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51 Cards in this Set

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The nutrient, gas exchange and waste removal organ of the fetus

6 to 8 inches in diameter

Occupies 1/3 of intrauterine surface


Moms arterial blood O2, diffuses into umbilical vein

Fetal blood picks up O2

Blood goes to through fetal circulation

Fetal blood, high in CO2, returns back to the placenta via umbilical arteries

CO2 diffuses into moms venous system and it is exhaled

Closer look at placenta

The embryo implants into the uterus by finger like projections (chorionic villi)

:These contain fetal vessels

As these continus to grow, the endometrium erodes, creating pockets (intervillous spaces)

:These contain maternal blood

Cotyledon: grouping of 15 to 28 villi and intervillous spaces

Closer look at placenta

Gas exchange takes place between fetal and maternal blood

No contact between either blood source

Placenta to attack and build the upper 1/3 of the baby cavity, it stays away from the cervical opeing, so birth is not obstructed in any way.

Umbilical cord

lifeline between fetus and mother

Mean length 55 cm (22 inches)

3 vessels surrounded by whartons jelly

:2 umbilical arteries/ 1 umbilical cord

AMNION: sack that surrounds the fetus and amniotic fluid

Amniotic fluid

1t 40 weeks, 1 liter of fluid

produced at 7 days

Made of maternal and amniotic membrane fluid

gIt is always being replenished and reabsorbed

24 to 26 weeks the fetal skin is permeable

Amniotic fluid

Skin starts to harden after 26 weeks, so skin is impermeable to the fluid (keratinization)

Absorption is now done by fetal swalling (500 ml/day) and

Fluid in the amniotic sack is replenished by fetal urination and lung fluids (500 ml/day)

Purpose of amniotic fluid

Allows for fetal movement

Protects from shock or maternal movement


Helps metabolism by giving fluids to fetus


Abnormally high amounts of fluid

:Greater than 2000 ml

Indicates a "swallowing problem of fetus

:May also indicate abnormalities such as


::Esophageal atresia

::TE fistula

Complication from this

:PROM (premature rupture of membrane)

:Lead to prolapse of cord

:A premature delivery


Decreased amount of amniotic fluid less than 500 ml

Caused by:

:Urinary tract defect

:Post term preganacy


:adhesion of body parts

:compression of the umbilical cord leading to asphyxia

:lung hypoplasia (failure of lung to deelop_

:limb deformaties

:Potters syndrome (worse case scenario, this is always fatal)

Fetal blood

Higher affinity for oxygen due to higher hemoglobin content


P50= 7.8 mmHg lower than the adult P50 of 27 mmHg

Highest PaO2 is in the umbilical vein (29 mmHG) SaO2= 80%


Not present (or non functional) in fetus due to immaturity of carotid sinus

Located in carotid arteries and aorta

Sensitive to PaO2, PaCO2, pH

Regulation of ventilation and the baby's first breath

Cental chemo receptors are located in the brain steam, they are the primary chemoreceptors (depedant on CO2)

Fetal to neonatal circulation

Foramen ovale closes

Ductus arteriosus closes

Ductus venosus closed

Decreased PVR for circulation to the lung

Decreased PVR/ lung circulation

umbilical cord clamped

Less blood returns to the right side of heart, so pressures decrease

Left heart pressures increase because it is no longer pumping blood back to the low resistant placenta, it is now pumping to the systemic system

Lung fluid expelled, relieving pressure on the pulmonary vessels

Decrease LVR/ lung circulation

Pulmonary vessels can now expand, hold more blood, decreasing PVR

Breathing starts and PAO2 increases causing vasodilation

With better pulmonary perfusion more blood is circulated to left atrium so left heart/system pressures increase

Ductus venosus closes

Remains open but not blood flow, function stops right away

Automatically closes within 3 to 7 days

:functional closure happens when cord is cut

Due to lack of blood flow

Foramen ovale closes

Closes via a flap valve when left pressures exceed right heart pressures

Happens immdiately

If right heart pressures exceed left, the foramen ovale can reopen allowing for shunting

Ductus arteriosus closes

Constricts and closes due to an increase in O2 tension

Decreased PVR allows right ventricle to pump blood easier into the lung and onto left heart, so there is less blood flow through the ductus arteriosus


can take 24 hours to functionally close and up to 3 weeks to to structurally close

ductus arteriosus closes (most problems, and most connection with

first hours: remains open but blood flow will be from the left to right because pressures are higher in left than right

Several hours later: constrictus due to higher PaO2

Functional closure 12 to 18 hours after birth

Total closed by 3 weeks

PROSTAGLANDINS keeps DA open in utero but are prohibited by high PaO2, causing constriction

INDOMETHICIN: GIven to hypoxic premature infants following delivery to help close DA (CLOSES DA)

Depending on CHD, need to keep open or to close

Factors responsible for 1st breath

TRANSIENT FETAL ASPHYXIA: fetal circulation is cut off. Hypoxia and hypercapnia arise. Chemoreceptors stimulated

THORAX COMPRESSED ON delivery, lung fluid removed, then reexpands for air entry


First breath

-60 to -100 cmH20, but decrease on subsequent breaths

VT= 40 cc initially, but only 20 cc exhaled

Establishing FRC, within a few hours after birth

Surfactant is present to decrease surface tension

If not can lead to RDS (respiratory distress syndrome)

Prenatal history

Risk factors Persings, Chapter 13

High Risk moms

Younger than 16, older than 40

History of previous births

Previous caesarian section, miscarriages, pre and postmature delivers, fetal/neonatal deaths

Smoking, drug use, alcohol abuse, diseases

High Risk Labors


Delayed birth after PROM (premature rupture of membrane)

Placental dislocation

Meconium stained amniotic fluid

Maternal medications

Maternal disorders


Pre eclampsia , increased blood pressure

Eclampsia: increased blood pressure with convulsions

Uteroplacental insufficiency (UPI)

Causes: pre and post maturity; maternal heart and pulmonary disease

Results of UPI:

:Lack of growth (IUGR) intrauterine growth retardation


:chronic fetal asphyxia

:Meconium stained amniotic fluid

Diabetic mom (page 22)

Complicates: 4% of US pregnancies

Mild form (controlled by diet): large infants (LGA) with no other problems. Infants have delayed lung maturation INFANTS HAVE DELAYED LUNG MATURATION

Insulin dependant: normal or small (SGA) babies with higher risk for hypoglycemia. Infants have increased lung maturation HYPOGLYCEMIA, INFANTS HAVE INCREASED LUNG MATURATION

diabetic complications

Mom has it, mom at risk for

chronic hypertension and pre: exlampsia

Mom has it and baby has problems with


Large infants with possible birth injury: shoulder displacement

Hyperinsulinemia: infant at risk for hypoglycemia after birth

UPI due to maternal hypertension, leading to hypoxia

Infants of diabetic moms (IDM)

Classic presentation: fat, large infant

If UPI present, there will be a decrease in fetal growth


CO interferes with O2 supply with fetus

Nicotine crosses placenta (greater than 15 % higher than maternal levels)

Causes developmental delays

Danger of premature delivery


Freely crosses placental barrier

O.5- 2 per 1000 births

:1 in 9 women report binge drinking during pregnancy

:1 in 5 women report drinking during pregnancy

Most problematic in 1st tirmester


the lifetime cost for one individual with FAS in 2016 was estimated to be 2.5 million $

Drugs as a risk factor

Sedatives: depress respirations. Poor muscle tone, trouble breathing/feeding after delivery

Narcotics: tremors, dyspnea, seizures, death from withdrawal, baby born addicted

Cocaine, causes placenta to detach too sooon. Causes bleeding, preterm birth and fetal death

Torch syndrome materanl infections page 24






ALl have similiar clinical manifestattions, so all grouped together

Toxoplasmosis (cat litter disesase)

Protozoa found in cat feces or eating raw meat

Mother may be asymptomatic or fluish

Can cause congenital defects

Diagnosis with antibodies in blood serum


Preventable if mom is vaccinated before conception

Highly contagious viral illness

Characterized by rash, swollen glands and join pain

May be asymptomatic

Affects fetus in first 5 months

Low body weight

cytomegalovirus (CMV)

member of herpes family

pregnant healthcare personnel should NOT treat infants with CMV

Spread by person to person contact

mom may be aymptomatic

Herpes simplex type 2

secually transmitted

acquired by fetus during birth via contact with genital secretions or following rupture of the membrane

c section preferred (if active)

Can affect CNS, skin, and has a high mortality if disseminated in the lung

HIV infection

Neonatal HIV is more commonly from infected mom

Risk factors for prenatal infections

:Mom is IV drug user

:Infant exposure to infected blood products or breast milk

Transmission of HIV

during delivery by coming in contact with moms blood

breast feeding

transufsion with infected blood

trasnplacental transfer (not all hiv moms pass the virus)

Zidovudine (AZT) antiretroviral drug, given prior too delivery to mom, then for 6 weeks to infant to reduce incidence of HIV coplications

Manifestations of HIV

failure to thrive (FTT)

Developmental delay

Infection risks

Treat with AZT, pentamidine (antimicrobial) to prevent and treat pneumocystis, steroids)

Group B streptococcus

Risk of death if premature delivery or PROM

Vaginal cultures at 35 to 37 weeks

Penicillin/ ampicillin

Multiple gestations

2 or more

Complications of multiple gestation

Premature labor and delivery

IUGR (intrauterine growth retardation): if identical twins, one twin will have a smaller placenta

Breech/ abnormal presentations during delivery (head up butt down)

Twin transufation syndrome (one twin bigger than other twin

Twin transfusion syndrome

One twin (larger)

Polycythemia,, CHF, hyperbilirubinemia

Second twin (smaller)

Anemic, shock from blood loss

Placental problems

Placental previa (to low in the uterus)

Rather than being attached to the upper wall of the uterus, the placenta lies low in the uterus, partially or completely covering the cervix

Placenta previa: complications for baby and mom

Associated with blood loss

IUGR due to poor placental perfusion

Fetal asphyxia

Life threatening hemorrhage

Cesarean delivery may be required

Abruption placenta

Tearing of the placenta away from the uterine wall prior to delivery

Mom can fall, or rear ended in a car accident, potential to rip placenta away from uterine wall

Abruption placenta

Normally attached placenta separates prematurely causing labor to begin

Maternal mortality up to 10 %, infant mortality up to 50%

Can be partial or complete

BLeeding can be visible or concealed

Risk if severe hypoxia and blood loss

Abruption Placenta

Maternal hypertension


Shortened umbilical cord

Uterine abnormalities

Excessive number of previous pregnancies

Abruption placenta risks for baby




Abruption placenta treatment

Replaced blood volume to mother

Mother positioned on lateral position to allow maximum placental circulation

Intensive monitoring

Emergency C section delivery in cases of maternal shock or fetal distress