Study Guide OB Final Exam

 Know gravida, TPAL, Nagele’s rule, Leopold’s maneuvers, version, ballottement,

SGA, AGA, LGA, Nulligravida, primigravida, intrapartum, antepartum

 GTPAL – G gravida, T term (39-40.6 wks), P para or preterm, A abortion

(miscarriage or abortion), L living children
 Nagele’s Rule: first day of last menstrual period- 3 months + 7 days
 First day of LMP was July 3: April 10
 First day of LMP was Dec 26: October 3
 First day of LMP was Jan 16: October 23

 Leopold’s Maneuvers: evaluates fetal presentation and position- determines delivery

and to place fetal monitor.
1. Feel fundus
2. Put hands on sides of abdomen to feel for feet and back
3. Feel lower pelvic area to determine presenting part
4. Get behind mom, move hands on each side of abdomen, if hands can meet head
isn’t engaged.
 Version: Not done until after 37 wks. Can induce labor. If done earlier in pregnancy,
fetus can move after
-external: change fetal position from breech to present cephalic
-Internal: done with twins during labor
 Ballottement: touching cervix during vag exam will cause fetus to rise in the amniotic
fluid and then rebound to its original position.
 Nullipara: Never been pregnant before or has not completed a pregnancy of 20 wks or
more.
 Primigravida: pregnant for the first time
 Intrapartum: during labor
 Antepartum: During pregnancy
 Know Fundal Height measurements
 • 36 weeks the fundus is the highest peak and then 40 weeks it goes down a little
because of lightening.


 Know normal changes during pregnancy and what causes the changes

 Cervix
o Cervix is very vascular
o Moms having vaginal bleeding
o Know what would be normal and abnormal for bleeding
o Softening of the cervix = positive Goodell’s sign
 *Skin and Hair
o Skin pigmentation changes due to estrogen, progesterone and alpha- melanocyte
stimulating hormones
 Eyes
o Can be corneal changes effecting their vision
o Not uncommon for women to have their prescription adjusted
o After pregnancy their vision will go back
 Respiratory
o Nasal stuffiness, nose bleeds, because of the progesterone
 GI
o N/V, slow down peristalsis increased risk of constipation, decreases emptying of
gall bladder so risk of cholecystitis, appendicitis
 Integumentary
o Linea Negra: dark line of pigmentation down abdomen will go away after
pregnancy
o Cholasma: “mask” pigmentation across nose and cheeks will go away
o Striae: stretch marks will fade but wont completely go away
o Spider nevi: bursted capillaries or red dots don’t go away
 Metabolism
o 25-35 pounds recommended weight gain
 Musculoskeletal
o Gait is altered, can’t see feet, more prone to falling
o Couvade- unintentional development of physical symptoms of pregnancy
 When people who are close to mom start having cravings or symptoms
that mom would have
 Know positive, presumptive and probable signs of pregnancy

o Presumptive – not getting period, N/V, increase urination, fatigue, breast changes,
quickening (fetal movement), hyperpigmentation
 In first trimester frequent urination caused by increase HCG hormone
levels
 Third trimester caused by pushing on the bladder
o Probable
 Positive pregnancy test
 Enlarged abdomen
 Hegars sign
 Chadwigs sign
 Goodells sign
 Ballottement – fetus rebounds
 Palpable fetal outline
 Braxton hicks contractions
 o Positive
 FHR sounds
 Fetal movement
 Fetal skeleton on x ray
 Fetal sonography
 Know the importance of maternal positioning during labor. Which positions
decrease and increase placental circulation

 Positions for pushing:

 Hands and knees- takes pressure off back, improves fetal circulation. *Common if
fetus is in distress
 Sitting or squatting- easier for delivery
 Side lying- L side improves blood flow. Use if fetus isn’t getting enough o2
 Self care: Provide info about discomfort that can occur, relaxation techniques,
patterned breathing. Have mom focus on something in the room. Prevent
hyperventilation- give emesis bag, o2 mask( s/s- tingling in hands/ feet, dizziness,
dyspnea, tachycardia,)
 Know fetal assessment methods

 Ultrasound:
 Documentation of gestational sac early in the pregnancy.
 Fetal number.
 Fetal heartbeat and breathing movements
 Assessment of gestational age.
 Survey of fetal anatomy for major malformations and sex
 Fetal presentation and position
 Placental location.
 Assessment of amniotic fluid volume.
 Evaluation for maternal pelvic masses.
 Determine sex 16 wks
 Transabdominal ultrasound- need bladder full about 8 oz water to see uterus
 Endovaginal ultrasound
 Crown-rump length: measures head to bottom and is the most useful measurement to
determine gestational age in first trimester
 Biparietal diameter of head
 Nuchal translucency test:
 Done at 11 1/7- 13 6/7 wks gestation
 Checks for trisomy 13,18,21
 If positive, baby will have accumulation of fluid at back of neck
 Umbilical Velocimetry- Doppler measures the red blood cells from the umbilical artery.
Highest peak is systolic and lowest is diastolic.
 Amniotic fluid assessment:
 Polyhydramnios: 1% of all pregnancies. Measured by AFI(Amniotic Fluid Index) 25
or > and 2,000ml or >. **2 L or more amniotic fluid.
 Oligohydramnios: less than 500ml of fluid
 Amniotic fluid tests:
 a-Fetoprotein (alpha-fetoprotein) (AFP)– fetal serum protein produced in the yolk
sac for the first 6 weeks of gestation and then by the fetal liver- can diagnose genetic
abnormalities
 not done on everyone, more high risk
 S/E:
 L/S ratio: Lecithin/Sphingomyelin- 2 components of surfactant. 30-32 wks= 1:1, 35
wks=2:1
 Chorionic Villus Sampling CVS:
 Sample from placenta- can be done in first trimester- to diagnose genetic, metabolic
and DNA studies. Does not detect neural tube defects.
 Prenatal Blood Tests:
 CBC
 Blood type, Rh Factor
 Rubella
 Hepatitis
 Syphilis
 HIV : contraindication for vaginal delivery
 PAPP-A-Plasma pregnancy associated plasma protein A
 Phosphatidylglycerol (PG)
 Tests fetal lung maturity
 Group B strep:
 Vaginal/rectal swab at 35-37 weeks
 Leading cause of meningitis, sepsis, pneumonia in newborns
Treat with Penicillin or Ampicillin within 4 hours of labor
 Know medications commonly used during pregnancy. Why are they prescribed and
what are the side effects?

 Know Placenta Previa and Abruptio Placentae. What are the signs and symptoms,
nursing interventions.

 Placenta Previa:
 Placenta is improperly implanted in the lower uterine segment
 Sudden onset of painful uterine bleeding in the later half of the pregnancy or
during delivery
 High risk pregnancy- scheduled c/s
 Abruptio Placentae:
 Can be caused by vasoconstriction (cocaine, cigarettes), multigravida, shorter
umbilical cord, HTN
 Is the premature separation of a normally implanted placenta from the uterine wall
 Abdominal tenderness, painless bleeding or painful if blood builds up
 Signs of bleeding: low BP, tachycardia, SOB, irregular/ rigid abdomen
 Know the affects of hyperglycemia during pregnancy for mom and baby. What
happens to insulin requirements for diabetic moms during pregnancy and after
delivery?
 Effects on mom:

o 2nd half of pregnancy increased resistant to insulin and decreased glucose

tolerance
 Going to make them more susceptible to having hyperglycemic issues
o Insulin requirement could double or even quadruple during pregnancy for
someone who has diabetes because it is so heard to control it, metabolism is
higher, you are eating more
o Risk of:
o Hydramnios- polyhydramnios
o Increase the amount of the amniotic fluid
o Pregnancy-induced hypertension (PIH)
o Preeclampsia
o Ketoacidosis
o Dystocia – difficult labor, babies tend to be larger
o monilial vaginitis – yeast
o Urinary tract infections – can cause preterm labor
o Retinopathy
 Effects on baby:
o Congenital anomalies 5% to 10% and are the major cause of death for infants of
diabetic mothers
o Anomalies often involve the heart, central nervous system, and skeletal system
o Large for gestational age (LGA)
 More risk for assisted, shoulder injury
o Birth trauma
 Know the signs & symptoms of hypoglycemia for a newborn. What are the risk
factors for a newborn to develop hypoglycemia? What are the nursing interventions
for an infant with hypoglycemia?
o Hypoglycemia :
o Shaky, sweaty, inconsolable
o Lethargic the more hypoglycemic they are
o Risk Factors: Maternal diabetes
o Nursing Interventions: checking blood glucose- needs to be above 40. If baby
can have oral intake, give formula or breastmilk, or IV glucose
 What is Polyhydramnios and oligohydramnios and what causes it?
 Polyhydramnios:
 Increase in the amount of amniotic fluid- 2 L or more of fluid.
 Causes: fetal abnormality (renal issues), maternal cause- infectious condition,
gestational diabetes, maternal RH incompatibility, pre-eclampsia, HTN
 Symptoms: Difficulty breathing & ambulating, Decreased urine production, Larger
abdominal size for one’s gestational age, Swelling of abdomen, vulva, legs, Excessive
weight gain
  Effect on mother:
o Indigestion
o Constipation
o Abdominal pain
o Heartburn
o Straie & Varicose veins
o Premature labor, PROM, postpartum hemorrhage, placental abruption,
umbilical cord prolapse
 Effect on Newborn:
o Preterm Birth
o Birth Defects (Down’s syndrome, cleft palate)
o Stillbirth: Death of the baby in the uterus after the 20th week gestation
o Fetal Malposition- breech more common
 Treatment:
o If harmful to fetus:
o Complete Bed rest
o Amnioreduction (pull fluid out with needle)- can cause PROM, fetal distress,
infection, poke the fetus, bleeding
Indomethocin-Prostaglandin inhibitor-prior to 31 weeks only

 Oligohydramnios:
 Less than 500ml of amniotic fluid
 Causes: PROM, post term gestation, placental insufficiency, antihypertensive meds,
fetal urinary tract abnormalities.
 Treatment: amnioinfusion, increased fluid intake
 Know what the newborn complications are for a mother who abuses cigarettes,
alcohol, or heroin during pregnancy. What are the s/s of maternal drug use in a
newborn?

 Nicotine (cigarettes)
o Vasoconstrictor, depletes blood flow to fetus, poor oxygenation
o Increased risk of spontaneous abortion and placental abruption, fetus tends to be
SGA, higher risk of SIDS, cleft palate
 Alcohol
o Can cause fetal alcohol syndrome leading to mental retardation, congenital
anomalies, intrauterine growth restriction
 Drug Exposed Newborn:
 Respiratory distress
 Jaundice
 Congenital anomalies & growth restriction
 Behavioral abnormalities- altered sleep wake, feeding difficulties
 Withdrawal
 Long term effects- motor, language, feeding
 Nursing: keep lights dim, low stimulation, cluster care
  Know ROM, PROM and what nursing interventions are involved with each? What
are you looking for as a nurse and what are the potential complications to the
newborn?

 PROM premature rupture of membranes: earlier than 37 wks

 Causes: chorioamnionitis, UTI
 Complications: infection, pre term labor, prolapse
 Management: labor induced if term or after 39 weeks, prevent further fluid loss, strict
bedrest, give Betamethasone* (steroid given IM to promote fetal lung maturity), give
antibiotics

 Know the meds that are used to induce labor. Know the side effects and nursing
interventions involved with administration of these meds.
 Meds used to Induce labor:
- Pitocin/ oxytocin: Given for induction of labor. Stimulates uterine smooth muscle
causing increased strength, duration and frequency of contractions. S/E: excess
uterine activity, fetal bradycardia or tachy, reduced FHR variability, prolonged
decelerations. Prolonged administration can lead to maternal fluid retention and
water intoxication.
Nursing: Monitor FHR and contractions. If non reassuring FHR- stop infusion,
flush with isotonic solution, put mom is L side lying position to increase fetal
blood flow, give O2 8-10L via mask. Post partum: monitor fundus, lochia for
clots, cramping, urine output, bladder distention.
 Know the common complications of pregnancy UTIs, anemia, and N&V. What
causes them and how are they treated?

 Care of the pregnant woman with anemia

o Anemia indicates inadequate levels of hemoglobin (Hb) in the blood
o Hemoglobin of less than 11g/dl – this is when you would want to start taking
action
o To prevent anemia, low-dose (30 mg/day) supplements of iron at the first prenatal
visit
 Every women takes this prophylactically
o If anemia is diagnosed, increased to 60 to 120 mg/day of iron
 Side effects of iron – constipation, black tarry stool
 Teaching: Increase fluids, increase high fiber foods
o Also probably would be put on stool softener
 Hyperemesis Gravidarum:
 Excess vomiting during pregnancy
 Complications: dehydration, ketonuria, weight loss of 5% or more of pre
pregnancy weight
 Treatment: give Zofran anti emetic, correct dehydration, restore electrolyte
balance, maintain nutrition (tpn, lipids)
 Know the s/s of ectopic pregnancy and treatment

 Ectopic Pregnancy
o Pregnancy that occurs anywhere outside of the uterus
 o Most common type is anywhere in the fallopian tube
o Really severe sharp pain on the effected side – fallopian tube can rupture
o Pregnancy test comes back positive – but not a true pregnancy that can go to term
o Need to surgically remove
o They give Methotrexate – folic acid inhibitor, inhibits cell reproduction
 Avoid foods with Folic acid – cereal, bread, green leafy vegetables
o At risk for developing scar tissue – could effect subsequent pregnancies
 Know the following medications, side effects, and nursing interventions: Pitocin,
Magnesium Sulfate, Betamethasone, and Terbutaline.
 Meds for preterm labor: Given to stop contractions and labor
- Magnesium Sulfate: Given to relax smooth muscle and suppress preterm labor.
S/E: blurred vision, lethargy, weakness, decreased DTR, respiratory depression.
Antidote: calcium gluconate. Nursing: assess DTR ( if hypotonic, too much Mag),
Respiratory rate above 12, urine output greater than 30ml/hr
-Also used as an anticonvulsant to prevent seizures in preeclampsia.
- Betamethasone (corticosteroid): Used to accelerate fetal lung maturity between
24-34 weeks. Reduces RDS, intraventricular hemorrhage, and death. This lessens
severity of preemie complications.
- Terbutaline (beta adrenergic): Delays preterm birth up to 48 hours to allow
administration of corticosteroids and antibiotics. S/E: tachycardia, tachypnea,
SOB, BBW against use longer than 48 hours. Monitor apical pulse and ecg for
dysrhythmias.
 Know the definition of prematurity and the associated risks

 Preterm Newborns: born before 37 weeks

 Cardiac problems- persistent fetal circulation adaptation doesnt occur*
 Thermoregulation- lack of brown fat, not as much fat tissue
 GI alterations- lack ability to suck and breathe at same time*
 Renal- cant compensate for dehydration, cant concentrate urine, difficulty excreting
medications
 Behavioral states- how they sleep, wake, feed
 Respiratory problems
 Management of nutrition & Fluid Requirements- often on TPN, lipids, NG tube
 Long term problems- behavioral, learning, cardiac
 Know what gestational trophoblastic pregnancy is

 Hydatidiform Mole - Gestational Trophoblastic Disease

o Abnormal development of the placenta
o Ususlly caused by the Y chromosome over duplicating and X isn’t
o Brown to red bleeding
o Uterine enlargement greater than gestational age or smaller than expected.
(dependent on type)
o Hcg levels high – another condition where the pregnancy test would be positive
o Treatment- D&C
o Monitor for cancer later on
 Know what ABO and RH incompatibility is, the risks, how to test for it, and
treatment
  85% has rh protein
 If mom is Rh positive, this will never be an issue
 If mom is negative, she doesn’t have antigen and baby does= problem
 Rh sensitization: If an RH neg. person is exposed to Rh pos. blood, an antigen-
antibody response occurs, antibodies are formed and the person becomes sensitized.
 When these cells are sensitized, they can become agglutinated and this will cause
hemolysis of RBCs in the baby
 Build up of hyperbilirubinemia: Kernicterus occurs (in the brain) which causes
severe mental retardation or death, or erythroblastosis fetalis ( agglutination and
lysing of rbcs)
 Rh negative mom and rh + baby 1st pregnancy: placental separation can cause fetal
and mother blood mixture. This causes mom to be exposed to the antigen, and now
has antibodies.
 If subsequent pregnancies occur with Rh + baby: the rh positive babies blood will be
attacked by the mothers antibodies, causing hemolysis and other complications
 Testing: know when mom should get RhoGam or not*
 Antepartal:
 At 28 weeks- Rh neg mother has titer drawn:
 No antibody is formed=RhoGam is given
 not sensitized and father is Rh positive or unknown=RhoGam is given
 Also give post abortion
 Post Partal:
 *Indirect Coombs- done on mother to determine the number of Rh positive
antibodies
 *Direct Coombs- done on infant to detect antibody coated Rh positive RBCs
 If both negative=no sensitization-give RhoGam within 72 hrs to prevent it
occurring in the future
 If both positive= monitor infant for hemolytic disease
 If Mom negative and infant positive- give Rho Gam
 ABO incompatibility:
 Type A or B has an antigen. Type O does not.
 Usually occurs with Type O mother and Type A or B infant.
 Know what TORCH stands for. Know how these diseases are transmitted to the
fetus

 TORCH
o T – toxoplasmosis
o The highest rate of fetal infection (65%) occurs when the mother contracts the
infection in the third trimester
o Contracted from eating undercooked meat, drinking unpasteurized milk (or any
kind of dairy products), contact of cat feces
o O – other infections (**Group B strep)
 All women are screened at 35-37 weeks
 For vaginal births, if GBS positive, will receive IV antibiotic prior at the onset
of birth
o R – rubella
o Greatest teratogenic effects of rubella on the fetus is during the first trimester*
o Early in the second trimester, the resultant fetal effect is most often permanent
*hearing impairment, microcephaly, or psychomotor retardation
 o C – cytomegalovirus
o Can result in extensive intrauterine tissue damage that leads to fetal death
o SGA*, tissues and organs affected are the blood, brain, and liver,* mental
retardation, learning disabilities, hearing loss*
o H- herpes
o Herpes simplex virus (HSV-I or HSV-II) infection can cause painful lesions in
the genital area
o Delivery- if no outbreak can be delivered vaginally
 But if they do have a vaginal delivery and they have it the baby can be blind
 Know what Pre-eclampsia and Eclampsia are. What assessment data is important?
s/s of increasing severity, Nursing interventions. Know HELLP syndrome. s/s,
treatment, lab work, and nursing interventions.

 Preeclampsia:
 3 characteristics: HTN, proteinuria, edema
 HTN= Increase in systolic blood pressure of 30 mm hg or an increase of diastolic
pressure of 15 mm hg over baseline after 20 weeks gestation
 Need to look based on 2 separate occasions. If no baseline- 140/90 or above is
considered hypertensive
 Preeclampsia indicates that this is a progressive disease unless there is
intervention to control it
 Eclampsia means “convulsion.” If a woman has a convulsion, she is considered
“eclamptic”
 Mild Preeclampsia:
 Blood pressure findings:
o Rise in systolic blood pressure of 30 mm hg or more or a rise in diastolic
blood pressure of 15 mm hg or more above the baseline
o 2 occasions at least 6 hours apart
 Generalized edema
 Wt gain more than 1.5kg/month 3rd trimester
 Proteinuria 1+ to 2+
 Severe Preeclampsia: HELLP
 H: hemolysis: RBCs lyse going through small vessel
 E: Elevated: liver has hard time functioning
 L: Liver enzymes
 L: Low
 P: Platelet count (thrombocytopenia): platelets are aggregated at site of damage
 Other Symptoms: nausea, vomiting, malaise, flulike symptoms, or epigastric pain,
oliguria, thrombocytopenia, fetal growth restriction
 Perinatal mortality with HELLP syndrome are high
 Platelet transfusion may be required if below 20,000 (can have spontaneous
stroke)
 Treatment of Severe Preeclampsia:
 Bed rest
 Diet- high-protein, moderate-sodium diet
 Anticonvulsants - Magnesium sulfate is the treatment of choice for convulsions (
antidote is calcium gluconate)
 Corticosteriods – controversial bc depends on gestational age
  Fluid and electrolyte replacement
 Sedatives- lowers bp
 Antihypertensives- nifidipine
 Nursing Assessment:
 Vitals every 1-4 hours
 Fetal HR
 Urine protein, gravity
 Edema, weight daily
 Strict I&O
 Pulmonary edema
 Deep tendon reflexes if on Mag
 Risk for abruptio placentae
 *Worsening signs: headache, blurry vision/ visual disturbance, epigastric pain
 Know the definition of physiological jaundice. Other causes of hyperbilirubinemia,
who is at increased risk, the treatments, complications of untreated
hyperbilirubinemia.

 Physiologic- caused by increase in RBC destruction, impairment of conjugation of

bilirubin, and increased reabsorption of bilirubin in intestinal tract. Occurs after 24 hours
of birth.
 Neuro signs of jaundice:
 Lethargy : wont wake for feedings
 Feeding difficulties
 Irritability/ fussiness
 Altered wake/ sleep pattern
 Alternating hypotonia or hypertonia
 Periodic breathing and apnea
 Treatment: unconjugated needs to be conjugated so it can be excreted
 Phototherapy- bili lamp. Goal is to prevent need for an exchange transfusion, and
brain damage.
 Kernicterus- excessive build up of bilirubin in brain that leads to mental retardation or
death
 Types of phototherapy- lamps, banks of light, bili blanket
 Complications of phototherapy:
 Elevated bilirubin level- initially high until its excreted
 Dehydration- babies can sweat
 Alteration in skin integrity
 Alteration in nutrition
 Eye damage- eyes are covered bc retina can be burned
 Alteration in thermal regulation
 Decreased parental bonding
 Causes of jaundice: drug exposed newborn, gestational diabetes, SGA, not getting
enough breast milk, breast milk doesn’t have enough nutrients
 Know when forcep extraction or vacuum extraction is used

Assistive Delivery:
 -Contraindications: severe fetal compromise, acute maternal conditions, high fetal station

 -prep: empty bladder, cervix dilated and membrane ruptured, anesthesia

 -Risks- cephalohematoma, skin tears, infection, facial nerve damage

 Know what a non-stress test and contraction stress test measures.

 Non stress Test: assesses neurologic system of fetus

 Measure the ability of the fetal heart to accelerate in association with fetal movement
 Reactive=good. Need at least 2 accelerations of 15 bpm lasting 15 seconds with each
fetal movement over 20 minute period.
 Non-Reactive=no fetal movement. They will have mom drink sugary drink or eat
something spicy to wake baby up.
 Biophysical profile: 5 variables
 Fetal breathing movements
 Fetal movements of body or limbs
 Fetal tone
 Amniotic fluid volume
 Reactive fetal heart rate with activity
 Maximum score is 10; 10/10 or 8/10 norm. Interventions vary with lower scores. 4
or below =immediate delivery
 Contraction stress test:
 Can the fetus withstand labor
 Cause a contraction and check how fetus responds
 CST measures the response of the fetal heart to the stress of uterine
contractions(caused by Oxytocin) . It is indicated for pregnancies at risk for placental
insufficiency or fetal compromise because of any of the following:
 IUGR- something preventing baby from growing
 Diabetes mellitus
 Postdates (42 or more weeks’ gestation)
 Nonreactive NST
 Results:
 Negative: Desired result. 3 contractions of good quality lasting 40 sec. in 10
minutes without decels. (fetus can handle hypoxia of contraction)
 Positive: repetitive late decels with more than 50% of contractions. Hypoxia
causes decreased FHR
 Equivocal or suspicious: nonpersistant decels

 Know common complications of preterm and term infants, and nursing

interventions for these infants. (tracheoesophageal atresia, TTN, RDS, meconium
aspiration syndrome, etc)

 RDS ( respiratory distress syndrome)

 Decreased surfactant
 Atelectasis
 Poor lung compliance ( contractions, nasal flaring, grunting)
 Poor ventilation
 Transient Tachypnea of Newborn (TTN):
  Occurs in full term baby
 Shortly after, expiratory grunting, tachypnea, nasal flaring, cyanosis
 Cause: over sedation during delivery, bleeding, prolapsed cord, breech babies,
maternal diabetes, c/s
 Meconium Aspiration Syndrome:
 Occurs if there is stress, trauma or infection in uterus
 Meconium in amniotic fluid indicates a potential hypoxic result.
 Meconium in lungs produces ball valve action ( air in, not out)
 Can cause bacterial infection
 Meconium Treatment:
 Intrauterine flush
 Initial, deep suctioning
 Resuscitation
 Ventilation
 Surfactant replacement
 CPAP
 Nitric oxide (dilates vessels)
 Newborns with Infection
 s/s: subtle behavioral changes, temperature instability*, feeding intolerance,
hyperbilirubinemia, tachycardia, spells of apnea or bradycardia
 First sign of sepsis in newborn is a low temperature * poor functioning immune
system
 Cold Stress in Newborn*
 1. Hypoxia: norepinephrine is released to break down brown fat, pulmonary
vasoconstrictor, decreased blood flow through lungs.
 2. Hyperbilirubinemia: metabolism is increased to burn off brown fat, and fatty acids
are left behind as a byproduct, and bilirubin builds up
 3. Hypoglycemia: increased metabolism, increased 02 consumption, increased
utilization of glucose
 Esophageal Atresia& tracheoesophageal Fistula:
- Failure of esophagus to develop properly by 5th week gestation.
- Symptoms: drooling, cyanosis, choking, coughing.
- Surgery performed asap- medical emergency
- Diagnose by trying to put in an NG tube
- Nursing care: NPO until healed, fed with TPN and lipids

 Know signs of fetal hypoxia

 Early sign of fetal hypoxia: decreased fetal heart rate and reactivity
 Late sign of fetal hypoxia: decreased tone

 Fetal Circulation: free response, explain and mention each step and shunts, what
stops fetal circulation
- One vein, 2 arteries: vein brings oxygenated blood to baby, arteries bring de-
oxygenated blood back to mother
- 1: mother receives blood, o2 through placenta, travel thru umbilical vein, when enters
into fetus:
- branches into 2 directions – 1st branch small amount going into liver, 2nd branch
ductus venosus shunts majority of blood into inferior vena cava
 - then goes into R atrium- small amount will go into R ventricle, pumps into pulmonary
artery- branches 2 ways: a small amount into lungs, majority goes thru ductus
arteriosis which leads to aorta. Majority of blood entering R atrium- shunted through
opening foramen ovale and bypass R ventricle into L atrium and L ventricle, and
pumped out thru aorta and to the body
- (pressures on heart are greater on R side, after birth pressure is greater on L)
- From lungs, returns thru pulmonary veins, into L atrium, L ventricle, pumps out
through aorta to body
- Once blood travels into aorta, it returns to placenta to be re-oxygenated through 2
umbilical arteries
 Fetal circulation after birth:
- First respirations on own increases O2 levels
- This stimulates pressure in R side to drop, and L side pressure to increase. This stops
blood from flowing through foramen ovale and allows the newborns lungs to
oxygenate the body, closing foramen ovale
- Increased aortic pressure to pulmonary artery closes ductus arteriosus
- Cord clamped- starts closure of ductus venosus

70 multiple choice
10 free response- fetal circulation essay, process and adaptations that stop fetal circulation
Common medications during pregnancy: iron, stool softeners-colace, folic acid (prevents
neural tube defects),
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