    <p>Shoulder dystocia</p> Signup and view all the answers

    During transport, what immediate actions should be taken for a 39w2d pregnant female if fetal monitoring shows concerning signs?

    <p>Position the patient in a left lateral position</p> Signup and view all the answers

    At what stage of development is an infant classified as a neonate?

    <p>Within the first 28 days of birth</p> Signup and view all the answers

    What situation can lead to a significant risk during a transport if a patient reports her water has broken?

    <p>Prolapsed umbilical cord</p> Signup and view all the answers

    What is a common consequence associated with a patient experiencing severe back pain during labor?

    <p>Fetal distress</p> Signup and view all the answers

    What is the typical arterial pH level necessary to sustain life in lung development?

    <p>$7.35$</p> Signup and view all the answers

    What is one significant risk associated with a magnesium sulfate administration during labor?

    <p>Respiratory depression</p> Signup and view all the answers

    Which of the following interventions is most appropriate to monitor a fetus during transport?

    <p>Continuous fetal heart rate monitoring</p> Signup and view all the answers

    Which of the following descriptions accurately defines a term newborn?

    <p>An infant delivered in the 37th to 42nd week of gestation</p> Signup and view all the answers

    What is the primary reason for avoiding flat positioning in a pregnant patient during transport?

    <p>Compresses the inferior vena cava</p> Signup and view all the answers

    Which of the following is a common effect of the increased respiratory rate during pregnancy?

    <p>Increased risk of respiratory alkalosis</p> Signup and view all the answers

    What is the significance of knowing the Last Menstrual Period (LMP) during emergency obstetric care?

    <p>Assists in estimating gestational age</p> Signup and view all the answers

    Which condition manifests as sudden onset severe abdominal pain and could indicate a life-threatening situation for a pregnant patient?

    <p>Ectopic pregnancy</p> Signup and view all the answers

    What should be the initial management approach for a patient experiencing shoulder dystocia during delivery?

    <p>Perform a McRoberts maneuver</p> Signup and view all the answers

    What does the presence of late decelerations in fetal heart rate monitoring typically indicate?

    <p>Placental insufficiency</p> Signup and view all the answers

    How much does blood volume typically increase in a pregnant patient during gestation?

    <p>40-45%</p> Signup and view all the answers

    What is the primary treatment for post-partum hemorrhage due to uterine atony?

    <p>Fundal massage and IV Pitocin</p> Signup and view all the answers

    What should be done when a mother presents with umbilical cord prolapse during labor?

    <p>Hold the presenting part off the cervix and cord</p> Signup and view all the answers

    What does a high variability in fetal heart rate indicate?

    <p>Healthy fetal condition</p> Signup and view all the answers

    What is the most appropriate initial action for a patient on a magnesium drip who has just received a bolus?

    <p>Load and go by rotor</p> Signup and view all the answers

    What complication should be closely monitored during a delivery of a neonate if the mother reports severe back pain?

    <p>Shoulder dystocia</p> Signup and view all the answers

    When preparing for transport of a fetus, which complication should be anticipated if the mother's water has broken?

    <p>Breech delivery</p> Signup and view all the answers

    Which fetal monitoring intervention is most critical when observing a deceleration pattern during transport?

    <p>Change maternal position</p> Signup and view all the answers

    Which of the following accurately defines a 'pre-term newborn'?

    <p>An infant born before the 37th week of gestation</p> Signup and view all the answers

    In the scenario where a 15-year-old female reports severe back pain after her water has broken, which complication is least likely to occur?

    <p>Gestational hypertension</p> Signup and view all the answers

    What should be anticipated in terms of neonatal emergencies during transport for a patient at 39 weeks and 2 days?

    <p>Higher likelihood of respiratory distress</p> Signup and view all the answers

    What is a critical monitoring parameter for a neonate at risk of respiratory failure during transport?

    <p>Oxygen saturation levels</p> Signup and view all the answers

    Which of the following does not describe a potential complication of delivery during transport?

    <p>Labor progression</p> Signup and view all the answers

    What is the best approach for managing a patient who recently had a magnesium sulfate bolus and is currently on a drip?

    <p>Ensure rapid transport to a facility</p> Signup and view all the answers

    Study Notes

    Changes During Pregnancy

    • Joints: Relax due to progesterone.
    • Gravid Uterus: Encroaches on adjacent structures.
    • Heart: Displaced to the left, causing left axis deviation on EKG. Consider this displacement for compressions.
    • Lungs: Diaphragm moves up 4cm, requiring chest tubes to be inserted one intercostal space higher.
    • IVC: Affected when laying flat.
    • Bowel: Changes impact lower extremity circulation.
    • Renal: GFR increases by 30%, making UTIs more likely.

    Vital Signs

    • Respiratory:
      • Rate increases.
      • Minute ventilation increases.
      • Respiratory alkalosis is common.
    • Cardiac:
      • Cardiac output increases 20-30% by 10 weeks gestation, up to 43% by term.
      • Baseline heart rate increases by 10 bpm.
      • Left axis deviation due to leftward displacement of heart.
      • Approximate 10mmHg decrease in blood pressure.

    Blood Volume

    • Circulatory volume increases 40-45% during pregnancy.
    • Increase is largely plasma, leading to dilutional anemia.
    • Pregnant patients may not exhibit clinical signs of hypovolemia until late and severe blood loss occurs.
    • Increased risk for DVT and PE.

    Obstetric Practice Pearls

    • Terminology: Use "miscarriage" instead of "spontaneous abortion."
    • Supine Hypotension: Maintain pelvic tilt to prevent gravid uterus weight from impeding IVC.
    • Provider Politics & Beliefs: Personal beliefs should not affect care.
    • Chest Tube Placement: Insert one ICS higher than normal due to upward shift of abdominal and thoracic contents.

    Pregnancy Complications

    • Hyperemesis Gravidarum: Persistent nausea and vomiting causing dehydration and malnutrition.
      • Treatment: Assess blood glucose, replace fluids, administer antiemetics, reduce visual stimuli.
    • Ectopic Pregnancy: Embryo implants outside the uterus.
      • Symptoms: Sudden onset of severe abdominal pain, hypovolemic shock.
      • Treatment: Manage blood loss and pain prehospital, methotrexate (early) or surgical definitively.
    • Hypertension in Pregnancy: Leading cause of maternal mortality. Criteria: Systolic >140mmHg or Diastolic >90mmHg on two separate readings >6 hours apart.
      • Treatment: Antipyretics.
    • Group B Streptococcus (GBS)
      • Requires initial IV penicillin dose during labor, plus Q4 hour ongoing dosing.
      • If not administered during labor, baby will require prophylactic treatment.
    • Breech Presentation: Do not apply traction to presenting part.
      • Treatment: Rotate fetus to one shoulder at the 12 o’clock position. Rotate fetus so baby's face is toward mother’s posterior. Place two fingers into vagina to hold vaginal wall off baby’s nose.
    • Shoulder Dystocia: Head delivers but shoulders impinge on pelvis.
      • Treatment: McRoberts maneuver (flex mother’s knees against her chest, apply suprapubic pressure).
    • Umbilical Cord Prolapse: Umbilical cord presents before the fetus.
      • Treatment: Hold presenting part off cervix and cord, provide 100% oxygen via nonrebreathing mask, position mother on all fours with knees to chest, hips above shoulders.
    • Nuchal Cord: Low incidence of complications.
      • Treatment: Pull loop back over baby’s head.
    • En Caul Delivery: Neonate delivered with amniotic sac intact.
      • Treatment: Rupture membranes after delivery.
    • Post-partum Hemorrhage: Blood loss >500mL within 24 hours of delivery.
      • Treatment: Identify and treat provocative factors (ex: lacerations, retained products, uterine atony). Employ direct pressure, sutures, D&C, IV Pitocin, fundal massage, placing baby to breast, and REBOA in zone 3 to OR. Manage hemodynamic stability with blood administration.
    • Cardiac Arrest in Pregnancy: Causes include Trauma, amniotic fluid embolism, peripartum cardiomyopathy, severe hypertension.
      • Treatment: A-OK (Atropine, Ondansetron, Ketorolac), ongoing resuscitation, rapid transport for perimortem cesarean section.
    • Rh Compatibility: Rh negative mother carrying Rh positive fetus.
      • Treatment: IM Rhogam at 28 weeks and delivery, or at the time of pregnancy loss.

    Delivery Pearls

    • Expect placental delivery up to 30 minutes after neonate.
    • Do not apply traction to umbilical cord.
    • Prioritize skin-to-skin contact if patients are stable. Prevents neonatal hypothermia.
    • Breastfeeding prevents neonatal hypoglycemia, encourages placental delivery, and helps prevent post-partum hemorrhage.

    Fetal Assessment and Heart Monitoring

    • Assessment: Palpate fetal position (head and buttocks), monitor fetal heart tones every 15 minutes (Doppler), use a tocodynamometer if available.
    • Fetal Heart Monitoring: Normal Fetal Heart Rate: 110-160 bpm.
      • Fetal Tachycardia: Compensates for transient hypoxia, maternal fever.
      • Fetal Bradycardia: Indicates fetal compromise (cord compression, placental insufficiency, maternal hypotension, uterine rupture).
    • Variability: Fluctuations from Baseline
      • Absent: No variability, associated with fetal distress.
      • Minimal: 0-5 bpm variability.
      • Moderate: 6-25 bpm variability.
      • Marked: >25 bpm variability.
    • Acceleration: Indicates fetal movement or stimulation. Increase in fetal heart rate >15 bpm lasting >15 seconds.
    • Decelerations:
      • Early Decelerations: Mirror contraction, normal during active labor, indicates head compression.
      • Variable Decelerations: Abrupt decrease in fetal HR, characterized by V or W shapes. Indicates: Cord compression or compromise.
        • Treatment: Change maternal position, fluid administration, 100% oxygen, tocolysis.
      • Late Decelerations: Nearly symmetrical with contraction, but begins and returns to baseline after the contraction ends. Indicates: Placental insufficiency. Requires: Immediate intervention.
    • Sinusoidal Pattern: Indicates impending fetal demise. High rate of fetal morbidity and mortality.

    Neonatal Care

    • 90-95% of live births require no medical intervention.
    • It takes up to 10 minutes for neonate to reach SpO2 >90%.
    • Care Steps:
      • Warm and dry neonate, discard wet towel.
      • Only suction if PPV given.
      • APGAR scores at 1- and 5-minutes post birth.

    Neonatal Terminology

    • Newborn: An infant within the first few hours of birth.
    • Neonate: An infant within the first 28 days of birth.
    • Term Newborn: An infant delivered in the 37th to 42nd week of gestation.
    • Pre-Term Newborn: An infant delivered prior to the 37th week of gestation.

    Normal Neonatal Vital Signs

    • Temperature (Axillary): 36.5-37.5ºC (97.7-99.5ºF)
    • Heart Rate: 120-160 bpm
    • Respirations: 30-60 breaths/min (can be irregular)
    • Blood Pressure (Systolic): 60-80 mmHg
    • Oxygen Saturation: 95-100%

    Neonatal Anatomy & Physiology

    • Thermoregulation:
      • Neonates are prone to hypothermia as they have larger surface area to body mass ratio, less subcutaneous fat, and immature shivering response.
    • Pulmonary System:
      • Lung development is unable to sustain life at 34 weeks gestation.
      • Surfactant production is not fully mature until 35 weeks.

    Changes During Pregnancy

    • Joints: Relax due to progesterone.
    • Gravid Uterus: Encroaches on adjacent structures.
    • Heart: Displaced to the left, causing left axis deviation on EKG.
    • Lungs: Diaphragm moves up 4cm.
    • IVC: Affected when laying flat.
    • Bowel: Changes in lower extremity circulation.
    • Renal: GFR increases by 30%, increasing UTI likelihood.

    Vital Signs

    • Respiratory:
      • Rate increases.
      • Minute ventilation increases.
      • Respiratory alkalosis.
    • Cardiac:
      • Cardiac output increases 20-30% by 10 weeks gestation, up to 43% by term.
      • Baseline heart rate increases by 10 bpm.
      • Left axis deviation due to leftward displacement of heart.
      • Decrease in blood pressure by approximately 10mmHg.

    Blood Volume

    • Circulatory volume increases 40-45% during pregnancy.
    • Mostly plasma, leading to dilutional anemia.
    • Pregnant patients may not exhibit clinical signs of hypovolemia until late and severe blood loss.
    • Increased risk for DVT and PE.

    Obstetrics Practice Pearls

    • Use "miscarriage" instead of "spontaneous abortion".
    • Always keep mother's pelvis tilted to prevent weight burden of gravid uterus off IVC.
    • Insert chest tubes one ICS higher than normal due to upward shift of abdominal and thoracic contents.
    • Avoid letting personal beliefs affect rendered care.

    Pregnancy Complications

    • Hyperemesis Gravidarum:
      • Persistent nausea and vomiting leading to dehydration and malnutrition.
      • Treatment:
        • Assess blood glucose.
        • Fluid replacement.
        • Antiemetics.
        • Reduce visual stimuli.
    • Ectopic Pregnancy:
      • Embryo implants outside the uterus.
      • Symptoms:
        • Sudden onset severe abdominal pain.
        • Hypovolemic shock.
      • Treatment:
        • Prehospital: Manage blood loss and pain.
        • Definitive: Methotrexate (early) or surgical.
    • Hypertension in Pregnancy:
      • Leading cause of maternal mortality.
      • Criteria: Systolic >140mmHg or Diastolic >90mmHg on two separate readings >6 hours.
    • Group B Streptococcus (GBS):
      • Requires initial dose of IV penicillin during labor, plus Q4 hour ongoing dosing.
      • If not administered during labor, baby will require prophylactic treatment.

    Delivery Complications

    • Breech Presentation:
      • Do not apply traction to presenting part.
      • Treatment:
        • Rotate fetus to one shoulder at the 12 o’clock position.
        • Rotate fetus so baby’s face is toward mother’s posterior.
        • Place two fingers into vagina to hold vaginal wall off baby’s nose.
    • Shoulder Dystocia:
      • Head delivers but shoulders impinge on pelvis.
      • Treatment: McRoberts maneuver (flex mother's knees against her chest, apply suprapubic pressure).
    • Umbilical Cord Prolapse:
      • Umbilical cord presents before fetus.
      • Treatment:
        • Hold presenting part off cervix and cord.
        • Place mother on 100% oxygen by nonrebreathing mask.
        • Position mother on all fours with knees to chest, hips above shoulders.
    • Nuchal Cord:
      • Low incidence of complications.
      • Treatment: Pull loop back over baby's head.
    • En Caul Delivery:
      • Neonate delivered with amniotic sac intact.
      • Treatment: Rupture membranes after delivery.
    • Post-partum Hemorrhage:
      • Blood loss >500mL within 24 hours of delivery.
      • Treatment:
        • Identify and treat provocative factors.
        • Lacerations: Apply direct pressure, suture repair.
        • Retained products: D&C.
        • Uterine atony: IV Pitocin, fundal massage, place baby to breast.
        • REBOA in zone 3 to OR.
        • Manage hemodynamic stability with blood administration.
    • Cardiac Arrest in Pregnancy:
      • Causes: Trauma, amniotic fluid embolism, peripartum cardiomyopathy, severe hypertension.
      • Treatment: A-OK (Atropine, Ondansetron, Ketorolak), ongoing resuscitation, rapid transport for perimortem cesarean section.
    • Rh Compatibility:
      • Rh negative mother carrying Rh positive fetus.
      • Treatment: IM Rhogam at 28 weeks and delivery, or at time of pregnancy loss.

    Delivery Pearls

    • Expect placental delivery up to 30 minutes after neonate.
    • Do not apply traction to umbilical cord.
    • Prioritize skin to skin contact if patients are stable.
      • Prevents neonatal hypothermia.
    • Breastfeeding prevents neonatal hypoglycemia.
      • Encourages placental delivery.
      • Prevents post-partum hemorrhage.

    Fetal Assessment and Heart Monitoring

    • Assessment:
      • Fetal position: Head and buttocks can be palpated.
      • Fetal heart monitoring: Doppler fetal heart tones every 15 minutes, tocodynamometer if available.
    • Fetal Heart Monitoring:
      • Normal Fetal Heart Rate: 110-160 bpm.
      • Fetal Tachycardia: Compensates for transient hypoxia, maternal fever.
      • Fetal Bradycardia: Indicates fetal compromise (cord compression, placental insufficiency, maternal hypotension, uterine rupture).
    • Variability:
      • Fluctuations from Baseline:
        • Absent: No variability, associated with fetal distress.
        • Minimal: 0-5 bpm variability.
        • Moderate: 6-25 bpm variability.
        • Marked: >25 bpm variability.
    • Acceleration:
      • Indicates fetal movement or stimulation.
      • Increase in fetal heart rate >15 bpm lasting >15 seconds.
    • Decelerations:
      • Early Decelerations: Mirror contraction, normal during active labor, indicates head compression.
      • Variable Decelerations: Abrupt decrease in fetal HR, characterized by V or W shapes.
        • Indicates: Cord compression or compromise.
        • Treatment: Change maternal position, fluid administration, 100% oxygen, tocolysis.
      • Late Decelerations: Nearly symmetrical with contraction, but begins and returns to baseline after the contraction ends.
        • Indicates: Placental insufficiency.
        • Requires: Immediate intervention.
    • Sinusoidal Pattern:
      • Indicates impending fetal demise.
      • High rate of fetal morbidity and mortality.

    Changes During Pregnancy

    • Joints: Soften due to progesterone.
    • Gravid Uterus: Expands and can press on adjacent structures.
    • Heart: Shifts left, causing left axis deviation on EKG.
    • Lungs: Diaphragm moves up, requiring chest tube insertion one intercostal space higher than usual.
    • IVC: Compression when laying flat.
    • Bowel: Alters lower extremity circulation.
    • Renal: Glomerular filtration rate (GFR) increases, raising UTI risk.

    Vital Signs During Pregnancy

    • Respiratory: Faster breathing, increased minute ventilation, respiratory alkalosis.
    • Cardiac: Heart output increases significantly, baseline heart rate rises, left axis deviation, slight blood pressure decrease.

    Blood Volume Changes During Pregnancy

    • Increases significantly, primarily due to plasma, causing dilutional anemia.
    • Pregnant patients may not show signs of hypovolemia until late and severe blood loss.
    • Increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).

    Obstetric Practice Pearls

    • Use "miscarriage" instead of "spontaneous abortion".
    • Keep pregnant patient's pelvis tilted to prevent pressure on IVC.
    • Do not let personal beliefs affect medical care.
    • Insert chest tubes one intercostal space higher than normal.

    Pregnancy Complications

    • Hyperemesis Gravidarum: Persistent nausea and vomiting, leading to dehydration and malnutrition. Assess blood glucose, provide fluids, antiemetics, reduce visual stimuli.
    • Ectopic Pregnancy: Embryo implants outside the uterus. Sudden severe abdominal pain, potential for hypovolemic shock. Prehospital care includes managing blood loss and pain. Definitive treatment includes methotrexate or surgery.
    • Hypertension in Pregnancy: Leading cause of maternal mortality. Systolic blood pressure above 140mmHg or diastolic above 90mmHg on two readings. Treat with antipyretics.
    • Group B Streptococcus (GBS): Requires IV penicillin during labor. Babies not exposed to treatment during labor need prophylactic treatment.
    • Breech Presentation: Don't apply traction on the presenting part. Rotate fetus to one shoulder at 12 o'clock position or face toward mother's posterior. Place two fingers into the vagina to hold the vaginal wall off the baby's nose.
    • Shoulder Dystocia: Head delivers but shoulders become lodged. Treat with McRoberts maneuver (flex the mother's knees against her chest and apply suprapubic pressure).
    • Umbilical Cord Prolapse: Cord presents before fetus. Hold the presenting part off the cervix and cord. Provide 100% oxygen by non-rebreathing mask. Position the mother on all fours with knees to chest, hips above shoulders.
    • Nuchal Cord: Low complication rate. Pull loop back over baby's head.
    • En Caul Delivery: Neonate delivered with amniotic sac intact. Rupture membranes after delivery.
    • Postpartum Hemorrhage: Blood loss over 500mL within 24 hours of delivery. Identify and treat causes. Manage hemodynamic stability with blood transfusions. Consider REBOA in zone 3 if transport to the OR is required.
    • Cardiac Arrest in Pregnancy: Can be caused by trauma, amniotic fluid embolism, cardiomyopathy, severe hypertension. Treat with A-OK (atropine, ondansetron, ketorolac), ongoing resuscitation, and rapid transport for perimortem cesarean section.
    • Rh Compatibility: Rh negative mother carrying Rh positive fetus. Administer IM Rhogam at 28 weeks and after delivery, or at time of pregnancy loss.

    Delivery Pearls

    • Expect placental delivery up to 30 minutes after the neonate.
    • Do not apply traction to the umbilical cord.
    • Prioritize skin-to-skin contact if patient is stable.
    • Skin-to-skin contact prevents neonatal hypothermia, breastfeeding prevents neonatal hypoglycemia, encourages placental delivery and reduces postpartum hemorrhage.

    Fetal Assessment and Heart Monitoring

    • Assessment: Check fetal position by palpating head and buttocks. Monitor fetal heart tones every 15 minutes with Doppler or toco.
    • Fetal Heart Monitoring:
      • Normal: 110-160 bpm.
      • Tachycardia: Compensates for transient hypoxia or maternal fever.
      • Bradycardia: Indicates fetal compromise such as cord compression, placental insufficiency, maternal hypotension, or uterine rupture.
    • Variability:
      • Absent: No variability, associated with fetal distress.
      • Minimal: 0-5 bpm variability.
      • Moderate: 6-25 bpm variability.
      • Marked: >25 bpm variability.
    • Accelerations: Indicate fetal movement or stimulation. Increase in fetal heart rate >15 bpm lasting >15 seconds.
    • Decelerations:
      • Early: Mirror contraction, normal during active labor, indicates head compression.
      • Variable: Abrupt decrease in fetal HR, V or W shaped, indicates cord compression or compromise, treat with position change, fluids, oxygen, tocolysis.
      • Late: Nearly symmetrical with contraction, but begins and returns to baseline after the contraction ends, indicates placental insufficiency, requires immediate intervention.
    • Sinusoidal Pattern: Impending fetal demise, high rate of fetal morbidity and mortality.

    Neonatal Care

    • 90-95% of live births require no medical intervention.
    • Neonates can take up to 10 minutes to reach SpO2 >90%.
    • Important steps include warming and drying the neonate, discarding wet towels, suctioning only if PPV is given, and performing APGAR scores at 1- and 5-minutes post-birth.

    Neonatal Terminology

    • Newborn: An infant within the first few hours of birth.
    • Neonate: An infant within the first 28 days of birth.
    • Term Newborn: An infant delivered in the 37th to 42nd week of gestation.
    • Pre-Term Newborn: An infant delivered prior to the 37th week of gestation.

    Normal Neonatal Vital Signs

    • Heart Rate: 120-160 bpm.
    • Respiratory Rate: 30-60 breaths per minute.
    • Temperature: 97.7-99.5°F (36.5-37.5°C).
    • Blood Pressure: Systolic 60-90 mmHG , Diastolic 40-60 mmHg.

    Neonatal Anatomy and Physiology

    • Thermoregulation: Neonates have difficulty regulating their temperature, prone to hypothermia.
    • Pulmonary System: Lung development in neonates is unable to sustain life at 37 weeks gestation. Pulmonary surfactant produced at 34-35 weeks gestation helps maintain lung function.
    • Cardiovascular System: The ductus arteriosus remains open at birth unless pulmonary vascular resistance drops to normal.
    • Gastrointestinal System: The digestive system is immature, and infants are prone to regurgitation and aspiration.
    • Metabolic System: Neonates are susceptible to hypoglycemia and electrolyte imbalances.
    • Immune System: Neonates have immature immune systems, making them extremely susceptible to infections.

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    Description

    This quiz covers the physiological changes that occur during pregnancy, including alterations in joints, heart position, lung function, and vital signs. It also examines the impact of increased blood volume and renal function on maternal health. Prepare to test your understanding of these key concepts essential for prenatal care.

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