Introduction To Fetal Monitoring

Question 1

Weight gain in pregnancy varies greatly.

Most pregnant women gain between _____ and _____kg (22lb to 28lb), putting on most of the weight after week ____.

Much of the extra weight is due to _____________ , but your body will also be storing fat, ready to make breast milk after your baby is born.

Answer 1

10kg and 12.5

20

your baby growing

Question 2

Fetal ultrasound

At the _____ week scan our sonographer can detect structural defects

Answer 2

20

Question 3

Postterm pregnancy is defined as pregnancy that has extended to or beyond ____ weeks of gestation (294 days), or estimated date of delivery (EDD) + _____ days

Answer 3

42

14

Question 4

___________________________, or IUGR, is when a baby in the womb (a fetus) does not grow as expected.

Answer 4

Intrauterine growth restriction

Question 5

Intermittent auscultation is the technique of listening to and counting the fetal heartbeats for ________ of time during __________. It is usually performed using a _______________ or a _______________ device, with the uterine contractions palpated by hand.

Answer 5

short periods

active labour

Pinard stethoscope; hand-held Doppler

Question 6

This method of measuring amniotic fluid is referred to as the ________________. If the amniotic fluid depth measures less than ___________, the pregnant woman has oligohydramnios (or polyhydramnios).

Answer 6

amniotic fluid index (AFI)

5 centimeters

Question 7

Normal pregnancy is assessed clinically

Maternal _________
Fetal ______
Fetal __________
Fetal ________
____________

Answer 7

weight gain

growth

movements

heart rate; Ultrasonically

Question 8

High risk pregnancies include:
________ pregnancy
___________
__________________
Diabetes mellitus
Cardiac disease
Sickle cell disease etc

Answer 8

Postdated; IUGR

PIH/Pre-eclampsia

Question 9

High risk pregnancies Are assessed clinically by ;

__________________
Daily fetal ______________
Electronically by _______________
Ultrasonically by _____________ and by ______ ultrasound
Assessing _______________

Answer 9

Intermittent auscultation
Daily fetal movement counting
Electronically by cardiotocography (CTG)
Ultrasonically by biophysical profile and by doppler ultrasound
Assessing state of liquor

Question 10

A _______ test result is the usual finding of antepartum tests for fetal wellbeing.

Answer 10

normal

Question 11

Even with persistently reassuring tests, perinatal death may still occur and each patient should be informed.
T/F

Answer 11

T

Question 12

The oldest and most widely used form of fetal assessment is ???

Answer 12

Daily fetal movement counting

Question 13

Fetal demise is preceded by cessation of fetal activity for _________hours.

Answer 13

24 - 48

Question 14

Fetal movement Counting

Is A good screening method from ___ to _____ weeks to select patients who require electronic monitoring.

Can detect up to ____% of fetuses destined to develop fetal distress

Answer 14

30 to 42

60

Question 15

Intermittent Auscultation

Can be done with _______ or _________.

Every _____ minutes in first stage of labour.
Every ____ minutes in second stage of labour.

Count rates at each review.

Answer 15

pinard or sonicaid

15;5

Question 16

Intermittent auscultation of the fetal heart is performed _______ and _________ after contractions

Answer 16

during and 30secs

Question 17

Normal FHR = ____-______ beats/min.

FHR > ____ beats/min = tachycardia.
FHR <_____ beats per/min = bradycardia.
Record on the partograph.

Answer 17

120 – 160

160; 120

Question 18

Intermittent auscultation is inferior to CTG monitoring

T/F

Answer 18

F

Has not been found to be inferior to CTG monitoring if properly conducted.

Question 19

The most commonly used antenatal test of fetal wellbeing is ???

Answer 19

CARDIOTOCOGRAPHY

Question 20

An (internal or external?) method of monitoring fetal heart rate

Answer 20

External

Question 21

CARDIOTOCOGRAPHY

Rationale – the presence of spontaneous fetal heart rate __________ associated with ____________ ( ____________ ) is an indicator of fetal wellbeing.

Answer 21

accelerations

fetal movements

fetal reactivity

Question 22

CHARACTERISTICS OF NORMAL FETAL HEART RATE PATTERN

Normal pattern is:
– Associated with a good outcome.
– Baseline rate between _____ and ______ beats/min.
– Variability of at least ____ beats/min.
-_______________ is associated with contractions.
– Presence of ___________.

Answer 22

120 and 160

5

No deceleration

accelerations

Question 23

INTRAPARTUM FETAL MONITORING

Intrapartum fetal monitoring means
To ___________________________

To detect at the earliest, any evidence of fetal jeopardy and Prompt action to be taken to save the fetus from the adverse effect of anoxia

Answer 23

watch the fetal behaviour during labour

Question 24

A normal fetus is well adapted to ____________________________ occurring during labour

Answer 24

intermittent hypoxia

Question 25

Intrapartum fetal monitoring The major danger to the fetus is ____________ due to prolonged periods of ____________

Answer 25

asphyxia oxygen reduction

Question 26

Intrapartum fetal monitoring The risk of asphyxia is more in cases where the mother has one or more high-risk factors like _______,______,_______. etc

Answer 26

anaemia, PIH, DM

Question 27

Oxytocin challenge Test Popular in USA Here oxytocin infusion is given to provoke ____________ within _________. The response of the FHR to the contractions is interpreted as in the __________ test.

Answer 27

3 uterine contractions; 10mins non-stress

Question 28

Disadvantages of oxytocin challenge test _________ and time consuming. Risk of ______________

Answer 28

Invasive hyperstimulation

Question 29

Biophysical profile The original BPP assigned a score of _____ or ______ according to the presence or absence of each of the five variables ________ ___________ ______________ ________________ ___________________

Answer 29

0 or 2 fetal tone fetal breathing movement fetal movement amniotic fluid volume Non stress test (done using CTG)

Question 30

Interpretation of biophysical profile score Score of _____ – normal Score of _____ – equivocal Score of _______ - abnormal

Answer 30

8 or 10 6 4 or less

Question 31

Modified BPP Consist of ______ and ______ Used widely If either of the variable is abnormal, a _________ or ____________ is performed.

Answer 31

Non-stress test and Amniotic Fluid index complete BPP or CST

Question 32

The __________,__________, and ___________ have similar low false-negative mortality rates – What is low false-negative mortalitity rates ?

Answer 32

modified BPP, CST and complete BPP defined as the number of fetal deaths within one week of a normal test result.

Question 33

Mention 2 pitfalls of modified BPP

Answer 33

No clear evidence that the 2 variables used are better predictors than the other variables omitted from the BPP. Requires 2 modalities for fetal evaluation while normal USS findings in BPP eliminates the need for NST.

Question 34

Examination of Amniotic fluid A route of access to information about the condition of the fetus in utero. May involve either __________ or ___________

Answer 34

amniocentesis or amnioscopy

Question 35

Examination of Amniotic fluid Applications: Diagnostic Between _____ and ______ weeks To detect ________ abnormality eg Trisomy 21 To detect some __________ defects by measuring alpha feto protein To detect _______ genetic disorder To detect certain _________________

Answer 35

15 and 20 chromosomal; open neural tube sex-linked inborn errors of metabolism

Question 36

Examination of Amniotic fluid Applications: After 20weeks To estimate bilirubin and antibody in _______________ To estimate phospholipids as a guide to ____________ For chemical and/or cytological analysis, to estimate __________ To perform angiography or fetography

Answer 36

rhesus isoimmunisation pulmonary maturity maturity

Question 37

Examination of Amniotic fluid Applications: Therapeutic For the temporary relief of _________ For intra-amniotic injection to ________________

Answer 37

hydramnios terminate pregnancy

Question 38

Meconium staining of liquor AMNII Said to be a sign of __________ Recent studies disregard its importance when considered in isolation

Answer 38

fetal distress

Question 39

Meconium staining has been classified according to the stage of labour as early and late. Early- when it is passed during the ______ stage of labour Late- when it is passed during the _______ stage after ______________________ The colour may vary from light yellow, light green, dark green to blackish

Answer 39

first second clear fluid has been noted previously

Question 40

Meconium staining of liquor AMNII Yellow or light green in the first stage of labour : _____________________ Thick dark green meconium in early labour : ________________________ Thick meconium associated with __________ variation should alert the obstetrician

Answer 40

insignificant if the rest of the findings are normal as in 50% of cases significantly increased incidence of meconium aspiration in the new born fetal heart

Question 41

Biochemical Monitoring FETAL SCALP pH To recognise _______ in cases of altered ______ patterns

Answer 41

acidosis FHR

Question 42

Biochemical monitoring Normal fetal scalp pH _______ pH _______, 50% of the neonates are normal. pH ______ the fetus is compromised and 30% of such infants are ________ at birth.

Answer 42

>7.25 >7.2 <7.2 depressed

Question 43

Biochemical monitoring Severe acidosis can lead to neonatal ______________ and ______________

Answer 43

Seizures and hypotonia