RSPT 2353 – Neonatal/Pediatric Cardiopulmonary Care
Lecture Notes
Reference & Reading: Chapter 3
I.
Terms that are heard in L&D: a.
Para/Gravida/Abortions
 Para (P) – Pregnancy
 Gravida (G) – Live births
 Abortions (A) – Either elective, or spontaneous
 Example: P3 G1 A1 b.
Type of delivery
 Vaginal
 Cesarean section
 VBAC c.
Current situation with mom and/or baby
II.
Maternal History a.
Risk Factors
 Incompetent cervix
 Toxic habits
 HTN
 Diabetes Mellitus
 Infectious Diseases – GBS, HSV, HBV
III.
Problems from Labor and/or Delivery a.
Dystocia – prolonged difficult labor b.
The longer the labor the more problems may arise c.
Causes include:
 Uterine dysfunction
 Abnormal Presentation
 Excessive fetal size
 Hydrocephalus
 Abnormality in size or shape of birth canal
IV.
Problems with the placenta, umbilical cord, & fetal membranes a.
Fetal membranes
 Premature Rupture of Membranes (PROM)
 No longer sterile;  risk of fetal infection
  fetal fluid sac b.
Placenta Previa – placenta implants in lower portion of the uterine cavity
 Low
 Partial
 Total

c.
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 d.
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
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 Cord knot – also called a true knot; a knot is made in the umbilical cord
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V.
Problems with Amniotic fluid (AFI) a.
Fluid within Amnion b.
Dynamic – constantly being replenished & absorbed c.
After 24-26 weeks gestation fluid is swallowed and replenished with fetal urine d.
P OLYHYDRAMNIOS – too much amniotic fluid present
 CNS malformations
 Orogastric malformations
 Down syndrome
 CHD
 IDM e.
O LIGOHYDRAMNIOS – scant or decreased amount of fluid
 Defect in urinary system – usually renal dysplasia or urethral stenosis
 Potter’s syndrome
 Implications include: lung Hypoplasia, asphyxia, and significant skeletal deformities
 Presentation later in gestation – umbilical cord compression
VI.
Mode of Delivery a.
Vaginal most common b.
Forceps/ vaccum extraction c.
C-section – there are several risks involved:
 Accidental cutting
 TTN
VII.
Multiple Gestation – more than one fetus present

a.
Higher incidence of premature labor b.
Fraternal twins – separate placentas c.
Identical twins – shared placenta
VIII.
Antenatal Assessment a.
Ultrasound b.
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:
1.
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
2.
Shake test – a.
Amniotic fluid mixed with ethanol b.
15 minutes later if there is a ring of bubble present, there is enough protein – lungs are mature
3.
Alpha-fetoprotein a.
Alpa-fetoprotein peaks in 12 th week and then decreases b.
If there is a break in fetal skin AFP will be present c.
High level usually indicates neural defect d.
Low level indicates Down Syndrome c.
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
 CST
1.
Negative – no late decals
2.
Positive – late decals w/ each contraction
3.
Suspicious – some late decals w/ some contractions d.
Biophysical Profile (Table 3-1)
 Determines fetal risk
 Tests: fetal breathing, fetal movement, fetal limb tone, NST, amniotic fluid volume e.
Fetal Heart Rate Monitoring
 Important reading along with variability

 Good indicator of what is going on with fetus during labor
 Three ways to monitor:
1.
External abdominal transducer
2.
Electrodes on abdomen
3.
Spiral electrode
 Uterine contractions are monitored with a tocodynamometer
 Fetal Heart Patterns
1.
Baseline
2.
Variability – changes with CNS depression, fetal sleep, narcotic or sedative use, etc.
3.
Bradycardia - <100bpm or a maintained 20 bpm drop from baseline
4.
Tachycardia – consistenly above 180 bpm; usually maternal fever
5.
Accelerations – FHR exceeds 160 bpm for <2 minutes; good sign
6.
Decelerations – FHR drops below 120 bpm for <2 minutes a.
Early (Type I) drops during contraction – benign b.
Late (Type II) don’t follow contractions – uretoplacental insufficiency during contractions c.
Variable (Type III) independent of contractions
– secondary to umbilical cord compression
IX.
High risk conditions a.
Premature labor – Prevention is better!
 Tocolysis – process of stopping labor
1.
Pharmacological – β -sympathomimetic (terbutaline & ritodine); anti-convulsant (magnesium sulfate)
 Identification of risks for premature labor
 Bedrest-
1.
Light-duty
2.
Bedrest (home or hospital)
3.
Trendelenburg b.
Postterm Pregnancy
 Increased risk for:
1.
Large size
2.
Meconium aspiration
3.
Obstetrical trauma
 Labor often induced

X.
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
1.
Umbilical cord is clamped, forcing blood to lower extremities, raising arterial blood pressure
2.
Initial breathing causes ↓ pulmonary vascular resistance (FRC & ↑PaO2)
 Closure of fetal shunts
1.
With ↑ pressures in L heart foramen ovale closes
2.
Ductus arteriosus closes with the absence of prostaglandins (smooth muscle constricts)
3.
Umbilical arteries & veins constrict & become ligaments
4.
Ductus venosus also constricts & becomes ligament