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Women's Health > Assessment of Foetal Wellbeing > Flashcards

Assessment of Foetal Wellbeing Flashcards

1
Q

What are the US parameters used in foetal surveillance?

A
  • Foetal biometry
  • AFI
  • Biphysical profile
  • Dopplers
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2
Q

What is foetal biometry?

A

-Head circumference
-Abdominal circumference
-Femur length
Involves absolute and serial measurements.

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3
Q

What is the amniotic fluid index?

A

Sum of the vertical depth of amniotic fluid in each of the four quadrants.
N: 7-20

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4
Q

What are the components of foetal activity assessed on US?

A
  • Body movements
  • Breathing movements
  • Tone
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5
Q

What is the biophysical profile of the foetus on US?

A

5 parameters, 2 points each. 8/10+ = reassuring

  • Body movements
  • Breathing movements
  • tone
  • Amniotic fluid index
  • CTG
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6
Q

What is assessed on doppler US?

A
  • Umbilical artery (waveform)

- MCA

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7
Q

What is the significance of the umbilical artery waveform?

A
  • Raised SDR, absent EDF, then reversed EDF a/w
  • progressive deterioration in placental gas exchange
  • evidenced by stepwise increase in perinatal mortality
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8
Q

Normal CTG baseline?

A

110-160bpm

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9
Q

Normal CTG variability?

A

5-25bpm

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10
Q

Normal CTG accelerations?

A

15bpm for 15s

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11
Q

Normal CTG decelerations?

A

No ominous decelerations

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12
Q

What are the abnormal CTG variability patterns?

A
  • INCREASED (>25bpm): hypoxia
  • REDUCED (3-5bpm): sick (hypoxia), sleeping, sedated, submature (SSSS)
  • ABSENT
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13
Q

Causes of sedation as detected by non-reactive, reduced variability CTG?

A
  • sedatives
  • anti-HT
  • anti convulsants
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14
Q

What are the characteristics of early decelerations?

A 
RARE
–  Timing: simultaneous with contraction, uniform, repetitive
–  Shape: Gradual onset and recovery
–  Depth: Almost invariably shallow
–  Cause: Head compression
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15
Q

Receptor associated with early decelerations?

A

Pain receptor

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16
Q

What are the characteristics of late decelerations?

A

– Timing: Uniform, repetitive, begin after contraction onset, recover after contraction complete
– Shape: Gradual onset and recovery
– Depth: May be deep or almost imperceptively shallow
– Cause: Hypoxia

17
Q

What are the characteristics of variable decelerations?

A

– Timing: Variable, but usually simultaneous with contraction, repetitive or intermittent
– Shape: Sudden onset and recovery
– Depth: Mild (<60bpm for <60 secs), Mod (>60bpm OR >60 secs), Severe (> 60bpm AND >60 secs)
– Cause: Cord compression

18
Q

How are variable decelerations classified?

A 
-Mild:
 60 bpm OR > 60 secs
-Severe
> 60 bpm AND > 60 secs
 OR
Delayed Recovery
OR
Rebound Tachycardia
19
Q

What are the characteristics of prolonged decelerations?

A
  • Shape: sustained bradycardia
  • Timing: more than 2 mins
  • Cause: sustained hypoxia
  • Receptor: chemoreceptor
20
Q

what are causes of sudden severe foetal hypoxia?

A
  • Cord compression
  • Maternal hypotension
  • Sustained uterine contraction
  • Placental abruption
21
Q

How are antenatal CTGs classified and what is the implication of each?

A
  • Reactive: (reassured). Normal baseline, normal variability, accelerations, no adverse decelerations.
  • Non-reactive (investigate). No accelerations, reduced variability.
  • Critical (DELIVER - C/S). Late decelerations, absent variability, sinusoidal pattern.
22
Q

How to investigate antenatal non reactive CTG?

A

Is it due to hypoxia??

  • Foetal stimulation tests e.g. VAST
  • Doppler US (UA waveform, MCA PSV)
  • Biophysical profile
23
Q

Characteristics of the gynaecoid pelvis?

A

Classic female pelvis.

  • Posterior sagittal diameter of inlet only slightly shorter than anterior sagittal diameter
  • posterior pelvis rounded and wide
  • sidewalls straight
  • spines not prominent
24
Q

What is mentum presentation?

A

Face presentation with foetal head hyperextended so occiput in contact with foetal back; chin (mentum) presenting.

25
Q

What are the types of cephalic presentations?

A
  • vertex
  • brow
  • face (mentum / chin point of reference)
26
Q

Why is incision in caesarean made in lower uterine segment?

A

Risk of uterine rupture; lower uterine segment does not actively contract during labour

27
Q

What is the risk of uterine rupture in VBAC after one prior caesarean?

A

1 in 200

28
Q

How does foetal umbilical artery Doppler US waveform change with increased gestation?

A

With increased gestation there is an increase in end diastolic flow velocity relative to peak systolic velocity causing increased S/D ratio.

29
Q

What is associated with increased S/D ratio?

A

Increased resistance in placental vascular bed.

  • pre eclampsia
  • IUGR
  • smoking
30
Q

When will a Doppler detect foetal heart tones?

A

10-12 weeks

31
Q

When can sensitive serum bHCG detect pregnancy?

A

8-9d post ovulation

32
Q

Causes of sustained bradycardia in labour?

A

I.e. acute foetal hypoxia.

  • Cord compression
  • Intrapartum abruption
  • Uterine hypertonus
  • Maternal hypotension (supine, epidural, drugs, vasovagal, anaphylaxis)
  • Foetal hypotension (vasa praevia)
  • maternal hypoxia (PE, APO)
33
Q

Acute management of sustained foetal bradycardia in labour?

A
  • General: improve oxygenation (O2, posture, reduce uterine contraction i.e. stop oxytocin)
  • Determine and treat aetiology (BP, contraction frequency, VE)
  • Reassess CTG
  • Delivery / foetal blood sampling
34
Q

Complications of spinal anaesthesia?

A
  • Inadequate block
  • High level block
  • Hypotension
  • Anxiety and pain
  • N / V
  • Pruritus
35
Q

what are the increased risks of emergency caesarean?

A
  • Aspiration
  • Infection
  • Operative complications (bladder, bowel injury)
  • Complications related to indication (full dilation, chorioamnionitis, abruption)
  • Time of day, fatigue

Women's Health (39 decks)

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