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Repro II > Quad screen and FHR > Flashcards

Quad screen and FHR Flashcards

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1
Q

office visits

A 
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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2
Q

quad screen

A 
test maternal blood for:
AFP 
hCG
Estriol
Inhibin-A
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3
Q

AFP

A

produced by fetus

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4
Q

hCG

A

produced by placenta

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5
Q

estriol

A

produced by both fetus and placenta

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6
Q

inhibin A

A

produced by placenta and ovaries

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7
Q

trisomy 21

A

nuchal translucency
decreased AFP and estriol
increased hCG and inhibin A

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8
Q

trisomy 18

A

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

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9
Q

trisomy 13

A

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

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10
Q

who should be screened with quad screen

A 
everyone, but particularly:
family hx of birth defects
35+
harmful meds during prego
DM
viral infection
radiation exposure
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11
Q

high AFP suggests

A

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

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12
Q

low levels of AFP and abnormal hCG and estriol

A

chromosomal defects

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13
Q

early gestation fetal heart

A

predominately under control of sympathetics and arterial chemoreceptors

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14
Q

late gestation fetal heart

A

under vagal control

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15
Q

baseline FHR

A

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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16
Q

bradycardia

A

FHR <110

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

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17
Q

etiologies of bradycardia

A

heart block
occiput posterior or transverse
serious fetal compormise

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18
Q

tachycardia

A

FHR>160

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

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19
Q

etiologies of tachy

A 
meternal fever
fetal hypoxia
fetal anemia
amnionitis
fetal tachyarrythmia 
SVT
heart failure
drugs
rebound
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20
Q

baseline change

A

decrease of increase in rate for >10min

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21
Q

baseline variability

A

fluctuations in FHR of more then 2 cycles/min

no distinction is made between short term and long term variability

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22
Q

grades of fluctuation

A

based on amplitude range

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23
Q

minimal variability

24
Q

moderate variability

25
marked variability
>25BPM
26
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
27
most significant intrapartum sign of fetal compromise
persistently minimal or absent FHR variability
28
etiologies of decreased variabiliyt
``` metabolic acidosis CNS depressants fetal sleep cycles congenital anomalies prematurity tachy preexisting neuro abnormality betamethasone ```
29
accelerations
abrupt increase in FHR above baseline with onset to peak <2min duration
30
adequate accelerations
10bmp above baseline for >10sec | >32wks >15bpm above baseline for >15sec
31
prolonged accelerations
increase in HR 2-10min
32
reactivity
increase of 15bpm for 15 seconds twice 20min period premature fetuses often do not have reactivity used in antenatal testing
33
episodic deceleration patterns
not associated with uterine contractions
34
periodic deceleration patterns
those associated with uterine contractions early and late decelerations variables can also be periodic
35
gradual decelerations
decrease to nadir >30secs
36
abrupt deceleration
decrease in FHR >15bpm <30 sec
37
early deceleration
gradual deceleration with the nadir at peak of contraction
38
late deceleration
gradual deceleration, but begins after onset of contraction and nadir occurs after peak of contraction
39
variable deceleration
abrupt deceleration lasting >15sec but <2min usually indicated cord compression not concerning unless continues to happen
40
recurrent decelerations
variable, early, or late | occur with >50% of contractions in 20min segment
41
prolonged deceleration
decrease of FHR >15bpm measured from most recently determined baseline rate deceleration lasts >2min, but <10min
42
etiologies of prolonged and recurrent decelerations
``` maternal hypotension uterine hyperactivity cord prolapse cord compression abruption artifact maternal seizure ```
43
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
44
etiologies of late decelerations
excessive uterine contractions maternal hypotension maternal hypoxemia reduced placental exchange (HTN, DM, IUGR, abruption)
45
management of late decelerations
``` place pt on left side discontinue oxytocin correct hypotension IV hydration Rx Tx tachyssystole O2 mask ```
46
if late decelerations persist for >30 min
must do scalp pH
47
scalp pH
>7.25 good 7.2-7.25 repeat in 30 min <7.2 delivery
48
recurrent late decelerations with minimal or absent variability
expeditious delivery
49
variable deceleration
vagally mediated via chemo and baroreceptors | accelerations before and after variable deceleration thoght to be partial cord occulsions
50
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
51
uterine contractions
quantified as number of contraction in 10 min averaged over 30min
52
normal uterine contractions
5 or less contractions in 10 min averaged over 30min
53
tachysystole
>5 contractions in 10min averaged over 30 min
54
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 ```
55
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
56
category III
FHR shows either of the following: sinusoidal pattern or absent variability with recurrent late decelerations, recurrent variable decelerations, or brady

Repro II (20 decks)

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