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Year 2 OBGYN > Antenatal testing > Flashcards

Antenatal testing Flashcards

1
Q

what is the goal of antenatal testing?

A

to prevent fetal death

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2
Q

are abnormal antenatal testing results reliable? what does this predict?

A

no

predicts wellness, not illness

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3
Q

what are the modalities of antenatal testing?

A
  • fetal movement assessment
  • nonstress test
  • contraction stress test
  • biophysical profile
  • umbilical artery doppler velocimetry
  • middle cerebral artery doppler velocimetry
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4
Q

the fetal nonstress test is based on what premise?

A

HR of a fetus that is not acidotic or neurologically depressed will temporarily accelerate with fetal movement

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5
Q

what is a good indicator of normal fetal autonomic function?

A

fetal heart reactivity

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6
Q

what is umbilical dopper US used to assess?

A

hemodynamic components of vascular impedence

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7
Q

how is umbilical flow velocity of a normal fetus characterized?

A

high velocity diastolic flow

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8
Q

in IUGR what happens to the umbilical artery diastolic flow?

A

decrease

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9
Q

how is IUGR screening done on PE and biochemical profile?

A
  • PE: maternal uterine fundal height

- biochemical: unexplained MSAFP raises risk of IUGR

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10
Q

who needs antenatal testing?

A
  • preexisting insulin requiring diabetics
  • previous history of intrauterine fetal demise
  • post-dates pregnancies (over 41 weeks)
  • chronic HTN
  • decreased fetal movement
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11
Q

what is fetal monitoring used to evaluate?

A

intrapartum fetal oxygenation

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12
Q

is fetal monitoring diagnostic or screening?

A

screening

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13
Q

when is external monitoring done?

A

clinically undesirable or impossible to rupture membranes

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14
Q

what is required for internal monitoring? why?

A
  • requires rupture of membranes / amniotomy

- need to place electrodes on fetus’ scalp

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15
Q

what does a tocodynamometer detect? what does it record?

A
  • detects alterations in the curvature of the abdomen resulting from changes of the contracting uterus
  • accurately records frequency and duration of contractions, but not amplitude
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16
Q

what does an intrauterine pressure catheter measure? when is it used?

A
  • measures pressure readings that indicate onset, strength (amplitude), and duration of contractions
  • inserted after ROM
17
Q

what is tachysystole in terms of uterine contractions?

A

over 5 contractions in 10 m averaged over 30 m

18
Q

the fetal baseline HR varies between what values?

A

110-160 bpm

19
Q

when should you look at FHR?

A

between contractions

20
Q

what is one of the best indicators of intact integration between CNS and HR of the fetus?

A

normal FHR variability

21
Q

what does normal FHR variability indicate?

A

intact integration between CNS and HR of the fetus

22
Q

at what week does a fetus produce normal variability in HR?

A

28 weeks

23
Q

loss of FHR variability indicates what condition?

A

fetal hypoxia

24
Q

what are the three primary mechanisms by which uterine contractions can cause a decrease in FHR?

A

COMPRESSION OF:

  • fetal head
  • umbilical cord
  • uterine myometrial vessels
25
Q

what is the term for when FHR changes are associated with contractions?

A

periodic

26
Q

what is the term for when FHR changes are NOT associated with contractions?

A

nonperiodic

27
Q

what two mechanisms alter FHR?

A
  • reflex response secondary to nervous control of the heart by direct nervous innervation or by humoral control of the ANS
  • transient slowing of the heart when fetal myocardial hypoxia is present
28
Q

what is the morphology of early deceleration?

A

visually apparent, usually symmetrical gradual decrease and return of the FHR with a contraction, OR a MIRROR IMAGE of the contraction

29
Q

what is the cause of early deceleration?

A

vagal stimulation from head compression

30
Q

what is the cause of transitory decreases in HR (late decelerations)?

A

uteroplacental insufficiency

31
Q

what is variable deceleration? what is the cause?

A

reflex change mediated by the vagus nerve generally caused by umbilical cord compression

32
Q

moderate FHR variability reliably predicts the absence of what process?

A

metabolic acidemia

33
Q

does intrapartum interruption of fetal oxygenation result in neurologic injury? what is the exception?

A

no

unless it progresses to the stage of significant metabolic acidemia

Year 2 OBGYN (33 decks)

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