Antepartum

Question 0

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

Answer 0

7 weeks

Question 1

What is the goal of Antepartum assessment

Answer 1

Goals:
To prevent fetal death
To avoid unnecessary interventions

Question 2

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

Answer 2

> 8 weeks

Question 3

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

Answer 3

20-30 weeks

Question 4

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

Answer 4

Third trimester

36 weeks

Question 5

4 states of behavioral states

Answer 5

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

Question 6

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

Answer 6

State 1F

Question 7

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

Answer 7

State 2F

Question 8

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

Answer 8

State 2F

Question 9

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

Answer 9

State 3F

Question 10

The existence of this state is disputed

Answer 10

State 3F

Question 11

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

Answer 11

State 4F

Question 12

This state corresponds to the awake state in infants

Answer 12

State 4F

Question 13

Fetuses spend most of their time

Answer 13

States 1F and 2F

Question 14

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

Answer 14

Independent

Question 15

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

Answer 15

Sleep cyclicity

Question 16

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

Answer 16

23 minutes

Question 17

As pregnancy advances, weak movements are superseded by more ____ movements, which increase from several weeks then subside at term.

Answer 17

Vigorous movement

Question 18

Methods to quantify fetal movements:

Answer 18

Tocodynameter
Ultrasound
Maternal perception

Question 19

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

Answer 19

28 weeks
10 distinct fetal movements
2 hours

Question 20

If a pregnant woman complains of reduced fetal movement:

Evaluate pregnancy either with (2)

Answer 20

Fetal heart rate monitoring

Ultrasound examination

Question 21

Characteristics of fetal breathing:

Answer 21

Discontinuous

Paradoxical chest wall movement

Question 22

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

Answer 22

Coughing of clear amniotic fluid debris

Question 23

Two types of respiratory movements

Answer 23

Gasps or sighs

Irregular burst of breathing

Question 24

Gasps or sigh which occurred frequently of ____ per minute

Answer 24

1-4 per minute

Question 25

Irregular bursts of breathing occurred at rates up to _____

Answer 25

240 cycles per minute

Question 26

Variables that may affect fetal breathing:

Answer 26

``` Hypoxia Labor Hypoglycemia Impending preterm labor Gestational age Cigarette smoking Amniocentesis ```

Question 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

Answer 27

Contraction stress test

Question 28

If the fetus is normal, in the contraction stress test, the brief periods of impaired oxygen exchange is well ___

Answer 28

Tolerated

Question 29

In the presence of late fetal heart rate decelerations indicates:

Answer 29

Uteroplacental insufficiency

Question 30

In the presence of variable decelerations in a contraction stress test this indicates:

Answer 30

Oligohydramios

Question 31

In the presence of an early fetal heart rate decelerations in contraction stress test this indicates:

Answer 31

Head compression

Question 32

In order to perform contraction stress test there must be at least __ contractions that last for ___ in a ____ minutes observation

Answer 32

3 - 40sec -10 minutes

Question 33

Contractions may be induced by either a ____ or ____

Answer 33

Nipple stimulation | Oxytocin

Question 34

Criteria for interpretation of the contraction stress test: | No late or significant variables decelerations

Answer 34

Negative

Question 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

Answer 35

Positive

Question 36

Criteria for interpretation of the contraction stress test: | Intermittent late decelerations or significant variable decelerations

Answer 36

Equivocal suspicious

Question 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

Answer 37

Equivocal hyperstimulatory

Question 38

Criteria for interpretation of the contraction stress test: | Fewer than three contractions in 10 mins or an uninterpretable tracing

Answer 38

Unsatisfactory

Question 39

This test uses this principle: | Normal fetuses will respond with fetal heart rate acceleration in response to fetal movement

Answer 39

Non stress testing

Question 40

This is the most widely used primary testing method for assessment of fetal well being

Answer 40

Nonstress testing

Question 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

Answer 41

Nonstress testing

Question 42

This is a test of fetal well being

Answer 42

NST

Question 43

Test of uteroplacental function

Answer 43

CST

Question 44

This factors can cause loss of fetal heart rate reactivity

Answer 44

Fetal sleep Magnesium sulfate Cigarette smoking

Question 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

Answer 45

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

Question 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

Answer 46

40 minutes

Question 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

Answer 47

Silent oscillatory pattern | 5 bpm

Question 48

Terminal cardiotocogram indicates the following:

Answer 48

Baseline oscillation less than 5 bpm Absence acceleration Late decelerations with spontaneous uterine contractions

Question 49

Lack fetal heart rate acceleration when not due to maternal sedation or fetal sleep is an ___ finding

Answer 49

Ominous

Question 50

The interval between tests is arbitrary set at __ days

Answer 50

7 days

Question 51

More frequent testing using NST is done in:

Answer 51

Post term pregnancy Type 1 Diabetes myelitis Fetal growth restriction Gestational hypertension

Question 52

Variable decelerations, if nonrepetitive and brief during NST are ___

Answer 52

Not an indicative of fetal compromise

Question 53

Repetitive variable decelerations in at least ___ in ___ minutes or decelerations lasting for more than __ minute is a WORST PROGNOSIS

Answer 53

3 within 20 minutes | Lasting for more than 1 minute

Question 54

If there is an indication of worst prognosis in NST you will do:

Answer 54

Ultrasound to check the amount of amniotic fluid volume

Question 55

False normal Nonstress test can cause fetal death within _ week of a reactive test, what are the causes?

Answer 55

1 week ``` Meconium aspiration Intrauterine infection Cord accident Congenital malformation Placental abruption ```

Question 56

This test use loud external sounds used to startle the fetus to provoke acceleration of the heart rate

Answer 56

Acoustic stimulation test

Question 57

What is the positive response in an acoustic stimulation test

Answer 57

Rapid appearance of fetal heart accelerations following acoustic stimulation

Question 58

5 biophysical components:

Answer 58

``` Fetal heart rate accelerations (NST) Fetal breathing Fetal movement Fetal tone Amniotic fluid volume ```

Question 59

What are the biophysical components detected by the ultrasound

Answer 59

Fetal breathing Fetal movement Fetal tone Amniotic fluid volume

Question 60

NST may be omitted if the _____ parameters are all normal

Answer 60

4 ultrasound

Question 61

NST score of 2: __ accelerations of ___ beats/min for ____ sec in ___ min NST score of 0: __ accelerations in ___ min

Answer 61

≥2 accelerations of ≥15 beats/min for ≥15 sec in 20–40 min 0 or 1 acceleration in 20–40 min

Question 62

Fetal Breathing score of 2: ___ episode of rhythmic breathing lasting ___ sec within ___ min Fetal Breathing score of 0: ___ sec of breathing in ___ min

Answer 62

≥1 episode of rhythmic breathing lasting ≥30 sec within 30 min < 30 sec of breathing in 30 min

Question 63

Fetal movement score of 2: __ discrete body or limb movements within ___ min Fetal movement score of 0: __ discrete movements

Answer 63

≥3 discrete body or limb movements within 30 min < 3 discrete movements

Question 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

Answer 64

≥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

Question 65

Amniotic volume score of 2: ___ HORIZONTAL/VERTICAL pocket ___ cm Amniotic volume score of 0: Largest ___ HORIZONTAL/VERTICAL pocket ___ cm

Answer 65

Single vertical pocket > 2 cm Largest single vertical pocket ≤ 2 cm

Question 66

The biophysical score: Normal variable Abnormal variable Highest score

Answer 66

2 0 10

Question 67

What BPS indicates a normal pH What BPS indicates significant fetal acidemia What BPS is a POOR PREDICTOR OF ABNORMAL OUTCOME

Answer 67

8 or 10 0 6

Question 68

This BPS score is a progressively more accurate predictor of abnormal outcome:

Answer 68

2 or 4

Question 69

The Normal Amniotic fluid index

Answer 69

5-24 cm

Question 70

The deepest vertical pocket normal value

Answer 70

2-8 cm

Question 71

What is the significance of a AFI <5cm

Answer 71

Increased risk of CS for fetal distress Low five minutes Apgar score Increase perinatally morbidity and mortality

Question 72

This is a non-invasive technique to assess fetal and maternal blood flow

Answer 72

Doppler velocimetry

Question 73

``` Doppler would detect the blood flow in this arteries: Fetal vessels (3) Maternal vessel (1) ```

Answer 73

Umbilical artery Middle cerebral artery Ductus venosus Uterine artery

Question 74

What is the goal of a Doppler velocimetry

Answer 74

To optimize time of delivery

Question 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

Answer 75

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

Question 76

To detect fetal anemia this vessel should be monitored

Answer 76

Middle cerebral artery

Question 77

Uterine blood flow increases from ____ early in gestation to ____ by term

Answer 77

50 mL/min early in gestation | 500 to 750 mL/min by term

Question 78

Increased resistance to flow and development of a ___ have been associated with ___

Answer 78

Diastolic notch | Pregnancy-induced hypertension

Question 79

increased impedance of uterine artery velocimetry at _____ weeks was predictive of superimposed preeclampsia developing in women with chronic hypertension

Answer 79

16 to 20 weeks

Question 80

2 points to consider in deciding when to begin Antepartum testing:

Answer 80

Prognosis of neonatal survival | Severity of maternal disease

Question 81

Antepartum testing must begin: Most high risk pregnancies: With severe complications:

Answer 81

32-34weeks | 26-28 weeks