Antepartum Flashcards

0
Q

What week that the fetal movement has a passive unstimulated fetal activity commence

A

7 weeks

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1
Q

What is the goal of Antepartum assessment

A

Goals:
To prevent fetal death
To avoid unnecessary interventions

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2
Q

What week that fetal body movements are never absent for time periods exceeding 13 minutes

A

> 8 weeks

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3
Q

General body movements become organized and the fetus starts to show rest activity:

A

20-30 weeks

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4
Q

Fetal movement maturation continues until about ____, when behavioral states are established in 80 percent of normal fetus

A

Third trimester

36 weeks

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5
Q

4 states of behavioral states

A

State 1F, 2F, 3F, and 4F

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6
Q

The quiescent state with a narrow oscillatory bandwidth of the fetal heart rate

A

State 1F

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7
Q

Includes frequent gross body movements, continuous eye movements, and wider oscillation of fetal heart rate

A

State 2F

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8
Q

This states is analogous to rapid eye movement or active sleep in the neonate

A

State 2F

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9
Q

Includes continuous eye movements, absence of body movements and NO accelerations of fetal heart rate

A

State 3F

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10
Q

The existence of this state is disputed

A

State 3F

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11
Q

One of the vigorous body movement with continuos eye movements and fetal heart rate accelerations

A

State 4F

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12
Q

This state corresponds to the awake state in infants

A

State 4F

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13
Q

Fetuses spend most of their time

A

States 1F and 2F

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14
Q

The sleep awake cycles of infants are ____ of the maternal sleep awake state

A

Independent

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15
Q

This has been described as varying from 20 minutes to as much as 75 minutes

A

Sleep cyclicity

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16
Q

The mean length of sleep cyclicity for the quiet or inactive state for term fetuses

A

23 minutes

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17
Q

As pregnancy advances, weak movements are superseded by more ____ movements, which increase from several weeks then subside at term.

A

Vigorous movement

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18
Q

Methods to quantify fetal movements:

A

Tocodynameter
Ultrasound
Maternal perception

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19
Q

The American College of obstetricians and gynecologist suggest that:
At ___ weeks all women must be able to count ___ distinct fetal movements daily in ___ hours

A

28 weeks
10 distinct fetal movements
2 hours

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20
Q

If a pregnant woman complains of reduced fetal movement:

Evaluate pregnancy either with (2)

A

Fetal heart rate monitoring

Ultrasound examination

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21
Q

Characteristics of fetal breathing:

A

Discontinuous

Paradoxical chest wall movement

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22
Q

Paradoxical chest movement is due to ____ of _____ such exchange appears to be essential for normal lung development

A

Coughing of clear amniotic fluid debris

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23
Q

Two types of respiratory movements

A

Gasps or sighs

Irregular burst of breathing

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24
Gasps or sigh which occurred frequently of ____ per minute
1-4 per minute
25
Irregular bursts of breathing occurred at rates up to _____
240 cycles per minute
26
Variables that may affect fetal breathing:
``` Hypoxia Labor Hypoglycemia Impending preterm labor Gestational age Cigarette smoking Amniocentesis ```
27
This test uses this principle: With uterine contractions, myometrial vessels are compressed which caused decreased blood flow to the intervillous space with a brief periods of impaired oxygen exchange
Contraction stress test
28
If the fetus is normal, in the contraction stress test, the brief periods of impaired oxygen exchange is well ___
Tolerated
29
In the presence of late fetal heart rate decelerations indicates:
Uteroplacental insufficiency
30
In the presence of variable decelerations in a contraction stress test this indicates:
Oligohydramios
31
In the presence of an early fetal heart rate decelerations in contraction stress test this indicates:
Head compression
32
In order to perform contraction stress test there must be at least __ contractions that last for ___ in a ____ minutes observation
3 - 40sec -10 minutes
33
Contractions may be induced by either a ____ or ____
Nipple stimulation | Oxytocin
34
Criteria for interpretation of the contraction stress test: | No late or significant variables decelerations
Negative
35
Criteria for interpretation of the contraction stress test: Late decelerations following 50% or more of contractions - even if the contraction frequency is fewer than three in 10 minutes
Positive
36
Criteria for interpretation of the contraction stress test: | Intermittent late decelerations or significant variable decelerations
Equivocal suspicious
37
Criteria for interpretation of the contraction stress test: Fetal heart rate that occurs in the presence of contractions more frequent than every 2 minutes or lasting longer than 90 seconds
Equivocal hyperstimulatory
38
Criteria for interpretation of the contraction stress test: | Fewer than three contractions in 10 mins or an uninterpretable tracing
Unsatisfactory
39
This test uses this principle: | Normal fetuses will respond with fetal heart rate acceleration in response to fetal movement
Non stress testing
40
This is the most widely used primary testing method for assessment of fetal well being
Nonstress testing
41
This test uses the principle: The heart rate of the fetus who IS NOT ACIDOTIC as result go hypoxia or neurological depression will temporarily accelerate in response to fetal movement
Nonstress testing
42
This is a test of fetal well being
NST
43
Test of uteroplacental function
CST
44
This factors can cause loss of fetal heart rate reactivity
Fetal sleep Magnesium sulfate Cigarette smoking
45
In the reactive Nonstress test: The acme of acceleration is ___ bpm or more above the baseline rate, and the acceleration last ____ or longer but less than ___ minutes in fetuses at or beyond 32 weeks The acme of acceleration is ___ bpm or more above the baseline rate! and the acceleration last ____ or longer but less than ___ minutes in fetuses at or before 32 weeks
15 bpm or longer that last for 15 seconds but less than 2 minutes 10 bpm or longer that last for 10 seconds but less than 2 minutes
46
It was also recommended that accelerations with or without fetal movements are accepted, and that a ___ minutes or longer tracing to account for fetal sleep should be performed before concluding that there was INSUFFICIENT FETAL REACTIVITY
40 minutes
47
This pattern consisted of a fetal heart rate baseline that oscillates less than ___ bpm and presumably indicate absent acceleration and beat to beat variability
Silent oscillatory pattern | 5 bpm
48
Terminal cardiotocogram indicates the following:
Baseline oscillation less than 5 bpm Absence acceleration Late decelerations with spontaneous uterine contractions
49
Lack fetal heart rate acceleration when not due to maternal sedation or fetal sleep is an ___ finding
Ominous
50
The interval between tests is arbitrary set at __ days
7 days
51
More frequent testing using NST is done in:
Post term pregnancy Type 1 Diabetes myelitis Fetal growth restriction Gestational hypertension
52
Variable decelerations, if nonrepetitive and brief during NST are ___
Not an indicative of fetal compromise
53
Repetitive variable decelerations in at least ___ in ___ minutes or decelerations lasting for more than __ minute is a WORST PROGNOSIS
3 within 20 minutes | Lasting for more than 1 minute
54
If there is an indication of worst prognosis in NST you will do:
Ultrasound to check the amount of amniotic fluid volume
55
False normal Nonstress test can cause fetal death within _ week of a reactive test, what are the causes?
1 week ``` Meconium aspiration Intrauterine infection Cord accident Congenital malformation Placental abruption ```
56
This test use loud external sounds used to startle the fetus to provoke acceleration of the heart rate
Acoustic stimulation test
57
What is the positive response in an acoustic stimulation test
Rapid appearance of fetal heart accelerations following acoustic stimulation
58
5 biophysical components:
``` Fetal heart rate accelerations (NST) Fetal breathing Fetal movement Fetal tone Amniotic fluid volume ```
59
What are the biophysical components detected by the ultrasound
Fetal breathing Fetal movement Fetal tone Amniotic fluid volume
60
NST may be omitted if the _____ parameters are all normal
4 ultrasound
61
NST score of 2: __ accelerations of ___ beats/min for ____ sec in ___ min NST score of 0: __ accelerations in ___ min
≥2 accelerations of ≥15 beats/min for ≥15 sec in 20–40 min 0 or 1 acceleration in 20–40 min
62
Fetal Breathing score of 2: ___ episode of rhythmic breathing lasting ___ sec within ___ min Fetal Breathing score of 0: ___ sec of breathing in ___ min
≥1 episode of rhythmic breathing lasting ≥30 sec within 30 min < 30 sec of breathing in 30 min
63
Fetal movement score of 2: __ discrete body or limb movements within ___ min Fetal movement score of 0: __ discrete movements
≥3 discrete body or limb movements within 30 min < 3 discrete movements
64
Fetal tone score of 2: ___ episode of extension of a fetal extremity with return to flexion, or ______ within 30 min Fetal tone score of 0: ___ extension / flexion events
≥1 episode of extension of a fetal extremity with return to flexion, or opening or closing of hand within 30 min 0 extension / flexion events
65
Amniotic volume score of 2: ___ HORIZONTAL/VERTICAL pocket ___ cm Amniotic volume score of 0: Largest ___ HORIZONTAL/VERTICAL pocket ___ cm
Single vertical pocket > 2 cm Largest single vertical pocket ≤ 2 cm
66
The biophysical score: Normal variable Abnormal variable Highest score
2 0 10
67
What BPS indicates a normal pH What BPS indicates significant fetal acidemia What BPS is a POOR PREDICTOR OF ABNORMAL OUTCOME
8 or 10 0 6
68
This BPS score is a progressively more accurate predictor of abnormal outcome:
2 or 4
69
The Normal Amniotic fluid index
5-24 cm
70
The deepest vertical pocket normal value
2-8 cm
71
What is the significance of a AFI <5cm
Increased risk of CS for fetal distress Low five minutes Apgar score Increase perinatally morbidity and mortality
72
This is a non-invasive technique to assess fetal and maternal blood flow
Doppler velocimetry
73
``` Doppler would detect the blood flow in this arteries: Fetal vessels (3) Maternal vessel (1) ```
Umbilical artery Middle cerebral artery Ductus venosus Uterine artery
74
What is the goal of a Doppler velocimetry
To optimize time of delivery
75
Placental vascular pathology: Will ___ the afterload leading to fetal hypoxemia (uterine artery flow is impeded manifesting as ____ S/D ratio, ____ end diastolic flow or even ____ end diastolic flow ) Middle cerebral artery ___ to redistribute blood to the brain ___ pressure in the ductus venosus due to ___ pressure in the right side of the heart
Increase afterload Increased S/D ration, absent end diastolic flow, reversed end diastolic flow Middle cerebral artery will dilate Increased pressure in the ductus venosus, increased in the R side of the heart
76
To detect fetal anemia this vessel should be monitored
Middle cerebral artery
77
Uterine blood flow increases from ____ early in gestation to ____ by term
50 mL/min early in gestation | 500 to 750 mL/min by term
78
Increased resistance to flow and development of a ___ have been associated with ___
Diastolic notch | Pregnancy-induced hypertension
79
increased impedance of uterine artery velocimetry at _____ weeks was predictive of superimposed preeclampsia developing in women with chronic hypertension
16 to 20 weeks
80
2 points to consider in deciding when to begin Antepartum testing:
Prognosis of neonatal survival | Severity of maternal disease
81
Antepartum testing must begin: Most high risk pregnancies: With severe complications:
32-34weeks | 26-28 weeks