Antepartum Flashcards
What week that the fetal movement has a passive unstimulated fetal activity commence
7 weeks
What is the goal of Antepartum assessment
Goals:
To prevent fetal death
To avoid unnecessary interventions
What week that fetal body movements are never absent for time periods exceeding 13 minutes
> 8 weeks
General body movements become organized and the fetus starts to show rest activity:
20-30 weeks
Fetal movement maturation continues until about ____, when behavioral states are established in 80 percent of normal fetus
Third trimester
36 weeks
4 states of behavioral states
State 1F, 2F, 3F, and 4F
The quiescent state with a narrow oscillatory bandwidth of the fetal heart rate
State 1F
Includes frequent gross body movements, continuous eye movements, and wider oscillation of fetal heart rate
State 2F
This states is analogous to rapid eye movement or active sleep in the neonate
State 2F
Includes continuous eye movements, absence of body movements and NO accelerations of fetal heart rate
State 3F
The existence of this state is disputed
State 3F
One of the vigorous body movement with continuos eye movements and fetal heart rate accelerations
State 4F
This state corresponds to the awake state in infants
State 4F
Fetuses spend most of their time
States 1F and 2F
The sleep awake cycles of infants are ____ of the maternal sleep awake state
Independent
This has been described as varying from 20 minutes to as much as 75 minutes
Sleep cyclicity
The mean length of sleep cyclicity for the quiet or inactive state for term fetuses
23 minutes
As pregnancy advances, weak movements are superseded by more ____ movements, which increase from several weeks then subside at term.
Vigorous movement
Methods to quantify fetal movements:
Tocodynameter
Ultrasound
Maternal perception
The American College of obstetricians and gynecologist suggest that:
At ___ weeks all women must be able to count ___ distinct fetal movements daily in ___ hours
28 weeks
10 distinct fetal movements
2 hours
If a pregnant woman complains of reduced fetal movement:
Evaluate pregnancy either with (2)
Fetal heart rate monitoring
Ultrasound examination
Characteristics of fetal breathing:
Discontinuous
Paradoxical chest wall movement
Paradoxical chest movement is due to ____ of _____ such exchange appears to be essential for normal lung development
Coughing of clear amniotic fluid debris
Two types of respiratory movements
Gasps or sighs
Irregular burst of breathing
Gasps or sigh which occurred frequently of ____ per minute
1-4 per minute
Irregular bursts of breathing occurred at rates up to _____
240 cycles per minute
Variables that may affect fetal breathing:
Hypoxia Labor Hypoglycemia Impending preterm labor Gestational age Cigarette smoking Amniocentesis
This test uses this principle:
With uterine contractions, myometrial vessels are compressed which caused decreased blood flow to the intervillous space with a brief periods of impaired oxygen exchange
Contraction stress test
If the fetus is normal, in the contraction stress test, the brief periods of impaired oxygen exchange is well ___
Tolerated
In the presence of late fetal heart rate decelerations indicates:
Uteroplacental insufficiency
In the presence of variable decelerations in a contraction stress test this indicates:
Oligohydramios
In the presence of an early fetal heart rate decelerations in contraction stress test this indicates:
Head compression
In order to perform contraction stress test there must be at least __ contractions that last for ___ in a ____ minutes observation
3 - 40sec -10 minutes
Contractions may be induced by either a ____ or ____
Nipple stimulation
Oxytocin
Criteria for interpretation of the contraction stress test:
No late or significant variables decelerations
Negative
Criteria for interpretation of the contraction stress test:
Late decelerations following 50% or more of contractions - even if the contraction frequency is fewer than three in 10 minutes
Positive
Criteria for interpretation of the contraction stress test:
Intermittent late decelerations or significant variable decelerations
Equivocal suspicious
Criteria for interpretation of the contraction stress test:
Fetal heart rate that occurs in the presence of contractions more frequent than every 2 minutes or lasting longer than 90 seconds
Equivocal hyperstimulatory
Criteria for interpretation of the contraction stress test:
Fewer than three contractions in 10 mins or an uninterpretable tracing
Unsatisfactory
This test uses this principle:
Normal fetuses will respond with fetal heart rate acceleration in response to fetal movement
Non stress testing
This is the most widely used primary testing method for assessment of fetal well being
Nonstress testing
This test uses the principle:
The heart rate of the fetus who IS NOT ACIDOTIC as result go hypoxia or neurological depression will temporarily accelerate in response to fetal movement
Nonstress testing
This is a test of fetal well being
NST
Test of uteroplacental function
CST
This factors can cause loss of fetal heart rate reactivity
Fetal sleep
Magnesium sulfate
Cigarette smoking
In the reactive Nonstress test:
The acme of acceleration is ___ bpm or more above the baseline rate, and the acceleration last ____ or longer but less than ___ minutes in fetuses at or beyond 32 weeks
The acme of acceleration is ___ bpm or more above the baseline rate! and the acceleration last ____ or longer but less than ___ minutes in fetuses at or before 32 weeks
15 bpm or longer that last for 15 seconds but less than 2 minutes
10 bpm or longer that last for 10 seconds but less than 2 minutes
It was also recommended that accelerations with or without fetal movements are accepted, and that a ___ minutes or longer tracing to account for fetal sleep should be performed before concluding that there was INSUFFICIENT FETAL REACTIVITY
40 minutes
This pattern consisted of a fetal heart rate baseline that oscillates less than ___ bpm and presumably indicate absent acceleration and beat to beat variability
Silent oscillatory pattern
5 bpm
Terminal cardiotocogram indicates the following:
Baseline oscillation less than 5 bpm
Absence acceleration
Late decelerations with spontaneous uterine contractions
Lack fetal heart rate acceleration when not due to maternal sedation or fetal sleep is an ___ finding
Ominous
The interval between tests is arbitrary set at __ days
7 days
More frequent testing using NST is done in:
Post term pregnancy
Type 1 Diabetes myelitis
Fetal growth restriction
Gestational hypertension
Variable decelerations, if nonrepetitive and brief during NST are ___
Not an indicative of fetal compromise
Repetitive variable decelerations in at least ___ in ___ minutes or decelerations lasting for more than __ minute is a WORST PROGNOSIS
3 within 20 minutes
Lasting for more than 1 minute
If there is an indication of worst prognosis in NST you will do:
Ultrasound to check the amount of amniotic fluid volume
False normal Nonstress test can cause fetal death within _ week of a reactive test, what are the causes?
1 week
Meconium aspiration Intrauterine infection Cord accident Congenital malformation Placental abruption
This test use loud external sounds used to startle the fetus to provoke acceleration of the heart rate
Acoustic stimulation test
What is the positive response in an acoustic stimulation test
Rapid appearance of fetal heart accelerations following acoustic stimulation
5 biophysical components:
Fetal heart rate accelerations (NST) Fetal breathing Fetal movement Fetal tone Amniotic fluid volume
What are the biophysical components detected by the ultrasound
Fetal breathing
Fetal movement
Fetal tone
Amniotic fluid volume
NST may be omitted if the _____ parameters are all normal
4 ultrasound
NST score of 2:
__ accelerations of ___ beats/min for ____ sec in ___ min
NST score of 0:
__ accelerations in ___ min
≥2 accelerations of ≥15 beats/min for ≥15 sec in 20–40 min
0 or 1 acceleration in 20–40 min
Fetal Breathing score of 2:
___ episode of rhythmic breathing lasting ___ sec within ___ min
Fetal Breathing score of 0:
___ sec of breathing in ___ min
≥1 episode of rhythmic breathing lasting ≥30 sec within 30 min
< 30 sec of breathing in 30 min
Fetal movement score of 2:
__ discrete body or limb movements within ___ min
Fetal movement score of 0:
__ discrete movements
≥3 discrete body or limb movements within 30 min
< 3 discrete movements
Fetal tone score of 2:
___ episode of extension of a fetal extremity with return to flexion, or ______ within 30 min
Fetal tone score of 0:
___ extension / flexion events
≥1 episode of extension of a fetal extremity with return to flexion, or opening or closing of hand within 30 min
0 extension / flexion events
Amniotic volume score of 2:
___ HORIZONTAL/VERTICAL pocket ___ cm
Amniotic volume score of 0:
Largest ___ HORIZONTAL/VERTICAL pocket ___ cm
Single vertical pocket > 2 cm
Largest single vertical pocket ≤ 2 cm
The biophysical score:
Normal variable
Abnormal variable
Highest score
2
0
10
What BPS indicates a normal pH
What BPS indicates significant fetal acidemia
What BPS is a POOR PREDICTOR OF ABNORMAL OUTCOME
8 or 10
0
6
This BPS score is a progressively more accurate predictor of abnormal outcome:
2 or 4
The Normal Amniotic fluid index
5-24 cm
The deepest vertical pocket normal value
2-8 cm
What is the significance of a AFI <5cm
Increased risk of CS for fetal distress
Low five minutes Apgar score
Increase perinatally morbidity and mortality
This is a non-invasive technique to assess fetal and maternal blood flow
Doppler velocimetry
Doppler would detect the blood flow in this arteries: Fetal vessels (3) Maternal vessel (1)
Umbilical artery
Middle cerebral artery
Ductus venosus
Uterine artery
What is the goal of a Doppler velocimetry
To optimize time of delivery
Placental vascular pathology:
Will ___ the afterload leading to fetal hypoxemia (uterine artery flow is impeded manifesting as ____ S/D ratio, ____ end diastolic flow or even ____ end diastolic flow )
Middle cerebral artery ___ to redistribute blood to the brain
___ pressure in the ductus venosus due to ___ pressure in the right side of the heart
Increase afterload
Increased S/D ration, absent end diastolic flow, reversed end diastolic flow
Middle cerebral artery will dilate
Increased pressure in the ductus venosus, increased in the R side of the heart
To detect fetal anemia this vessel should be monitored
Middle cerebral artery
Uterine blood flow increases from ____ early in gestation to ____ by term
50 mL/min early in gestation
500 to 750 mL/min by term
Increased resistance to flow and development of a ___ have been associated with ___
Diastolic notch
Pregnancy-induced hypertension
increased impedance of uterine artery velocimetry at _____ weeks was predictive of superimposed preeclampsia developing in women with chronic hypertension
16 to 20 weeks
2 points to consider in deciding when to begin Antepartum testing:
Prognosis of neonatal survival
Severity of maternal disease
Antepartum testing must begin:
Most high risk pregnancies:
With severe complications:
32-34weeks
26-28 weeks
