BIOPHYSICAL PROFILE - 2 or more accels in 20

FETAL APGAR minutes

➔ Indicates CNS function and checking the - Acceleration: ↑ FHR 15
fetus's oxygenation beats/15 minutes
➔ 5 parameters; score is 2 per parameter ● Abnormal – Nonreactive
➔ Usually done at 28 weeks AOG - No accels or <15 in 20
➔ 2 = done; 1 = lacking; 0 = not done minutes
➔ Scoring: ● Unsatisfactory – Poor quality
- 10 = perfect
- 7 & above = (+) fetal well-being CONTRACTION STRESS TEST
- 5-6 = Contraction Stress Test (CST) ➔ 34-36 weeks AOG
- <4 = (+) fetal distress → indicated for ➔ Done: after abnormal NST = <6 BPP
CS delivery ➔ Checks for:
1. Fetal Breathing 1. Function of placenta
● Via sonogram/UTZ 2. Fetal well-being
● At least 30 seconds of sustained fetal 3. Fetal ability to tolerate labor
breathing movement for 30 minutes of 4. BP monitoring
observation (1 episode) 5. 3 palpable contractions for 40 seconds
2. Fetal Movement within 10 minutes (baseline)
➔ Give mother mild contraction:
● Via sonogram/UTZ ● Nipple rolling; or
● At least 3 episodes of fetal limb or trunk ● Diluted oxytocin: IV 10 units (diluted)
movement within 30 minutes of observation ➔ Results:
3. Fetal Tone ● Normal: No changes/No decels
● Via sonogram/UTZ (negative CST)
● Fetus must extend and flex extremities or ● Abnormal: Positive CST → Late
spine for 30 minutes of observation decelerations
4. Amniotic Fluid - w/ 50% ↑ contraction
● Via sonogram/UTZ ● Equivocal: Decels
● A pocket of amniotic fluid more than 2 cm in - w/ 50% of contraction
vertical diameter ● Unsatisfactory: Poor quality
5. Fetal Heart Reactivity
● Non-Stress Test (NST) VARIABLE CORD COMPRESSION
● Side-side
● Trendelenburg
NON-STRESS TEST (NST) ● Modified Sims
➔ 32-34 weeks AOG ● Knee chest
● Rupture of BOW
➔ Position: side-lying ● FHR varies w/ uterine
➔ ↑ carbs snacks, orange juice, buko juice contraction (during acme)
➔ Mother eats ⇒ baby moves
➔ Monitor: BP & FHR for 20 minutes EARLY HEAD COMPRESSION
DECELERATION ● Monitor FHR
➔ UTZ transducer; tocodynamometer ● (✓) delivery
➔ Instruct mother to press the button every ● Decel FHR before peak uterine
movement → baseline contraction
➔ Checks for fetal heart reactivity:
ACCELERATION OKAY! 15 beats/15 seconds
1. Function of placenta
2. Fetal well-being LATE PLACENTAL/UTEROPLACENTAL
3. FHR in response to fetal movement DECELERATION INSUFFICIENCY
➔ Acceleration ● O2 (8-10 L/min) via face mask
● Left side-lying
● ↑ FHR: 15-15 (15 beats in 15 seconds) ● Decels after peak uterine
● Normal FHR: 120-160 bpm contractions
(variability)
**Cord prolapse – push the cord away from the fetal
➔ Deceleration
presenting part; check FHR by palpating the cord; CS
● ↓ FHR
delivery
➔ Non-reassuring
● Increment: start of the contraction; building up
● No variability
● Acme: peak
➔ Results:
● Decrement: slowing down
● Normal – Reactive
 AMNIOCENTESIS LABOR AND DELIVERY
➔ Aspiration of amniotic fluid POWER
➔ Invasive procedure 1. Uterine contraction
➔ (✓) informed consent ● Duration: 40-60 seconds (max. 90
➔ Position: supine seconds)
● Left side-lying (after) - Start of contraction up to its
➔ During: UTZ-guided end
● <20 weeks = full bladder (uterine ● Interval: 3-5 minutes
support) - End of contraction to the start
● >20 weeks = empty bladder of the next contraction
● Needle gauge: 20-22 ● Frequency: duration → interval
● Using local anesthesia (around 6 minutes)
● Aspirating 15-20 mL - Start of contraction up to the
➔ Aftercare: start of the next contraction
● Rest for 30 minutes ● Intensity: 25-50 mmHg
● If Rh (-) → give RhoGAM - Mild, moderate, strong
● Observe the following (report to MD):
- Child
- Fever
- Bleeding
- Leak of fluid into the site
- Uterine contraction/cramping
- ↓ fetal movement ●Tetanic contractions
- dangerous/fatal
Amniotic Fluid is analyzed for: - Too short interval w/ long
➢ A – Alpha Fetoprotein (AFP) duration
● ↑ = neural tube defect (spina bifida) ● Uterine rupture
● ↓ = chromosomal abnormality (Down - Internal bleeding =
Syndrome) hypovolemic shock
➢ P – Premature Labor (Fetal Fibronectin) 2. Pushing ability
● Fibronectin is a glycoprotein (acts as ● Push = during contraction
the glue of placenta to uterus) present ● Not contracting = pant/breathing
before 20 weeks and 37 weeks above technique
● First 20 weeks = found in the amniotic
fluid PASSAGEWAY
● > 20 weeks = none can be found in ➔ Canals (pelvic, cervical, vaginal)
amniotic fluid (normal) ➔ Gynecoid – female pelvis
● 37 weeks = can be found again in the
amniotic fluid
● 20-37 weeks = negative fibronectin Anterior-posterior Transverse Oblique
➢ I – Incompatibility (bilirubin)
● Hemolytic disease Inlet 11 cm 13 cm 12 cm
➢ E – Errors of Metabolism
Cavity 12 cm 12 cm 12 cm
● Inborn /NBS (Newborn Screening)
Problem Outlet 13 cm 11 cm 12 cm
➢ R – Ratio of L/S (Lecithin/Sphingomyelin)
● Normal – 2:1
● Abnormal: PSYCHE
- (x) lung maturity – lun ➔ Emotional structure (anxiety, fear)
surfactant is not yet enough
- Pregnant mother is given PASSENGER
corticosteroids IM →
Betamethasone (Celestone) 1. Fetal Head
for lung maturity a. Diamond: closes at 12-18 months
- ↓ immunity = risk for infection (Anterior fontanelle)
(reverse isolation) b. Triangular: closes at 2-3 months
➢ C – Color
(Posterior fontanelle)
● Normal: slightly yellow
● Green: w/ meconium ● Sunken/depressed fontanelle
● Yellow: bilirubin = DHN
➢ E – Skin ● Bulging/tense = increasing
● Epithelial cells – checked for genetic ICP (hydrocephalus,
analysis meningitis); normal if the child
is crying
 3. Fetal Position
● Mother quadrant – fetal landmark
● Always look for the occiput (reference)
● LOP: painful, prolonged
● LOA: most ideal position

c. Suboccipitobregmatic: 9.5 cm
● Full flexion
● Anterior fontanelle to occipital
bone
d. Occipitofrontal: 12 cm
● Frontal bone to posterior
fontanelle 4. Fetal Attitude
e. Occipitomental: 13.5 cm ● Face (complete extension, poor
● Mentum to posterior fontanelle flexion): 13.5 cm
2. Fetal Presentation ● Sinciput (military attitude, moderate
● Breech flexion): 12 cm
- Frank: flexed hips, extended ● Brow (partial extension)
knees ● Vertex (full flexion): most ideal
- Complete: flexed hips, flexed attitude – 9.5 cm
knees
- Footling
● Shoulder
● Cephalic – most ideal presentation

5. Fetal Lie
● Relationship of fetal and maternal lie
● Longitudinal – cephalic & breech
(most ideal)
● Transverse – shoulder
6. Fetal Station
● Fetal progress
● 0 = ischial spine
● (-) = above
● (+) = below
 Active ● 4-7 cm
● Moderate
● (✓) epidural anesthesia –lumbar
area
- Fetal position/side-lying
- 3-5 cm dilation
- Vasodilation = hypotension
(monitor BP)

Transition ● 8-10 cm
● Strong → very strong

MECHANISM OF LABOR STAGE 2: STAGE OF EXPULSION

➔ Full dilation → delivery of fetus
➔ Episiotomy
- (x) pressure to fetal head
- (x) laceration
- Natural anesthesia – cut w/
contraction (during contraction)
- Ritgen's
maneuver: using
gauze to support
the perineum
during delivery

STAGE 3: STAGE OF PLACENTA

➔ Delivery of fetus → delivery of placenta
➔ Signs of placental separation:
a. Sudden gush of blood
b. Lengthening of the cord
c. Uterus becomes globular and firm –
Calkin’s sign
➔ Brandt-Andrews maneuver

STAGES OF LABOR AND DELIVERY

STAGE 1: STAGE OF DILATATION ➔ Oxytocin; or
➔ From true labor → full dilation of cervix ➔ Methergine/Methylene Ergonovine Maleate
➔ True labor: - IM; check BP first (↑ BP)
● Regular contractions ➔ Fundal massage – best in preventing
● Abdominal + lumbosacral pain bleeding and uterine atony
- Not relieved by walking
● Cervical changes = dilation + STAGE 4: STAGE OF RECOVERY
effacement (IE) ➔ Postpartum
● Show – operculum ➔ Delivery of placenta (4-6 hours) → 4-6 weeks
➔ LAT postpartum
Latent ● 0-3 cm ➔ First 2 hours → V/S every 15 minutes
● Mild contractions - ↑ temp within 1st 24 hours =
● (✓) ambulation
dehydration (↑ fluid intake/hydration)
 - ↑ temp after 24 hours = infection; ➔ Characteristics:
CBC/blood culture (3-5 days) to check ● Board-like abdomen/uterine rigidity
for specific bacteria ➔ Complication:
● DIC (Disseminated Intravascular
HIGH-RISK PREGNANCY Coagulation) – bleeding tendencies
RISK FACTORS
1. Age: <16 to >35 years old ABORTION
2. Weight: over/underweight ➔ < 20 weeks termination
3. Height: <5 feet ➔ Common cause:
4. Family history - Defective ovum
5. Pre-existing condition - Infection
6. Smokers, alcoholics, drug users - Trauma
- Heavy substance abuse
PLACENTA PREVIA TYPES
➔ Low-lying placenta 1. Spontaneous/Miscarriage
➔ Bright-red vaginal bleeding (painless) ● Natural cause (toxoplasmosis)
➔ Marginal, Partial, Total - Cat litter
- Unpasteurized milk
- Raw meat
● Mental trauma
2. Induced
● Therapeutic, elective
3. Complete
● Expelled all contents
4. Incomplete
➔ Characteristics: ● Retained fragments → can cause
- Uterus infection
- ↑ fundal height 5. Missed
- No IE/sex ● All are still inside (stillbirth)
6. Threatened
ABRUPTIO PLACENTA ● No cervical changes – baby is still
➔ Premature separation of normally implanted alive; spotting, cramping
placenta 7. Inevitable
➔ Dark-red bleeding (painful) – hx of cocaine ● w/ cervical changes – baby is still alive
abuse 8. Habitual
➔ Marginal (from the side) ● 3 or more abortions
➔ Partial (concealed) ● Incompetent cervix – cerclage
➔ Complete (concreted) - McDonald’s: temporary, NSD
- Shirodkar-Barter: permanent,
CS

SIGNS AND SYMPTOMS OF ABORTION

● Cramping
● Spotting
● Bleeding → tachycardia, cold, clammy skin =
shock
MANAGEMENT
1. No intercourse – until the bleeding stops
2. Check number of perineal pads
3. D&C = Dilation & Curettage
- Vacuum curettage
4. Missed abortion – 2nd trimester
- D&E – Dilatation & Evacuation
- Misoprostol (Cytotec)
5. Antibiotics
6. Blood and fluid replacement
7. Rh (-) = RhoGAM
 H. MOLE / HYDATIDIFORM / GESTATIONAL ➢ Intermittent
TROPHOBLASTIC DISEASE ➢ Gentle and quick upon removal
● Failure to develop to full-term placenta ➢ Circular
● Trophoblast – ↑ instead of becoming a ➢ Mouth first
placenta
- Vesicles WARMING/THERMOREGULATION
- Grape-like ● Preventing hypothermia → hypoglycemia
- UTZ: snowflakes ● Swaddle
● Source of heat: brown fats
- NB are not capable of shivering –
hypothalamus is not yet matured
● Dry and wrap → evaporation
● Paddings surface → conduction
● blanket/shield → convection
● Keep aways from walls/ceilings → radiation

APGAR
SIGNS AND SYMPTOMS ● Response to extrauterine life
1. Big uterus
2. Vaginal bleeding (dark brown) – brownish
3. ↑ HCG = 1-2 mIU
● Hyperemesis gravidarum
● (+) pregnancy test
● Risk factors:
- Low socioeconomic status
- Family history
- History of Clomid therapy
➢ Clomiphene Citrate – to
ovulate; fertility drug
➢ Estrogen agonist = stimulates
ovaries to ovulate
➢ 50 mg for 5 days
➢ If no ovulation, double dose ● Acrocyanosis – blue extremities. Pink body
- 100 mg for 5 days - Intermittent for 7-14 days
- Max. 3 courses ● Blue (cyanosis)
- Hypercyanotic spell/Blue spell/Tet
MANAGEMENT spell
1. Suction curettage - Congenital heart defect
2. D&C - Right to left shunting (↓ O2)
3. Monitor HCG every 2 weeks up to 4 weeks ➢ Tetralogy of Fallot (4 defects)
4. No pregnancy for 1 year – risk for another H. 1. Pulmonary stenosis
Mole → choriocarcinoma (cancer) 2. Right ventricular
hypertrophy
PRIORITIES IN NEWBORN 3. Overriding aorta
AIRWAY 4. Ventricular septal
defect
● Bulb syringe → How to use?
➢ Tricuspid Atresia – no
1. Position: side-lying (supine w/ head on
tricuspid valve
the side)
● Pulse – most important criteria
2. Compress
● Grimace – movement of facial muscle
3. Decompress/release (mouth)
● Normal respiration – periodic respiration:
4. Compress
30-60 cpm
5. Decompress (nose)
- Irregular depth, rhythm, rate w/ apnea
● Suction catheter
of <15 seconds
➢ How long: 5-10 seconds
● Scoring:
- Max. 10 seconds
➢ Perfect score: 10
- Tracheostomy: 10 seconds
➢ Usual score: 9 (d/t acrocyanosis)
 ➢ 0-3: Severe Distress ➢ Normal:
- CPR/needs resuscitation - 5-10% of weight loos after
- PALS (Pediatric Advanced birth → back after 10-14 days
Life Support) - x2 = 6 months
➢ 4-7: Moderately Distress - x3 = 1 year
- suctioning/oxygen ● Height: 46-54 cm
➢ 8-10: Healthy
- Unang Yakap: vigorous cry; 2. Vitamin K
prone to mother’s ● Aquamephyton/Phytonadione
abdomen/chest ● To prevent bleeding
- 1st 30 seconds: Immediate ● IM – vastus lateralis
and Thorough Drying
- (✓) respiration = quick 3. Ophthalmic Ointment
assessment ● To prevent opthalmia neonatorum
● Done 2 times: 1-minute and 5-minutes after ● gonorrhea/chlamydia
birth ● Inner → outer canthus
- 3rd APGAR: optional (10 minutes) if ● Solution drops: lower conjunctiva
score is <7
4. Cord Care
IDENTIFICATION ● Water (boiled → cooled)
● ID band/bracelet ● Hemophilia = bleeding
➢ Name/MR #/DOB - Only affects male
➢ Before transferring NB to the nursery - Female = carriers only
➢ To prevent:
- Simulation of birth
- Concealment of birth

ROUTINE CARE
1. Anthropometric Measurement
● HC: 33-35 cm (above eyebrow and
ears/pinna)
● CC: 31-33 cm (nipple line)
● AC: 31-33 cm (above umbilicus)
● Weight: 2.5-4 kg (10th-90th
percentile)
➢ Below 10th percentile: SGA
- Small for gestational age
- Mother w/ HPN, smoker
➢ Below 5th percentile: FTT
- Failure to thrive (growth
failure)
➢ Above 90th percentile
- LGA - large for gestational
age
- Child of mother w/ GDM/DM
- LGA but w/ hypoglycemia
- Risk for fracture (clavicular
fracture)
- Paralysis of face
- Paralysis of brachial plexus
(Erb palsy, or Erb-Duchenne
paralysis)
- Subconjunctival hemorrhage
➢ <2500g–LBW
➢ 1000-1500g – VLBW
➢ 1000-500g – EVLBW