RSPT 2353 – Neonatal/Pediatric Cardiopulmonary Care
Terms that are heard in L&D: a.
Para (P) – Pregnancy
Gravida (G) – Live births
Abortions (A) – Either elective, or spontaneous
Example: P3 G1 A1 b.
Type of delivery
Current situation with mom and/or baby
Infectious Diseases – GBS, HSV, HBV
Problems from Labor and/or Delivery a.
Dystocia – prolonged difficult labor
The longer the labor the more problems may arise c.
Excessive fetal size
Abnormality in size or shape of birth canal
Problems with the placenta, umbilical cord, & fetal membranes a.
Fetal membranes b.
Premature Rupture of Membranes (PROM)
No longer sterile;
risk of fetal infection
fetal fluid sac
Placenta Previa – placenta implants in lower portion of the uterine cavity
Abruptio Placentae –
A normally attached placenta separates prematurely from uterine wall
Most common cause is Preeclampsia or eclampsia (PIH)
Many risks involve for both mother, fetus & at delivery
Umbilical Cord Problems
Prolapsed cord – the umbilical cord presents in the cervix into the birth canal before the baby
Nuchal cord – the umbilical cord wraps around the baby’s neck
Cord knot – also called a true knot; a knot is made in the umbilical cord
Problems with Amniotic fluid (AFI) a.
Fluid within Amnion
Dynamic – constantly being replenished & absorbed
After 24-26 weeks gestation fluid is swallowed and replenished with fetal urine d.
– too much amniotic fluid present
– scant or decreased amount of fluid
Defect in urinary system – usually renal dysplasia or urethral stenosis
Implications include: lung Hypoplasia, asphyxia, and significant skeletal deformities
Presentation later in gestation – umbilical cord compression
Mode of Delivery a.
Vaginal most common
Forceps/ vaccum extraction
C-section – there are several risks involved:
Multiple Gestation – more than one fetus present
Higher incidence of premature labor
Fraternal twins – separate placentas c.
Identical twins – shared placenta
Antenatal Assessment a.
Amniocentsis – Performed to run for a variety of tests
Routinely done on mothers over 35
Not common practice because of risks involved
Tests that can be performed:
L/S ratio – a.
Determines lung maturity b.
compares amount of lecithin to sphingomyelin in amniotic fluid c.
lungs considered mature when L/S ration reaches 2:1
Shake test – a.
Amniotic fluid mixed with ethanol
15 minutes later if there is a ring of bubble present, there is enough protein – lungs are mature c.
Alpa-fetoprotein peaks in 12 th
week and then b.
If there is a break in fetal skin AFP will be c.
High level usually indicates neural defect
Low level indicates Down Syndrome
Nonstress Test and Contraction stress test
FHR is monitored with fetal movement (NST) or with induced contractions (CST)
Reactive NST - FHR
with movement or contraction
Negative – no late decals
Positive – late decals w/ each contraction
Suspicious – some late decals w/ some contractions
Biophysical Profile (Table 3-1)
Determines fetal risk
Tests: fetal breathing, fetal movement, fetal limb tone, NST, amniotic fluid volume
Fetal Heart Rate Monitoring
Important reading along with variability
Good indicator of what is going on with fetus during labor
Three ways to monitor:
External abdominal transducer
Electrodes on abdomen
Uterine contractions are monitored with a tocodynamometer
Fetal Heart Patterns
Variability – changes with CNS depression, fetal sleep,
narcotic or sedative use, etc.
Bradycardia - <100bpm or a maintained 20 bpm drop from baseline
Tachycardia – consistenly above 180 bpm; usually maternal fever
Accelerations – FHR exceeds 160 bpm for <2 minutes; good sign
Decelerations – FHR drops below 120 bpm for <2 minutes a.
Early (Type I) drops during contraction – benign
Late (Type II) don’t follow contractions – c.
uretoplacental insufficiency during contractions
Variable (Type III) independent of contractions
– secondary to umbilical cord compression
High risk conditions a.
Premature labor – Prevention is better!
Tocolysis – process of stopping labor
Identification of risks for premature labor
-sympathomimetic (terbutaline & ritodine); anti-convulsant (magnesium sulfate)
Bedrest (home or hospital)
Increased risk for:
Labor often induced
Adaptation to Extrauterine Life a.
The first breath – Three things that influence the initiation of the first breath
Chemoreceptors detect changes in PaO2 & PaCO2 stimulate the baby to breathe
Thoracic recoil and baby leaves vaginal canal
Abrupt change in environment b.
Change from fetal to adult circulation
Changes in circulatory Pressures
Umbilical cord is clamped, forcing blood to lower extremities, raising arterial blood pressure
Initial breathing causes ↓ pulmonary vascular resistance (FRC & ↑PaO2)
Closure of fetal shunts
With ↑ pressures in L heart foramen ovale closes
Ductus arteriosus closes with the absence of prostaglandins (smooth muscle constricts)
Umbilical arteries & veins constrict & become ligaments
Ductus venosus also constricts & becomes ligament