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Practice bulletins > #145 Antepartum Fetal Surveillance > Flashcards

#145 Antepartum Fetal Surveillance Flashcards

1
Q

What is the goal of antepartum fetal surveillance?

A

Prevent fetal death

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2
Q

Can fetal death from umbilical cord accident be predicted on antepartum fetal surveillance?

A

No, sudden event, not generally well predicted by tests

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3
Q

True or false, maternal-fetal movement assessment “kick counts” is a method of antepartum fetal surveillance

A

True

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4
Q

How do you counsel a woman on kick counts?

A

Multiple protocols.
Option 1: Lie on side, feel belly, perception of 10 distinct movements in a period of up to 2 hours = reassuring
Option 2: Count movements for 1 hour three times per week. Reassuring if equal or exceeded established baseline

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5
Q

Do uterine contractions improve, worsen, or have no effect on fetal oxygenation?

A

Transiently worsen

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6
Q

What is defined as an adequate contraction stress test?

A

At least three contractions persist for at least 40 seconds each in a 10-minute period

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7
Q

Do contractions for contraction stress test need to be induced?

A

No, can use spontaneous contractions if frequent enough

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8
Q

How are contractions induced for a contraction stress test?

A

Nipple stimulation or IV oxytocin

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9
Q

Which method of inducing contractions for contraction stress test is faster, nipple stimulation or IV oxytocin?

A

Nipple stimulation, usually takes half the time

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10
Q

What is a negative contraction stress test?

A

No late or significant variable decelerations

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11
Q

What is a positive contraction stress test?

A

Late decelerations after 50% or more of contractions

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12
Q

What is an equivocal contraction stress test?

A

FHR decelerations that occur in the presence of contractions more frequent than every 2 minutes or lasting longer than 90 seconds

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13
Q

What is an equivocal-suspicious contraction stress test?

A

Intermittent late decelerations or significant variable decelerations

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14
Q

What is an unsatisfactory contraction stress test?

A

Fewer than three contractions in 10 minutes or an uninterpretable tracing

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15
Q

What is fetal heart rate reactivity thought to be a good indicator of?

A

Normal fetal autonomic function

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16
Q

What can cause decrease fetal heart rate reactivity?

A

Fetal sleep cycle, any cause of CNS depression including fetal acidemia

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17
Q

What is the use of vibroacoustic stimulation for NSTs?

A

Can elicit accelerations. Reduces the frequency on non reactive NSTs by 40%

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18
Q

What percentage of NSTs from normal 24-28wk fetuses are non reactive?

A

Up to 50%

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19
Q

What percentage of NSTs from normal 28-32wk fetuses are non reactive?

A

15%

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20
Q

What is the definition of an acceleartion for GA <32 wks

A

10 x 10

21
Q

What are the components of a biophysical profile?

A

NST, breathing, movement, tone, MVP

22
Q

What is required to score points for breathing on BPP?

A

One or more episodes of rhythmic fetal breathing of 30 seconds or more within 30 minutes

23
Q

What is required to score points for movement on BPP?

A

Three or more discrete body or limb movements within 30 minutes

24
Q

What is required to score points for tone on BPP?

A

One or more episodes of extension of a fetal extremity with return to flexion, or opening or closing of a hand

25
Q

What is required to score points for amniotic fluid volumem on BPP?

A

A single deepest vertical pocket greater than 2cm

26
Q

What makes up a modified BPP?

A

NST and amniotic fluid volume assessment

27
Q

In which pregnancies are fetal umbilical artery dopplers indicated?

A

Pregnancies complicated by fetal growth restriction

28
Q

What is the negative predictive value of an NST for fetal death in the next week?

A

99.8%

29
Q

What is the negative predictive value of a BPP for fetal death in next week?

A

99.9%

30
Q

Has antepartum fetal surveillance been shown to decrease rik of fetal death?

A

Lack of high-quality evidence that it decreases risk of fetal death. Most evidenc supporting it is circumstantial and observational

31
Q

What maternal conditions are indications for antepartum fetal surveillance?

A

pregestaional DM, HTN, SLE, CKD, APLS, poorly controlled hyperthyroid, hemoglobinopathies, cyanotic heart disease

32
Q

What pregnancy-related conditions are indications for antepartum fetal surveillance?

A

gHTN, PEC, decreased fetal movement, GDM (poorly controlled or medicated), oligo, fetal growth restriction, late term/postterm, isoimmunization, previous fetal demise, monochorionic multiple gestation (w/ significant growth discrepency)

33
Q

How early should you start antepartum fetal testing?

A

Usually not prior to 32 weeks unless multiple high risk comorbidiites

34
Q

How often should you perform antepartum fetal testing?

A

Depends on clinical scenario. Typically once per week

35
Q

How often should you repeat a growth ultrasound for a growth restricted baby?

A

Every 3-4 weeks. Not more frequently than every 2 because of inherent error associated with US measurements

36
Q

What is the next step in management for a pregnant women in DKA with non reassuring antepartum fetal testing?

A

Correct maternal condition and retest fetus

37
Q

True or false, antepartum fetal testing has high positive predictive value?

A

False

38
Q

What score on a BPP is considered equivocal?

A

6/10

39
Q

How do you manage a fetus with a 6/10 BPP at 36 weeks?

A

Repeat BPP in 24 hours

40
Q

How do you manage a fetus with a BPP 6/10 at 37 weeks?

A

Further evaluation, consideration of delivery

41
Q

What is the next step in management for BPP 4/10? Does recommendation change based on gestational age?

A

Usually indicates delivery is warranted. For pregnancies less than 32 weeks, management should be individualized and extended monitoring may be appropriate

42
Q

At what gestational age should you deliver a growth restricted fetus with absent end-diastolic flow, based on SMFM guidelines?

A

At or beyond 34 weeks

43
Q

At what gestational age should you deliver a growth restricted fetus with reversed end-diastolic flow, based on SMFM guidelines?

A

At or beyond 32 weeks

44
Q

At what gestational age should you deliver a growth restricted fetus with elevated S/D ratio (ie, >95%tile), but diastolic flow still present, based on SMFM guidelines?

A

At or beyond 37 weeks

45
Q

Should AFI or MVP be used to drive management decisions? Why?

A

MVP. Clinical trials indicate that use of MVP (instead of AFI) to diagnose oligohydramnios is associated with a reduction in unnecessary interventions without an increase in adverse perinatal outcomes

46
Q

When should you consider delivery for a patient with uncomplicated isolated and persistent oligohydramnios?

A

Delivery at 36-37 weeks

47
Q

What is the recommendation regarding follow up of amniotic fluid measurements in setting of PPROM?

A

May often be safely omitted

48
Q

What is the role of umbilical artery dopplers in a normally grown fetus?

A

Has not been shown to be predictive of outcomes in fetuses without growth restriction

49
Q

Is it recommended for women to perform daily fetal movement assessments?

A

No, has not been shown to reduce fetal death or increase rate of intervention

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