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10 OB > Antepartum Assessment > Flashcards

Antepartum Assessment Flashcards

1
Q

__ fetal movements in up to 2 hours is considered normal

A

10 fetal movements

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2
Q

t/f normal fetal heart rate baseline and variability means an intact sympathetic nervous system

A

false, INTACT AUTONOMIC NERVOUS SYSTEM

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3
Q

components of the fhr tracing

A

baseline fetal heart rate
variability
accelerations
decelerations

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4
Q

how to take baseline fetal heart rate

A

identify 2 min segment without periods of marked FHR variability, periodic or episodic changes, and segments of baseline that differ by more than 25 beats

round to the nearest 5 bpm increment

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5
Q

fetal heart rates

A

normal 110-160 bpm
tachy >160
brady <110

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6
Q

causes of bradycardia in baseline fetal heart rate

A

normal variation
bradycardia after deceleration
- hypoxia (abruptio placenta, amniotic fluid embolism)
- decreased umbilical blood flow (cord prolapse or uterine rupture)
- dec uterine blood flow (severe maternal hpn)

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7
Q

causes of tachycardia in baseline fetal heart rate

A

maternal and fetal infection
second stage of labor
drugs

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8
Q

types of baseline fhr variability

A

moderate 5-25 bpm
marked >25 bpm
minimal <5 bpm
absent/undetectable

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9
Q

cause of decreased fhr variability

A 
hypoxia/acidosis (+ dec fhr)
fetal sleep cycles (do vibroacoustic stimulation)
congenital anomalies
extreme prematurity
fetal tachycardia
preexisting neuro abnormalities
medications (magnesium sulfate)
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10
Q

hypothesis for nonstress test

A

hr of fetus who is not acidotic as a result of hypoxia or neurological depression will temporarily accelerate in response to fetal movement

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11
Q

what is a reactive nst

A

at least 2 accelerations within a 20 min window

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12
Q

back up test for a nonreactive nst

A

vibroacoustic stimulation test: loud external sound can provoke fhr acceleration

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13
Q

test that examines the fetal heart rate characteristics in response to uterine contractions

A

contraction stress test

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14
Q

t/f the hypoxic fetus who has inadequate oxygen reserves cannot tolerate uterine contractions and develops late decelerations

A

true

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15
Q

contraindications for uterine stress test

A
  • premature rupture of membranes
  • previous classical cs
  • placenta previa
  • cervical incompetence
  • hx of premature labor
  • multiple gestation
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16
Q

characteristics of early deceleration

A
  • symmetrical gradual decrease and return
  • nadir deceleration is same time as peak contraction
  • caused by head compression during second stage of labor
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17
Q

characteristics of late deceleration

A
  • symmetrical gradual decrease
  • nadir deceleration is AFTER peak contraction
  • caused by uteroplacental insufficiency
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18
Q

what is a positive cst

A

late decelerations following > 50% of contractions

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19
Q

what are equivocal-suspicious results of cst

A

intermittent late decelerations or significant variable decelerations

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20
Q

what are equivocal-hyperstimulatory results of cst

A

decelerations in the presence of contractions occurring more frequently than every 2 min or more than 90 secs

21
Q

what are unsatisfactory results of cst

A

<3 contractions in 10 mins

22
Q

characteristics of variable deceleration

A

apparent abrupt decrease in fhr >/= 15 bpm, >15 sec but < 2 min

23
Q

causes of variable deceleration

A

oligohydramnios
fetal head descent
cord prolapse

24
Q

what are done during sonographic assessment

A

fetal biometry
biophysical score
doppler velocimetry

25
Q

small for gestation age vs iugr

A

sga: fetal size and weight at birth are less than expected regardless of cause (<10th percentile)
iugr: abnormal growth velocity pattern due to placental insufficiency

26
Q

components of biophysical profile scoring

A

slide 43

27
Q

interpretation of bps

A

slide 44

normal afv = ok
dec afv = deliver

28
Q

when does placental blood flow increase

A

20th week

REVIEW SLIDE 47

29
Q

absent vs reversed edf

A

absent: at least 60% of placental vessels are obliterated
reversed: at least 70% of placental vessels are diseased (fetal distress in 3-5 days)

30
Q

t/f late adaptation in the fetal circulation includes preferential shunting for blood flow to brain, heart, and adrenals (brain sparing reflex)

A

false, EARLY ADAPTATION

31
Q

review slide 51

A

ok

32
Q

maternal indications for antepartum fetal surveillance

A

dm, hpn, sle, ckd, aps
hemoglobinopathies
cyanotic heart disease
hyperthyroidism

33
Q

pregnancy related indications for antepartum fetal surveillance

A 
preeclampsia
decreased fetal movement
gestational diabetes
oligohydramnios
fetal growth restriction
postterm
previous detal demise
monochorionic twin
34
Q

when should atepartum fetal surveillance be started?

A

32 weeks aog

for multiple/high risk: 26 wks or aog when delivery is considered

35
Q

what is the recommended frequency of antepartum fetal surveillance

A

if indication is not persistent, no need to repeat

if indication persists or high risk, test periodically

36
Q

first principle of fhr interpretation

A

all clinically significant decelerations reflect interruption of the pathway of oxygen transfer from the environment to the fetus at one or more points.

37
Q

t/f sustained or recurrent interruption of oxygen transfer, reflected in the FHR tracing as deceleration, has the potential to result in hypoxic neurologic injury.

A

true

38
Q

steps that result to metabolic acidemia

A

hypoxemia -> hypoxia -> metabolic acidosis -> metabolic acidemia

39
Q

second principle of fhr interpretation

A

acute intrapartum interruption of fetal oxygenation does not result in neurologic injury in the absence of significant metabolic acidemia.

Significant metabolic acidemia is defined as an umbilical artery pH of <7 and base deficit of >/= 12mmol/L

40
Q

third principle of fhr interpretation

A

moderate variability and /or accelerations reliably predict the absence of fetal metabolic acidemia at the time they are observed.

41
Q

characteristics for category 1 fhr

A 
110-160 bpm
moderate variability
- late and variable decelerations
\+/- early decelerations
\+/- accelerations
42
Q

characteristics of category 3 fhr

A

absent fhr variability with:

  • recurrent late d
  • recurrent variable d
  • bradycardia

sinusoidal pattern

43
Q

sinusoidal pattern

A

usually seen in fetal anemia and intraamniotic infection

44
Q

characteristics of category 2 fhr

A

anything else

requires evaluation and surveillance

45
Q

what to do when pt is in category 2

A
  • discontinue oxytocin
  • cervical exam: cord prolapse, rapid cervical dilatation, descent of fetal head
  • change maternal position to recumbent position
  • monitor for hypotension
  • asses for uterine hyperstimulation
46
Q

t/f if there is no efm, intermittent auscultation can be done every 5-15 mins

A

true

47
Q

other intrapartum assessment techniques

A

fetal scalp blood sampling (deliver if <7.2 ph)
fetal scalp stimulation (no acceleration if + acidosis)
fetal pulse oximetry (cs if <30% between 2 contractions)

48
Q

t/f There is an approximately one-hour window from the start of the FHR pattern containing minimal baseline variability and late or prolonged decelerations

A

true

49
Q

if vaginal delivery is not likely before the onset of metabolic acidemia ___ must be done

A

operative delivery

10 OB (6 decks)

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