Antepartum assessment Flashcards by Zahra Kalifa

what are the types of fetal surveillance?

Antenatal: maternal self-assessment, NST, US, doppler.

- intrapartum: auscultation of fetal heart rate, electrical fetal monitoring, fetal blood scalp sampling

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What is the maternal self-assessment of fetal wellbeing?

Kick counting (10movement in 1hr)

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What is a normal fetus NST finding?

Normal fetus respond to fetal movement with
- HR >15 Bpm
- for 15 sec
(Acceleration)

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What is non-stress test vs stress test?

NST: HR without any external stress (medications, uteine contraction, illness)

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How many accelerations is considered normal in a reactive NST?

2 acceleration

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BPP is usually taken at which week?

After 28 weeks.

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What is the normal profile for BPP

10 (each score is given 2)

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What are the component of biophysical profile?

1- fetal breathing movement 
2- gross body movement 
3- fetal tone 
4- amniotic fluid volume 
5- NST

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What is the normal fetal breathing movement?

within 30 min:

One or more fetal breathing lasting 30 sec

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What is the normal gross body movement in BPP

within30 min: 3 or more body\limb

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What is the normal fetal tone in BPP

Within 30 min: 1 or more active extension\flexsion - OR - opening\closing of the hand

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What is the normal amniotic fluid volume

deepest vertical pocket: Greater than 2cm

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When do we proceed with doppler assessment of the umbilical artery?

Decreased fetal fluid, tone, or BPP less than 10

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How can we determine blood flood, from which arteries?

1- umbilical artery
2- uterine artery
3- ductus venosus

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What is the most problematic cause for fetal hypoxia

Placental insufficency measured by fetal umbilical artery

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What does absent diastole mean in doppler assessment of umbilical artery?

Compromised blood flow

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What does reversed diastole mean in doppler assessment of umbilical artery?

At risk of fetal death and need to be delivered immediately

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What are the causes for compromised blood flow to the fetus?

1- umbilical cord: one artery, vasa previa
2- placenta: infarction, abruptio
3- maternal: HTN, Hypo, anemia, seizure
4- fetal: anemia, infection, twin, IUGR
5- uterine: hyperstimulation, tetanic contraction

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What are the chain of events after decreased perfusion to fetus?

Hypoxic acedemia > resp acidosis > met acidosis >encephalopathy > CP

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how to auscultate for fetal heart rate intrapartum?

beginning
of 1 contraction to the beginning of other.

Using doppler or stethoscope

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What is the duration of listening to fetal heart rate intrapartum?

Every 30 min (1st stage)

Every 15 min (2nd state)

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How to measure fetal heart rate in high risk patients?

Using continues electrical fetal heart rate monitoring

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What does EFM report?

FHR, MHR, uterine contractions,

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How to interpret fetal heart rate?

DR C BRAVADO

Determine risk
contraction
baseline rate
variability
acceleration & deceleration
overall assessment

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How to determine the risk?

Patients history, fetal reserve, and labor progression

How to assess the uterine activity pattern?

either by extranal toco or IUPC or palpation

What to assess in uterine activity

1- frequency 2- duration 3- intensity 3- resting tone

How to measure the frequency of contraction in external toco?

From peak to peak | Adquate: in 10 min we have 3 or more

How to measure the duration of contraction in external toco?

Every red line is a minute

How to measure the intensity of contraction in external toco? s

Substracting the peak from the baseline | Adquate: 200 or more

What unit used in IUPC to assess uterine activity?

MVU which is indicative of intensity

IUPC is a | Quantative vs Quallitative

Quantitative

When is IUPC is more useful?

- Obesity | - dysfunctional labor

What is the normal FHR baseline range

110-160

How to measure the baseline heartrate

Any 2 minutes in 10 minutes That is NOT 1- changes (periodic\episodic) 2- variability 3- segment differ by >25bpm

What is bradycardia in baseline rate

<110 in 2minutes

What are the causes of bradycardia in fetus?

- magnesium sulfate - prematurity - fetal heart problem (AV block)

What are the cause of tachycardia?

Chorioamionitis, maternal fever, fetal heart problem

Whay is variability

Fluctuation in baseline heart rate

How to measure variability in heart rate?

Choosing 1 minute of 10 min section (Free from accelration\decelration) Measureing the difference between higest and lowest

What does variability indicate

The baby wellneing | Normallly: 2-25

What if the variability is: <3: 3-5: >25:

- absent (compromised if >40min) - Decreased (problem) - increased (problem or fetal movement)

Name pathological causes of increased variability > 25 bpm

1- mild hypoxia 2- fetal gasping 3- unknown

How to intervene in marked variability

Attach fetal scalp electrode and measure PH

differentiate between acceleration\deceleration and variability

Variability is still within the baseline | Wheras the acceleration\deceleration is any increase or decrease beyond the baseline

What is prolonged acceleration

More than 2 minutes | Less than 10 minutes

What is tachycardia in terms of acceleratio

>10 minutes

Differentiate the normal acceleration at <32 and 32 + beyond

- <32: 10bpm for 10sec - 32 & beyond: 15bpm for 15sec All should be less than <2 min

What could be the causes for absent accelration

Hypoxic acidemia or fetal abnormality

What are the types of deceleration?

1- early 2- variable (uncomplicated or complicated) 3- late

What is early deceleration

Decerlation that concide with contractions Onset deceleration= begining of contractio Ending \\ = ending Peak = peak

Fetal head compression gives an image of which type of deceleration

Early deceleration

What is late deceleration usually associated with

Uteroplacental insufficency | Fetal acdemia

How is late deceletion

Peak of contraction = start of deceleration

Variable deceleration is commonly caused by

Vagal stimulation due to cord compression | Could be associated with fetal acidemia

What causes prolonged deceleration

Cord compression or prolapse - oligohydaminos

What is the action taken in prolonged deceleration

Vaginal exam to rule out cord prolapse - prepare for delivery

Where do we commonly see variable deceleration

Late stages of labor

What does variable decleration mean

Deceleration not associated with uterine contraction

How to manage oligohydraminos?

- Change position of mother - give IV fluid - oxygenate - scalp PH

Sinusoidal pattern is associated with

Severe fetomaternal anemia, hemorrhage, abruptio placenta | Severe blood insufficency

What should be the next step after diagnosing sinusoidal pattern?

Should be delivered immediately

In which cases should we immidiately plan for delivery

1- absent variability (+late or variable deceleration or bradycardia) 2- sinusoidal pattern

What are the benifits of fetal scalp blood

Reduce the increased operative intervention

At which week is fetal scalp blood sampling approrpriate?

>34

What are the contraindications for fetal scalp sampeling

- Family history of hemophilia or bleeding disorder - face presentation - maternal infection or intrauterine sepsis

When is delivery indicated

PH <7.2 | Or 7.21-7.24 if rapid fall since last sample

Antepartum assessment Flashcards

(67 cards)