Maternal Factors

1
Maternal Factors

• Maternal Condition Fetal Outcome
• Previous pregnancy Complication same outcome as
  previous
• Diabetes mellitus LGA, congenital
  malformations, RDS, hypoglycemia
• Pregnancy induced hypertension Prematurity, SGA,
  (preclampsia)
• Maternal age less than 17 low birth weight,
  prematurity
• Maternal age greater than 35 prematurity,
  chromosomal defects

2
Maternal Factors

• Maternal Condition Fetal Outcome
• Placenta previa prematurity, bleeding, SGA
• Placenta abruptio Fetal asphyxia, bleeding
• Alcohol consumption SGA, CNS dysfunction,
  mental retardation, facial dysmorphology
• Smoking SGA, prematurity, mental
  retardation, SIDS
• Drug Use Placental abruption, IUGR,
  prematurity, CNS abnormalities,
  withdrawal disorders

3
Fetal Assessment

• Ultrasound
• Widely used non-invasive technique
• Evaluate fetal anatomy, growth, position
• Localize placenta w/in placenta
• Measure amniotic fluid volume
• Estimate fetal growth over time
• Used to guide amniocentesis

4
Fetal Assessment

• Amniocentesis
• Commonly performed invasive procedure
• Needle inserted (sterile condition) into amniotic
  sac
• Evaluate fetal lung maturation
• Rh isoimmuniztion severe anemia 2nd to hemolysis
• Assess fetal chromosomal abnormality

5
Fetal Assessment

• Nonstress Test and Contraction Stress Test
• Monitor fetal heart rate (FHR)
• Nonstress (NST) response when fetus moves
• Reactive.. Rise in FHR at least 15 bpm lasting
  more 15 seconds
• Highly correlated with normal uteroplacenta
  function
• No change in maternal clinical status
• Normal fetal survival if perfromed w/in 1 week of
  delivery

6
Fetal Assessment

• Contraction Stress Test
• Continuously monitoring FHR during uterine
  contractions
• Stimulated by oxytocin
• Normal uterine contraction fetal P02 drop 12 mm
  Hg slowing FHR
• Known as late deceleration
• Negative CST no late deceleration of FHR
  w/contraction
• Contraction occur w/ frequency of 3 per 10
  minutes
• Positive CST late decelerations w/every
  contraction
• Suspicious CST some but not all contractions
  accompanied w/late deceleration
• Abnormal CST may prompt further evaluation of
  delivery

7
Fetal Assessment

• Fetal BioPhysical Profile
• Variable
• Fetal breathing movements
• Gross body movement
• Fetal tone
• Reactive FHR
• Qualitative amniotic fluid volume (AFV)

8
Fetal Assessment

• Fetal BioPhysical Profile
• Likened to Apgar score
• Score of 0 2
• Four assessed by ultrasound fetal breathing,
  fetal tone, gross body movement, and amniotic
• Fifth determine by NST
• BRP score
• 8 10 considered normal
• Score of 6 repeat w/in 24 hours
• BRP 0 4 clearly abnormal
• Associated with poor perinatal outcomes
• Immediate delivery

9
Fetal Assessment

• Blood Gas Values
• Fetal Scalpfetal scalp puncture
• First Stage Labor Second Stage Labor
• pH 7.33 7.29
• PC02 44 46
• P02 22 16
• HC03- 20 17
• Scalp blood pH
• greater than 7.25 reassuring
• Less than 7.15 high risk of fetal acidemia

10
Fetal Assessment

• Blood Gas Values
• Umbilical Cord at birth
• Umbilical artery Umbilical Vein
• pH 7.24 7.32
• PC02 49 38
• P02 16 27
• HC03- 19 20
• Scalp blood pH
• greater than 7.25 reassuring
• Less than 7.15 high risk of fetal acidemia

11
Fetal Assessment

• Blood Gas Values
• Arterial Sample after Birth
• 5- 10 minutes 30 minutes 60 minutes
• pH 7.21 7.30 7.33
• PC02 46 38 36
• P02 50 54 64
• HC03- 17 18 19
• Scalp blood pH
• greater than 7.25 reassuring
• Less than 7.15 high risk of fetal acidemia