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fetal surveillance Flashcards

(67 cards)

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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
what is the equivocal or suspicious CST?
intermittent of significant variable decels but no late decels
26
what is the equivocal hyperstimulation?
FHR decels that occur in contractions more frequently than every 2 min or >90 sec
27
what is the unsatisfactory CST?
<3 contractions in 10 min or uninterpretable tracing
28
differentiate accels from decels
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
acoustic stimulation test mechanics
loud external sounds used to startle fetus provoking FHR accel positive response is rapid accel this is done when fetus is asleep
30
components of biophysical profile
``` HR accel breathing mvmt tone AFV ```
31
score of 2 for NST, breathing, mvmt, tone, & AFV
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
further eval is not warranted regardless of BPS composite score if largest vertical AFP <2cm, T or F?
false
33
BPS score of 10 interpretation & mgmt
normal | no indication for intervention; repeat test weekly exc in DM & postterm px
34
BPS score of 8 (normal AFV) interpretation & mgmt
normal | no indication for intervention; repeat test weekly exc in DM & postterm px
35
BPS score of 8 (NST not done) interpretation & mgmt
normal | no indication for intervention; repeat test weekly exc in DM & postterm px
36
BPS score of 8 (dec AFV) interpretation & mgmt
chronic fetal asphyxia suspected | deliver
37
BPS score of 6 interpretation & mgmt
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
BPS score of 4 interpretation & mgmt
probable fetal asphyxia repeat testing same day; repeat test <6: deliver >32 wks: deliver
39
BPS score of 0-2 interpretation & mgmt
deliver
40
what is the modified BPS?
vibro acoustic NST was performed 2x weekly w/ AFI determination (<5cm was considered abnormal)
41
ACOG reccom for diagnosing oligohyramnios, AFI or deepest vertical pocket?
deepest vertical pocket
42
doppler velocimetry, what are the vessels evaluated for growth restricted fetuses
UMA MCA DV
43
UMA mirrors what circulation?
downstream resistance of placental circulation
44
normal EDF
1/3 of systole
45
AEDV
umbilical artery resistance rises, diastolic velocity falls then become absent
46
REDV
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
most significant prognostic feature in fetal growth restriction & placental insufficiency
EDF
48
>34 wks w/ persistent AEDV interpretation & mgmt
uteroplacental insufficiency | deliver
49
<34 wks w/ persistent AEDV mgmt
individualized mgmt
50
REDV, BPS normal, AFI adequate, no decels on NST, normal venous doppler, approach?
antenatal steroids before delivery
51
MCA ideal location for doppler assessment
2mm from its origin from the internal carotid
52
clinical significance of MCA
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
differentiate MCA flow in anemic fetus from brain-sparing hypoxia)
Anemic: inc waveform | Brain-sparing: dec waveform
54
doppler vessel, what is the best predictor of perinatal outcome?
ductus venosus
55
clinical significance of DV
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
DV: absent a-wave interpretation
abnormal late-diastolic filling
57
DV: reversed a-wave interpretation
abnormal late-diastolic filling
58
DV: dec v-wave & D-wave, reversed a-wave interpretation
abnormal end-systolic (v) and holo-systolic (D, a) filling
59
DV: "M-shape", dec v-wave, absent a-wave interpretation
abnormal end-systolic (v) and late-diastolic (a) filling
60
DV: dec v-wave & D-wave interpretation
abnormal end-systolic (v) and early-diastolic (D) filling
61
clinical significance of UtA
reflects impedance in utero-placental circulation | predict devt of preeclampsia & IUGR (16-18 wks)
62
what is the abnormal finding in UtA doppler?
end diastolic notch
63
REDV mgmt if >32 wks
antenatal steroids before delivery
64
IUGR & inc S/D ratio >95% mgmt
deliver at 37 wks
65
uncomlicated, isolated oligohydramnios mgmt
deliver at 36-37 wks
66
uncomlicated, isolated oligohydramnios at <36 wks mgmt
do follow-ups
67
recomm growth sacn in IUGR is every?
3-4 wks

obstetrics (11 decks)

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