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OBSTETRICS > 1M - Antenatal Fetal Surveillance > Flashcards

1M - Antenatal Fetal Surveillance Flashcards

1
Q

amount of fetal death before labor?

A

2/3

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2
Q

This causes inadequate delivery of nutrients or respiratory substances to fetal tissues

A

Uteroplacental insufficiency

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3
Q

Fetal complications of antepartum asphyxia?

A

Stillbirth and metabolic acidosis at birth

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4
Q

What are the 4 categories of antenatal testing techniques?

A

Maternal assessment of fetal activity
Cardiotocographic assessment with or without induced contractions
Sonographic assessment of fetal behavior and/or amniotic fluid volume
doppler velocimetry

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5
Q

What are the extremes of fetal growth?

A

Fetal growth restriction and fetal macrosomia

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6
Q

Fetal risk factors associated with small for gestational age fetus?

A

aneuploidy
fetal malformations
multiple gestations
fetal infections: cytomegalovirus, toxoplasmosis, rubella, malaria

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7
Q

What are the placental risk factors for small for gestational age fetus?

A

Abruption
placenta previa and accreta
chorioangioma

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8
Q

A women with a fundic height of 25 cm in her 26th week of gestation is recommended to be tested for fetal growth restriction. T or F?

A

False

at 24 weeks, the fundic height should correspond to the age of gestation

a measurement of more than 2-3 cm less is the threshold before recommendation

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9
Q

What is the position of the mother when being examined for fundic height?

A

Semi recumbent

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10
Q

What are the steps in fundal height measurement?

A

Semi recumbent position with empty bladder
Determine fundus with 2 hands
Secure tape at top of fundus
Measure fundus using tape along the longitudinal axis
Plot and record

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11
Q

What is the parameter that suggests intarauterine growth restriction during fundic height test?

A

More than 4 cm difference and less than 10th percentile in size

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12
Q

This is a harbinger or impending fetal death according to Sadovsky?

A

Diminished fetal heart activity

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13
Q

When does passive unstimulated fetal activity commence?

A

As early 7 weeks

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14
Q

Beyond 8 weeks, fetal body movements are perceived every?

A

13 minutes

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15
Q

When does the fetus start to show rest-activity cycles

A

20-30 weeks

Max activity at 28-32 weeks

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16
Q

Period of active fetal body movements last about how long?

A

40 minutes

longest period without fetal movement is 75 minutes

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17
Q

What time of the day do fetal movements peak?

A

9:00 pm to 1:00 am

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18
Q

This stage of fetal behavioral state is the quiescent state (quiet sleep) with narrow oscillatory bandwidth of the fetal heart rate?

A

Stage 1F

Fetus spend most of their time in stage 1F and 2F

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19
Q

This stage of fetal behavioral state is analogous to rapid eye movement or active sleep phase in neonates.

A

Stage 2F

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20
Q

This stage includes continuous eye movements without body movements and no accelerations in heart rate.

A

Stage 3F

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21
Q

One of the vigorous body movement with continuous eye movements and fetal heart rate accelerations. This is the awake state.

A

Stage 4F

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22
Q

In daily fetal movement count, how many movements can the mother perceive every 30 minutes?

A

3 movements

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23
Q

In Cardiff Count to 10 method, what time would the mother start counting for fetal movements and for how long?

A

At 9 am and for 12 hours

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24
Q

How many fetal movements should be present within the 12 hour period in Cardiff Count to 10 method?

A

10

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25
Q

Based on the Sadovsky Method, how many fetal movements should the mother record while laying for 1 hour?

A

4 fetal movements

If not felt within the first hour, monitor for a second hour, if still not reached, further evaluation is recommended

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26
Q

This technique is used to monitor fetal heart rate and uterine contractions to monitor fetal well being and detect early fetal distress?

A

Cardiotocography

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27
Q

Normal fetal heart rate is?

A

110-160 bpm

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28
Q

Most common explanation for fetal tachycardia?

A

Chorioamnionitis with fever or any cause of maternal fever

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29
Q

Causes of fetal bradcardia?

A

Post dated gestation
occiput posterior presentation
transverse presentation

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30
Q

What is the normal variability?

A

5-25

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31
Q

Variability indicates what?

A

neurological system state of the fetus to adapt its fetal heart rate response to the environment

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32
Q

What is non reassuring variability?

A

Less than 5 bpm for between 30-50 minutes

More than 25 bpm for 15-25 minutes

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33
Q

What is abnormal variability?

A

Less than 5 bpm for more than 50 minutes
More than 25 bpm more than 25 minutes
sinusoidal

34
Q

What can cause reduced variability?

A

Fetal sleeping - should not last more than 40 minutes
Fetal acidosis due to hypoxia
fetal tachycardia
drugs
Prematurity - variability is reduced for less than 28 weeks gestation
congenital heart abnormalities

35
Q

This is defined as an abrupt increase in the baseline
fetal heart rate of greater than 15 bpm for greater
than 15 seconds.

A

Accelerations

36
Q

Accelerations are reassuring? T or F?

A

True

Accelerations coinciding with contractions is a sign of a healthy fetus; and are common during labor

37
Q

At less than 32 weeks, what is the fetal heart rate acceleration?

A

more than 10 bpm for >10 secs

38
Q

at more than 32 weeks, what is the expected fetal heart rate acceleration?

A

more than 15 bpm for >15 secs

39
Q

What is prolonged acceleration?

A

More than 2 mins but less than 10 minutes

40
Q

Defined as e an abrupt decrease in the baseline
fetal heart rate of greater than 15bpm for greater
than 15 seconds.

A

deceleration

41
Q

When do early decelerations happen?

A

Start when the uterine contraction begins and recover when uterine contraction stops

42
Q

What is the cause of decelerations?

A

Increase in intracranial pressure which increases vaginal tone

43
Q

Early deceleration resolving after uterine contractions end are pathological? T or F?

A

False, they are physiological

44
Q

Variable decelerations have a relationship with uterine contractions? T or F

A

False, no relationship

45
Q

What is the usual cause of variable deceleration?

A

Umbilical cord compression

Initially, umbilical vein is compressed causing acceleration and then when the artery is compressed, there is rapid deceleration and when pressure is relieved, another acceleration towards normal occurs

46
Q

What do we call the acceleration before and after a variable

deceleration which is a sign that the fetus is not yet hypoxic and is adapting to reduced blood flow?

A

Shoulder of deceleration

47
Q

This deceleration occurs at the peak of contraction and ends after the contraction ends?

A

Late deceleration

48
Q

Late deceleration indicates what situations?

A

Uteroplacental insufficiency

Insufficient blood flow to uterus and placenta which causes fetal hypoxia and acidosis

Caused by:
maternal hypotension
pre eclampsia
uterine hyperstimulation

49
Q

Prolonged deceleration lasts for how long?

A

More than 2 mins but less than 10 mins

50
Q

Non reassuring prolonged deceleration lasts for?

A

2-3 mins

51
Q

abnormal prolonged deceleration lasts for?

A

> 3 mins

52
Q

If deceleration lasts for more than 10 minutes, there is a baseline change. What are the causes of prolonged deceleration for more than 10 mins?

A 
Prolonged cord compression
prolonged uterine hyperstimulation
severe abruptio placenta
eclamptic seizure
conduction anesthesia
53
Q

This pattern in cardiotocograph is very concerning as it is associated with high rates of fetal morbidity and mortality. This is characterized by smooth, regular, wavelike patterns with no variability.

A

Sinusoidal pattern

54
Q

If a sinusoidal pattern is present, what are the current conditions of the fetus?

A

severe fetal hypoxia
severe fetal anemia
fetal/maternal hemorrhage

55
Q

This pattern is characterized by rapid irregular, abrupt up and down fluctuations across the baseline with amplitude of > 25 beats per minute. Zig zag pattern for 1 minute

A

Saltatory

56
Q

Saltatory pattern indicates what?

A

autonomic instability with exaggerated autonomic response

57
Q

This test measures the fetal heart rate of the fetus in response to its movement?

A

Non stress test

58
Q

A reactive non stress test is normal or abnormal?

A

Normal

59
Q

If the fetus is normal, as the fetus moves, what happens to the fetal heart rate?

A

There will be acceleration

60
Q

Non stress test is done in what position?

A

Left lateral recumbent position

61
Q

What is a normal non stress test?

A

2 or more accelerations 15 or more each lasting 15 secs and occurring within 20 mins of the test

62
Q

Enumerate the amplitude ranges?

A

Absent
Minimal - 0 to 5
Moderate - 6-25
Marked - > 25

63
Q

Contraction stress test measure what?

A

Uteroplacental function by inducing contraction

64
Q

If a pathology in uteroplacental blood flow is present, what is seen in cardiotocograph?

A

Late decelerations

65
Q

Contraction stress test is deemed positive if?

A

Late decelerations are present in more than 50% of the induced contractions

66
Q

What is present in suspicious contraction stress test?

A

abnormal baseline fetal heart rate and intermittent late, variable decelerations

67
Q

Unsatisfactory contraction stress test is noted if?

A

Not enough contractions are elicited. Fewer than 3 contractions per 10 minutes. Or uninterpretable reading

68
Q

Contraindications to contraction stress test?

A

Preterm labor
PROM
Hx of extensive surgery or classic CS
placenta previa

69
Q

What is hyperstimulation in contraction stress test?

A

Fetal heart rate decelerations that occur in the presence of contractions more frequent than every 2 minutes or lasting longer than 90 secs.

70
Q

If upon biophysical scoring, an score of 6/8 or 6/10 is achieved, what would be the next step?

A

reassessment

71
Q

What test identifies oligohydramnios and polyhydramnio?

A

amniotic fluid measurement.

Normal value is 2-8 cm

72
Q

What are additional tests added to the modified biophysical scoring test?

A

AFI and fetal non stress test

73
Q

What are normal values for NST and AFI for modified biophysical scoring test?

A

AFI of >5 cm and a reactive NST

74
Q

When do we consider an umbilical doppler velocimetry abnormal?

A

If there is absent diastolic flow and when flow index is 2 points greater than SD for gestational age (95th percentile for gestational age)

75
Q

In the presence of fetal hypoxia, what happens to middle cerebral artery impedance?

A

it decreases to increase blood flow to the middle cerebral artery to facilitate brain sparing

76
Q

This test is an indirect

measure of uterine artery vascular resistance

A

uterine artery velocimetry

77
Q

As gestation advances in normal pregnancy, what happens to the uterine vascular resistance?

A

It decreases.

78
Q

What drug is given at 16 weeks of gestation in women who are at risk for fetal growth restriction due to elevated uterine artery resistance?

A

Aspirin

79
Q

What are abnormal findings on doppler uterine artery velocimetry?

A

bilateral uterine notches and pulsatility index > 1.45 in both arteries

80
Q

Testing uterine artery velocimetry is appropriate at what age of gestation for those at risk of stillbirht?

A

32-34 weeks

81
Q

In pregnancies with

multiple or particularly worrisome high-risk conditions, testing may be initiated as early as?

A

26-28 weeks

82
Q

a vertical pocket of amniotic fluid greater than 2 cm or amniotic fluid index of 5 cm or less is defined as?

A

Oligohydramnios

OBSTETRICS (36 decks)

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