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obstetrics > fetal surveillance > Flashcards

fetal surveillance Flashcards

1
Q

testing should be as early as _ wks for women w/ worrisome conditions

A

26-28wks

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2
Q

maternal conditions indicated for antepartum surveillance

A 
severe hypothyroidism
symptomathic hgbpathy
cyanotic heart ds
chronic renal ds
DM
marked uterine anomalies
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3
Q

placental conditions indicated for antepartum surveillance

A 
APAS
SLE
htn do
thrombophilia
marked placental anomalies
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4
Q

fetal conditions indicated for antepartum surveillance

A 
dec fetal mvmt
oligohydramnios
polyhydramnios
IUGR
postterm pregnancy
macrosomia
fetal anomalies
multiple gestations
previous stillbirth
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5
Q

passive unstimulated activity commences as early as?

A

7 wks

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6
Q

fetal body mvmt are never absent for periods exceeding 13mins

A

8 wks

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7
Q

general body mvmt become organized

A

20-30 wks

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8
Q

clinical methods used to quantify fetal mvmt

A

tocodynamometer
utz
maternal subjective perception

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9
Q

2 types of respiratory mvmt

A

gasp/sighs (1-4/min)

irreg burst of breathing (240/min)

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10
Q

factors affecting fetal respiratory mvmt

A 
hypoxia
hypoglycemia
sound stimuli
cigarette
amniocentesis
impending preterm labor
gestationla age
FHR
inc w/ maternal meals
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11
Q

respiratory motion in inspiration & expiration

A

I: chest collapse, abdomen expand
E: chest expand

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12
Q

NST is based on this hypothesis

A

FHR that is non-academic as a result of fetal hypoxia or neuro depression will temporarily accelerate in response to fetal mvmt

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13
Q

normal FHR acceleration per AOG

A

> 32 wks: >15bpm above baseline lasting >15 sec but <2min

<32 wks: >10bpm above baseline lasting >10 sec

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14
Q

procedure of NST

A

palpate for fetal back then secure doppler upon hearing fetal HR
palpate fundus then attach tocodynamometer
ask px to lie in LLD
start recording w/ minimum 25 mins monitoring

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15
Q

what is the normal NST?

A

reactive NST

- >2 accels peaking at >15bpm above baseline lasting >15sec all w/in 20min of test

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16
Q

NST can be extended unto >40mins to account for fetal sleep cycles? T or F?

A

true

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17
Q

what is the abnormal NST?

A

non-reactive NST

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18
Q

interval bet. testing for px w/ abnormal NST

A

7 days

ACOG: 2x a week for px with postterm gestation; pre-gestational DM; fetal growth restriction; htn

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19
Q

CST: late decelerations interpretation

A

utero-placental pathology

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20
Q

CST: variable deceleration interpretation

A

cord compression (oligohydramnios, placnetal insufficiency)

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21
Q

procedure of CST

A

FHR & uterine contractions are recorded simultaneously
>3 spontaneous uterine contractions of >40 sec in 10 mins are present, no uterine stimulation necessary
<3 spontaneous uterine contractions of >40 sec in 10 mins, induce contraction either w/ oxytocin or nipple stimulation

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22
Q

dose of oxytocin for inducing contraction

A

dilute IV infusion at rate of 0.5mU/min and doubled every 20 mins

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23
Q

what is the normal CST?

A

negative CST

no late or significant variable decels

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24
Q

what is the abnormal CST?

A

positive CST

uniform repetitive late FHR decels following >50% contractions

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25
Q

what is the equivocal or suspicious CST?

A

intermittent of significant variable decels but no late decels

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26
Q

what is the equivocal hyperstimulation?

A

FHR decels that occur in contractions more frequently than every 2 min or >90 sec

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27
Q

what is the unsatisfactory CST?

A

<3 contractions in 10 min or uninterpretable tracing

28
Q

differentiate accels from decels

A

A: upward inc of baseline >15 beats for min lasting >15 sec
D: downward dec of baseline >15 beats for min lasting >15 sec

29
Q

acoustic stimulation test mechanics

A

loud external sounds used to startle fetus provoking FHR accel
positive response is rapid accel
this is done when fetus is asleep

30
Q

components of biophysical profile

A 
HR accel
breathing
mvmt
tone
AFV
31
Q

score of 2 for NST, breathing, mvmt, tone, & AFV

A

NST: reactive NST
breathing: >1 ep of rhythmic breathing lastng >30 sec w/in 30min
mvmt: >3 discrete limb mvmt w/in 30min
tone: >1 ep of extremity extension & subsequent return to flexion
AFV: AFP measuring >2cm in 1 planes perpendicular to each other 2x2cm pocket

32
Q

further eval is not warranted regardless of BPS composite score if largest vertical AFP <2cm, T or F?

A

false

33
Q

BPS score of 10 interpretation & mgmt

A

normal

no indication for intervention; repeat test weekly exc in DM & postterm px

34
Q

BPS score of 8 (normal AFV) interpretation & mgmt

A

normal

no indication for intervention; repeat test weekly exc in DM & postterm px

35
Q

BPS score of 8 (NST not done) interpretation & mgmt

A

normal

no indication for intervention; repeat test weekly exc in DM & postterm px

36
Q

BPS score of 8 (dec AFV) interpretation & mgmt

A

chronic fetal asphyxia suspected

deliver

37
Q

BPS score of 6 interpretation & mgmt

A

possible fetal asphyxia
AFV abnormal: deliver
normal fluid at >36 wks w/ favorable cervix: deliver
repeat test <6: deliver
repeat test >6: observe & repeat per protocol

38
Q

BPS score of 4 interpretation & mgmt

A

probable fetal asphyxia
repeat testing same day; repeat test <6: deliver
>32 wks: deliver

39
Q

BPS score of 0-2 interpretation & mgmt

A

deliver

40
Q

what is the modified BPS?

A

vibro acoustic NST was performed 2x weekly w/ AFI determination (<5cm was considered abnormal)

41
Q

ACOG reccom for diagnosing oligohyramnios, AFI or deepest vertical pocket?

A

deepest vertical pocket

42
Q

doppler velocimetry, what are the vessels evaluated for growth restricted fetuses

A

UMA
MCA
DV

43
Q

UMA mirrors what circulation?

A

downstream resistance of placental circulation

44
Q

normal EDF

A

1/3 of systole

45
Q

AEDV

A

umbilical artery resistance rises, diastolic velocity falls then become absent

46
Q

REDV

A

further rise in resistance causing insufficient, rigid placental circulation recoils after being distended by pulse pressure
may precede fetal death by only hours to days

47
Q

most significant prognostic feature in fetal growth restriction & placental insufficiency

A

EDF

48
Q

> 34 wks w/ persistent AEDV interpretation & mgmt

A

uteroplacental insufficiency

deliver

49
Q

<34 wks w/ persistent AEDV mgmt

A

individualized mgmt

50
Q

REDV, BPS normal, AFI adequate, no decels on NST, normal venous doppler, approach?

A

antenatal steroids before delivery

51
Q

MCA ideal location for doppler assessment

A

2mm from its origin from the internal carotid

52
Q

clinical significance of MCA

A

detect several fetal anemia (MCA peak systolic velocity)
brain sparing hypoxia (reduce cerebrovascular impedance, inc blood flow to MCA)
cardiac decompensation (normalization, MCA diastolic falls returning to high resistance patter)

53
Q

differentiate MCA flow in anemic fetus from brain-sparing hypoxia)

A

Anemic: inc waveform

Brain-sparing: dec waveform

54
Q

doppler vessel, what is the best predictor of perinatal outcome?

A

ductus venosus

55
Q

clinical significance of DV

A

triphasic blood flow pattern reflecting pressure changes w/in right heart d/t no intervening valvular structures
fetal demise w/in 1 wk (absent or reversed flow during atrial systole)

56
Q

DV: absent a-wave interpretation

A

abnormal late-diastolic filling

57
Q

DV: reversed a-wave interpretation

A

abnormal late-diastolic filling

58
Q

DV: dec v-wave & D-wave, reversed a-wave interpretation

A

abnormal end-systolic (v) and holo-systolic (D, a) filling

59
Q

DV: “M-shape”, dec v-wave, absent a-wave interpretation

A

abnormal end-systolic (v) and late-diastolic (a) filling

60
Q

DV: dec v-wave & D-wave interpretation

A

abnormal end-systolic (v) and early-diastolic (D) filling

61
Q

clinical significance of UtA

A

reflects impedance in utero-placental circulation

predict devt of preeclampsia & IUGR (16-18 wks)

62
Q

what is the abnormal finding in UtA doppler?

A

end diastolic notch

63
Q

REDV mgmt if >32 wks

A

antenatal steroids before delivery

64
Q

IUGR & inc S/D ratio >95% mgmt

A

deliver at 37 wks

65
Q

uncomlicated, isolated oligohydramnios mgmt

A

deliver at 36-37 wks

66
Q

uncomlicated, isolated oligohydramnios at <36 wks mgmt

A

do follow-ups

67
Q

recomm growth sacn in IUGR is every?

A

3-4 wks

obstetrics (11 decks)

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