Fetal and Neonate assessment

Question 1

The mean duration of a singleton pregnancy (birth of only one child during a single delivery with a gestation of 20 weeks or more) is __________

Answer 1

280 days/40 weeks

Question 2

Term is defined as the period from __________________ (optimal time for delivery)

Answer 2

37 weeks to 42 weeks

Question 3

Early term ______weeks

Answer 3

37 to 38

Question 4

Full term ______weeks

Answer 4

39 to 40

Question 5

Late term ______weeks

Answer 5

41 to 42

Question 6

Determinations of gestational age is most accurate when ultrasonographic measurement of the fetus or embryo is performed in the ___________________.

Answer 6

first trimester (up to and including 14 weeks)

Question 7

Recommended for all pregnancies given its ability to :

Answer 7

1. Viability
2. Fetal number
3. Placental location
4. Screen for fetal structural abnormalities in the second trimester

Question 8

An increased risk for delivering a small-for-gestational age baby and/or having a preterm delivery is associated with _____________________________.

Answer 8

low maternal gestational weight gain.

Question 9

Higher risk for delivering a large-for-gestational age baby and/or cesarean delivery is associated with ____________.

Answer 9

excessive gestational weight gain.

Question 10

Although the _________ examination has several limitations (especially in the setting of a small fetus, maternal obesity, multiple pregnancy, uterine fibroids, or polyhydramnios), it is safe, is well tolerated, and may add valuable information to assist in antepartum management.

Answer 10

abdominal

Question 11

what is Leopold Maneuver designed to do?

Answer 11

identify specific fetal landmarks or to reveal a specific relationship between the fetus and the mother

Question 12

1st maneuver - measurement of fundal (uterus) height, uterus can be palpated above the pelvic brim at approximately 12 weeks’ gestation then should increase 1 cm per week, reaching the umbilicus at ________.

Answer 12

20-22 weeks

Question 13

Fundal height between 20 and 32 weeks gestation (in cm) is __________ ______ to the gestational age ( in weeks) in a healthy women of average weight with an appropriately growing fetus.

Answer 13

approximately equal

Question 14

Maximal fundal height occurs at approximately ___ weeks’ gestation, after which time the fetus drops into the pelvis in preparation for labor

Answer 14

36

Question 15

Fetal Growth Restriction is associated with a number of significant adverse perinatal outcomes: (5)

Answer 15

1. Intrauterine Demise
2. Neonatal Morbidity
3. Neonatal Mortality
4. Cognitive Delay in
   Childhood
5. Chronic Diseases (Obesity, Type II Diabetes, CAD, Stroke in Adulthood

Question 16

Maternal disorders associated with fetal growth restriction include any condition that can potentially result in vascular disease, such as :

Answer 16

pregestational diabetes, hypertension, antiphospholipid antibody syndrome, autoimmune diseases and renal insufficiency, malnutrition, and substance abuse

Question 17

Fetal conditions that may result in growth restriction include:

Answer 17

teratogen exposure, including certain medications; intrauterine infection; aneuploidy, most often trisomy 13 and trisomy 18; and some structural malformations, such as abdominal wall defects and congenital heart disease.

Question 18

Fetal growth restriction is associated with an increased risk for ______

Answer 18

stillbirth

Question 19

The risk for stillbirth is further increased when fetal growth restriction occurs in the context of ________ or _______.

Answer 19

oligohydramnios or abnormal diastolic blood flow in the umbilical artery.

Question 20

_____& ______diagnosis of fetal growth restriction coupled with ________________leads to an improvement in perinatal outcome. If fetal growth restriction is suspected clinically and on the basis of ultrasonography, a thorough evaluation of the mother and fetus is indicated.

Answer 20

Early and accurate, appropriate intervention

Question 21

Fetal macrosomia, defined as growth beyond an _________________regardless of gestational age

Answer 21

absolute birth weight of 4000 g or 4500 g

Question 22

the risk for labor abnormalities, maternal morbidity, and newborn complications increases with birth weights between__________ & _______; newborn and maternal morbidity increases significantly with birth weights between ___________ and perinatal mortality (e.g., stillbirth and neonatal mortality) increase with birthweights _____________ Shoulder dystocia, defined as a failure of delivery of the fetal shoulder(s) after initial attempts at downward traction, is the most serious consequence of fetal macrosomia, and requires additional maneuvers to effect delivery.46 The fetal injuries associated with shoulder dystocia include fracture of the clavicle and damage to the nerves of the brachial plexus, resulting in Erb-Duchenne paralysis, of which the vast majority resolve by 1 year of age. Compared with a prevalence of 0.2% to 3.0% for all vaginal deliveries, the risk for shoulder dystocia at birth weights of 4500 grams or more is 9% to 14%, and increases further in the setting of maternal diabetes to 20% to 50%.47,48

Answer 22

4000 and 4499 g; 4500 and 4999 g; greather than 5000 g.

Question 23

Estimated fetal weight measurements are_____________ in macrosomic fetuses than in normally grown fetuses, and factors such as low amniotic fluid volume, advancing gestational age, maternal obesity, and fetal position can compound these inaccuracies

Answer 23

less accurate

Question 24

A number of alternative ultrasonographic measurements have therefore been proposed in an attempt to better identify the macrosomic fetus, including fetal abdominal circumference alone,__________cheek-to-cheek diameter and ___________________________________.However, these measurements remain investigational.

Answer 24

umbilical cord circumference

subcutaneous fat in the mid humerus, thigh, abdominal wall, and shoulder

Question 25

Is fetal macrosomia an indication for induction of labor?

Answer 25

No may increase risk for c-section and no does not improve outcomes

Question 26

At what weight is it recommended to due an elective c-section for macrosomic fetus?

Answer 26

exceeds 4500g in diabetic women

or 5000g in non diabectic woman

Question 27

A low FHR ______is associated with an increased risk for pregnancy loss, although congenital complete heart block should be excluded

Answer 27

(< 100 bpm)

Question 28

Fetal movements (“quickening”) are typically reported at ________ weeks’ gestation by nulliparous women and at ________weeks’ gestation by parous women; the presence of fetal movements is strongly correlated with fetal health.

Answer 28

18 to 20, 16 to 18

Question 29

The normal fetus exhibits an average of ________(range of 0 to 130) gross body movements per hour, with fewer movements during the day and increased activity between 9:00 PM and 1:00 AM

Answer 29

20 to 50

Question 30

Biophysical Profile

The five variables described in the original BPP were

Answer 30

(1) gross fetal body movements, (2) fetal tone (i.e., flexion and extension of limbs), (3) amniotic fluid volume, (4) fetal breathing movements, and (5) the NST (Table 6.4).75 More recently, the BPP has been interpreted without the NST.

Question 31

Contraction Stress Test the response of the FHR to uterine contractions induced by either _____ or ____.

Answer 31

intravenous oxytocin administration or nipple stimulation

Question 32

A minimum of ____contractions for at least ___seconds in a __-minute period is required to interpret the test. A negative CST (no late or severe late decelerations with contractions) is reassuring and suggestive of a healthy, well-oxygenated fetus.

Answer 32

3, 40, 10

Question 33

_____ ______can be used for the noninvasive measurement of fetal circulation,

Answer 33

Doppler velocimetry

Question 34

As one of the few arteries that normally has diastolic flow, the ______ _____ is frequently evaluated during pregnancy

Answer 34

umbilical artery

Question 35

Factors that affect placental vascular ______, ______, and ____.

Answer 35

1. resistance include gestational age, 2.placental location, 3.pregnancy complications

Question 36

Women of advanced maternal age (____ years or older at EDD) are at higher risk for having a pregnancy complicated by fetal aneuploidy and are routinely offered noninvasive prenatal screening and an invasive diagnostic procedure (either amniocentesis or chorionic villus sampling

Answer 36

> 35

Question 37

Amniotic fluid is composed of ______, _____,______, and ________.

Answer 37

fetal urine, lung fluid, skin transudate, and water

Question 38

Amniotic fluids contains ______, ________, and ________.

Answer 38

electrolytes, proteins, and desquamated fetal cells (amniocytes).

Question 39

Amniocentesis can be used to measure various substances such as _______ and ______for assessing fetal lung maturity, to look for pathogenic bacteria for confirmation of an intra-amniotic infection, and to obtain fetal cells for determination of fetal karyotype or performance of specific genetic analyses.

Answer 39

lecithin and sphingomyelin

Question 40

The most common indication for second-trimester amniocentesis is ___________

Answer 40

cytogenetic analysis of fetal cells

Question 41

As with amniocentesis, the most serious complication of CVS is ______ ____.

Answer 41

spontaneous abortion.

Question 42

______ appears to be associated with a higher risk for pregnancy loss than late amniocentesis

Answer 42

CHORIONIC VILLUS SAMPLING

Question 43

One complication unique to CVS involves the _____________.

Answer 43

interpretation of the genetic test results

Question 44

Hydrops Fetalis is

Answer 44

abnormal accumulation of fluid in more than one fetal extravascular compartment, including ascites, pericardial effusion, pleural effusion, subcutaneous edema, and/or placental edema

Question 45

Risk factors for stillbirth include extremes of

Answer 45

maternal age, chromosomal disorders, congenital malformations, antenatal infection, multiple pregnancy, prior unexplained IUFD, postterm pregnancy, fetal macrosomia, male fetus, umbilical cord and placental abnormalities, and underlying maternal medical conditions (e.g., chronic hypertension, pregestational or gestational diabetes mellitus, autoimmune disorders, inherited or acquired thrombophilia).

Question 46

The ideal case for fetal surgery consists of a _________ pregnancy before ____ _____. (i.e., before 23 to 24 weeks’ gestation

Answer 46

singleton, fetal viability

Question 47

Before in utero surgery can be recommended,

Answer 47

a thorough evaluation must be performed

Question 48

The only two randomized controlled trials published to date in fetal surgery—one on tracheal occlusion for the management of congenital diaphragmatic hernia226 and the other on prenatal versus postnatal repair of myelomeningocele229—found _______________________ Moreover, although pediatric benefit with open maternal-fetal surgery for myelomeningocele repair has been observed, there are significant maternal risks, including the need for cesarean delivery with all future pregnancies (similar to that for women with a history of a classical cesarean delivery

Answer 48

little significant benefit to in utero surgery.