4.) Modern Methods For Monitoring Pregancy

Question 1

Q: Why do we assess the uterine artery using a Doppler?

Answer 1

A: The uterine artery Doppler is used to evaluate placental perfusion. It shows increased resistance and reduced diastolic flow if trophoblastic invasion is impaired, which may indicate a risk for preeclampsia or other placental insufficiency-related complications.

Question 2

Q: Why is the middle cerebral artery (MCA) assessed using Doppler?

Answer 2

A: The MCA is assessed to detect fetal hypoxia (brain-sparing effect) and fetal anemia through increased peak systolic velocity.

Question 3

Why is the umbilical artery assessed using Doppler?

Answer 3

A: The umbilical artery is assessed to evaluate placental resistance and fetal oxygenation; abnormal flow indicates placental insufficiency.

Question 4

Q: When is fetal cardiac activity and heart rate detected?

Answer 4

A: The initial flicker of cardiac activity is detected by 6–8 weeks via ultrasound, while a measurable fetal heart rate is typically detected by 10–13 weeks.

Question 5

Q: How is an ectopic pregnancy terminated, and what are the options?

Answer 5

A:
• Medical: Methotrexate stops trophoblast growth in early, unruptured ectopics. Only if <3.5cm and patient stable

•	Surgical:
•	Salpingectomy: Removes the fallopian tube.
•	Salpingostomy: Removes the ectopic, preserving the tube.

Question 6

Q: How do we test the Rh factor in a baby?

Answer 6

• Non-invasive: Non-invasive prenatal testing (NIPT) analyzes fetal DNA in maternal blood.

•	Invasive:
•	Amniocentesis: Indirectly assesses Rh status through amniotic fluid.


•	Percutaneous umbilical blood sampling (PUBS): Directly tests fetal blood from the umbilical cord.

Question 7

Q: What is tocolytic therapy, and when is it used?

Answer 7

Tocolytic therapy suppresses uterine contractions to improve placental perfusion and fetal oxygenation, often used in the management of fetal asphyxia or preterm labor.

•	Standard practice: Nifedipine (calcium channel blocker) or Atosiban (oxytocin receptor antagonist).

•	Additional option: Magnesium sulfate is primarily used for neuroprotection or in preeclampsia but may be considered in specific cases.

Question 8

Question: How is cardiotocography (CTG) done?

Answer 8

Answer: CTG is done by placing two sensors on the abdomen:
1. Ultrasound Transducer to measure the fetal heart rate.
2. Tocodynamometer to measure uterine contractions.
Data is recorded and displayed on a monitor for real-time assessment.

Question 9

Flashcard

Question: What are the different types of results for Tocography?

Answer 9

Answer:
1. Normal (Reactive): Regular contractions, 2–3 minutes apart, 30–60 seconds long.
2. Hypertonic (Excessive): Too frequent or long contractions (>5 in 10 minutes, >90 seconds).
3. Hypotonic (Inadequate): Infrequent or weak contractions.
4. Irregular (Non-Specific): Contractions with no consistent pattern.

Question 10

What are the cardinal movements of labor ?

Answer 10

engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.