Antepartum Fetal Testing

Question 1

Most common reason for antenatal fetal testing

Answer 1

decreased fetal movement.

Next steo in management is come in for NST

Question 2

Other indications for antenatal fetal testing?

Answer 2

Diabetes
Post dates
Chronic HTN
IUGR

Question 3

Non Stress Test (NST)

Answer 3

uses external electrodes to see if the fetal is moving. If is it, there will be accelerations then comes back down. -good if they are spontaneous and not related to contractions

Question 4

What is an acceleration?

Answer 4

abrupt increases in FHR above baseline for 32 weeks, they should be >15 beats/min lasting >15 sec

Question 5

If we have a reactive NST, is that good?

Answer 5

yes the rate of fetal compromise is 3/1000

• FOLLOW up in a week
• requires 2 or more accel in 20 mins

Question 6

Non-reactive NST

Answer 6

MUST meet all of the criteria for reactive NST.

-usually due to fetus being asleep, drug sedatives, CNS anomaly

Question 7

Management of nonreactive NST?

Answer 7

Vibroacoustic stimulation- baby wakes up and moves–> accel

–If still nonreactiuve then you do Biophysical Profile (BPP)

Question 8

What is oligohydramnios on the amniotic fluid index? Is it a part of the BPP?

Question 9

What is borderline on the amniotic fluid index?

Answer 9

5-8 cm

Question 10

What is normal on the amniotic fluid index?

Answer 10

9-25 cm

Question 11

What is polyhydramnios on the amniotic fluid index?

Answer 11

> 25cm

Question 12

BPP measures 5 parts of fetal wellbeing?

Answer 12

1. Nonstress Test [0-2]
2. four quadrant AFI [0-2]
3. fetal gross body movements (head mvmts) [0-2]
4. fetal extremity tone (extension of toes) [0-2]
5. fetal breathing movements (chest wall mvmts) [0-2]

Question 13

Modified BPP

Answer 13

NST and AFI are good enough to be evaluated alone

Question 14

A score of 8-10 on the BPP tells you what?

Answer 14

highly reassuring of fetal wellbeing

-repeat test weekly

Question 15

A score of 4-6 on the BPP tells you what?

Answer 15

worrisome: deliver if >36 weeks; lungs are matured

Question 16

A score of 0-2 on the BPP tells you what?

Answer 16

hypoxia–> prompt delivery

Question 17

Contraction Stress test (CST)

Answer 17

tests the fetus’ ability to tolerate temporary decreases in blood flow as when occurs in contraction. a baby that is acidotic will show acidosis–> late decelerations. Don’t want to see gradual decrease below baseline.
Contraction begins, decel begins
Contraction ends, decel ends

Question 18

If no spontaneous contractions present, how do you proceed? Is this positive or negative CST?

Answer 18

may induce with oxytocin or nipple stim with warm towel

–it is positive (nonreassuring)

Question 19

if >3 contractions are present in 10 mins, the CST component can be assessed as

Answer 19

negative or positive
…Negative is reassuring
…Positive is non-reassuring