OB- Maternal-fetal assessment

700-800ml (10-15% of maternal)

Chorionic villi

• 1. Intervillous blood flow
• 2. Placenta surface area
• 3. membrane permeability
• 4. O2 tension b/w uterine & umbilical vessels
• 5. Hgb affinity and concentration
• 6. Umbilical cord blood flow

Maternal BP & anesthesia induction

• 1. Maternal issues (HTN, DM, vascular dx)
• 2. Placenta previa, abruptio, infactions
• 3. intrauterine infection
• 4. circumvallage placenta

• 1. Increase fetal CO (3-4x than adult)
• 2. Increase O2 carrying (HbF)
• 3. Increased affinitity for O2 (HbF)
• 4. Anatomical fetal shunts

• Range (120-160)
• <30wks--> 160
• >30wks --> 140

• 1. O2 status
• 2. Infection
• 3. Acid-base/electrolye imbalance

• -Begin instruction ~24-28 weeks. 
• -Tell them to establish the time of day most active (usually evening)
• -Perform daily around same time (decide how long it takes to normally get to 10 kicks)
• -Call if decrease movement than normal or no movement in 12 hrs
• -If decreased fetal movement--> suggest drinking some juice (sugar) or drink something cold, move to a different side and retry kick count

True (Externol-Toco can only show frequency)

• tone- 5-15mm Hg
• frequency- 3-5min
• Duration- 30-60sec
• Intensity- 50-75mmHg (peak contxn)

-SUSTAINED increase in HR >160 for 10min 

(can intermittently go up to 160 and not be tachy because it can be due to fetal activity--> like if you did a couple jumping jacks, your HR would increase briefly)

Fetal: anemia, hypoxia, cardiac, arrythmia

Maternal: fever, hyperthyroidism

Placenta: amnionitis

Drugs: Terb & parasympatholytic

-Baseline <120 or 30bpm drop from baseline x 10 min

• 1. Fetal hypoxia (cord compression, bradyarrhythmias)
• 2. Maternal hypotension/hypothermia
• 3. Drugs (beta-blockers, anesthetics

It's beat to beat changes in the HR. Meaning the HR is just just consistently 140--> changes beat to beat from 140- 145- 152-143-138.  Means the fetus is well-oxygenated.  If not well oxygenated--> fetus doesn't want to move to conserve oxygen and you'll have less variability

Short term--> no longer really used but is exact beat-beat change

Long term--> rhythmic flucations in FHR (3-5 cycles per min)  Easier to determine visually looking a strip.

omnious--> decreased fetal oxygenation or CNS insult or disorder

• -Hypoxia, acidosis
• -Drugs
• -fetal sleep
• -congenital anomaly
• -extreme prematurity
• -fetal cardiac arrhythmias

• 1. Narcotics (morphine/stadol)
• 2. Rh isoimmunized (impending death--> stat c-section)

• 1. absent
• 2. minimal
• 3. moderate
• 4. marked
• 5 sinusoidal

• Reassuring that fetus is well-oxygenated at that moment
• -Has to be >15bpm above baseline for 15min
• -Associated with fetal movement/contractions

• -common, usually transient and associated with cord compression (NOT associated with poor outcomes)
• -Mild (<30bmp below baseline)
• -Mod (<50bpm below baseline)
• -Severe (<70bmp, slow return to baseline)

**Abrupt return to baseline is a reassuring sign of good oxygenation despite cord compression

• -Benign
• -Associated with head compression
• -FHR is mirror image of contraction or starts decreasing just before contraction visualized

• -Ominous when persistant or uncorrectable.  Most worrisome w/ tachycardia and no variability
• -Late decels suggest uteroplacental INSUFFICIENCY

-fetal hypoxia, metabolic acidosis

• -Decreased oxygenation, poor prognosis
• -If doesn't return to baseline in 2min--> usually expedite delivery--> forceps/vacumn or c-section

• -Prolonged contraction
• -Fetal--> pelvic exam, FSE/IUPC placement, rapid descent, cord prolapse
• -Maternal--> hypotension, valsalva, hypoxia

• -Requires intact neuro
• -FM triggers accel >85% of the time
• -Healthy term fetus should have 3-4 accels with 20-25bmp accel above baseline, lasting ~40 sec

• -Sleeping fetus
• -CNS depressants (narcotics/propranolol)
• -Uteroplacental insufficiency (smoking, maternal dx)

• -must have 2 15bpm x15sec in 15mins
• -Reassuring for 7 days

• -3 moderate contxn in 10min, lasting 40-60 with reassuring FHR
• -NO late decels
• - Don't have to see accelerations to be neg

• 1. risk for premature labor
• 2. premature labor
• 3. mult gestation
• 4. cervical incompetence
• 5. risk for uterine rupture

Fetal distress with contractions--> may see late decels with contraction

Amniotic fluid index--> sum of vertical diamter of largest pocket in each abd quadrant

• Normal- 8-18
• Borderline- 5.1-8.
• Oligo <or = 5
• Poly > or = 25

• 1. perinatal mortality
• 2. lethal congenital anomaly
• 3. IUGR

• 1. NTD
• 2. Obstruction of GI tract
• 3. Mult gestation
• 4. fetal hydrops

2

• 1. NST
• U/S
• 2. Fetal breathing mvmt
• 3. fetal mvmt
• 4. Tone
• 5. AFI

• 10--> normal, low risk for chronic asphyxia
•          repeat weekly or 2x/wk for DM/>42wks
• 8--> normal, low risk of chronic asphyxia
•         repeat weekly unless oligo--> deliver
• 6--> suspect chronic asphyxia
•         >36 then deliver
•         <36, do amnio & if <2--> repeat BPP
•         in 4-6hrs, deliver if amnio
• 4--> deliver >32 wks, repeat if <32wks
• 0-2--> extend test to 120min, if persists then deliver

-1 episode (>30sec) in 30 min

-3 "discrete" body movements in 30min

-1 episode of active limb/trunk extension with return to flexion (open/close hand)

At least 1 pocket = 2x1cm