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Flashcards in Quad screen and FHR Deck (56):
1

office visits

first visit 8-10 wks (earlier if at risk for ectopic)
every 4 wks for first 2 wks
every 2-3 weeks until 36wks
every wk after 36
postpartum 21 and 56 days

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quad screen

test maternal blood for:
AFP
hCG
Estriol
Inhibin-A

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AFP

produced by fetus

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hCG

produced by placenta

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estriol

produced by both fetus and placenta

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inhibin A

produced by placenta and ovaries

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trisomy 21

nuchal translucency
decreased AFP and estriol
increased hCG and inhibin A

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trisomy 18

aka edwards syndrome
decreased AFP, hCG, estriol
normal inhibin A
live for 5-15days

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trisomy 13

aka pataus syndrome
nuchal translucency
quad screening usually normal, sometimes hCG increased
median survival 2.5 days

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who should be screened with quad screen

everyone, but particularly:
family hx of birth defects
35+
harmful meds during prego
DM
viral infection
radiation exposure

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high AFP suggests

neural tube defects
spina bifida, anencephaly
most common cause of elevated AFP is inaccurate dating of prego

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low levels of AFP and abnormal hCG and estriol

chromosomal defects

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early gestation fetal heart

predominately under control of sympathetics and arterial chemoreceptors

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late gestation fetal heart

under vagal control

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baseline FHR

heart rate during a ten min (minimum of 2 min)segment rounded to nearest 5 beat/min increment excluding segments that differ by more then 25beats/min

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bradycardia

FHR <110
110-119 in absence of other concerning patterns is not usually a sign of compromise

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etiologies of bradycardia

heart block
occiput posterior or transverse
serious fetal compormise

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tachycardia

FHR>160
in presense of good variability tachy is not a sign of fetal distress

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etiologies of tachy

meternal fever
fetal hypoxia
fetal anemia
amnionitis
fetal tachyarrythmia
SVT
heart failure
drugs
rebound

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baseline change

decrease of increase in rate for >10min

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baseline variability

fluctuations in FHR of more then 2 cycles/min
no distinction is made between short term and long term variability

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grades of fluctuation

based on amplitude range

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minimal variability

<5BPM

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moderate variability

6-25BPM

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marked variability

>25BPM

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sinusoidal pattern

regular amplitude and frequency and is exluded in the definition of varability
lasts 10min with fixed period of 3-5 cycles/min and an amplitude 5-15bpm

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most significant intrapartum sign of fetal compromise

persistently minimal or absent FHR variability

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etiologies of decreased variabiliyt

metabolic acidosis
CNS depressants
fetal sleep cycles
congenital anomalies
prematurity
tachy
preexisting neuro abnormality
betamethasone

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accelerations

abrupt increase in FHR above baseline with onset to peak <2min duration

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adequate accelerations

10bmp above baseline for >10sec
>32wks >15bpm above baseline for >15sec

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prolonged accelerations

increase in HR 2-10min

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reactivity

increase of 15bpm for 15 seconds twice 20min period
premature fetuses often do not have reactivity
used in antenatal testing

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episodic deceleration patterns

not associated with uterine contractions

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periodic deceleration patterns

those associated with uterine contractions
early and late decelerations
variables can also be periodic

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gradual decelerations

decrease to nadir >30secs

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abrupt deceleration

decrease in FHR >15bpm <30 sec

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early deceleration

gradual deceleration with the nadir at peak of contraction

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late deceleration

gradual deceleration, but begins after onset of contraction and nadir occurs after peak of contraction

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variable deceleration

abrupt deceleration lasting >15sec but <2min
usually indicated cord compression
not concerning unless continues to happen

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recurrent decelerations

variable, early, or late
occur with >50% of contractions in 20min segment

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prolonged deceleration

decrease of FHR >15bpm measured from most recently determined baseline rate
deceleration lasts >2min, but <10min

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etiologies of prolonged and recurrent decelerations

maternal hypotension
uterine hyperactivity
cord prolapse
cord compression
abruption
artifact
maternal seizure

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late decelerations associated with preservation of beat-beat variability

appear to be mediated by aa chemo receptors in mild hypoxia
decreased O2 -> vasoconstriction -> HTN -> decreased HR

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etiologies of late decelerations

excessive uterine contractions
maternal hypotension
maternal hypoxemia
reduced placental exchange (HTN, DM, IUGR, abruption)

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management of late decelerations

place pt on left side
discontinue oxytocin
correct hypotension
IV hydration
Rx Tx tachyssystole
O2 mask

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if late decelerations persist for >30 min

must do scalp pH

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scalp pH

>7.25 good
7.2-7.25 repeat in 30 min
<7.2 delivery

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recurrent late decelerations with minimal or absent variability

expeditious delivery

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variable deceleration

vagally mediated via chemo and baroreceptors
accelerations before and after variable deceleration thoght to be partial cord occulsions

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management of variables

change positions to where FHR pattern most improved
discontinue oxytocin
check for cord prolapse or imminent delivery by vag exam
consider aminoinfusion
O2 administration

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uterine contractions

quantified as number of contraction in 10 min averaged over 30min

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normal uterine contractions

5 or less contractions in 10 min averaged over 30min

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tachysystole

>5 contractions in 10min averaged over 30 min

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category I

normal
FHR shows ALL of the following:
baseline 110-160
moderate FHR variability
accelerations present or absent
no late or variable decelerations
may have early decelerations

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category II

indeterminate
FHR shows ANY of the following
tachy
brady w/o absent variability
absent variability w/o recurrent decelerations
marked variability
absence of accelerations after stimulation
prolonged deceleration >2min, but <10min
recurrent late decelerations with moderate variability
variable decelerations with slow return to baseline and/or overshoot

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category III

FHR shows either of the following:
sinusoidal pattern or
absent variability with recurrent late decelerations, recurrent variable decelerations, or
brady