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OB GYN > Antepartum > Flashcards

Antepartum Flashcards

0
Q

What week that the fetal movement has a passive unstimulated fetal activity commence

A

7 weeks

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1
Q

What is the goal of Antepartum assessment

A

Goals:
To prevent fetal death
To avoid unnecessary interventions

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2
Q

What week that fetal body movements are never absent for time periods exceeding 13 minutes

A

> 8 weeks

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3
Q

General body movements become organized and the fetus starts to show rest activity:

A

20-30 weeks

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4
Q

Fetal movement maturation continues until about ____, when behavioral states are established in 80 percent of normal fetus

A

Third trimester

36 weeks

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5
Q

4 states of behavioral states

A

State 1F, 2F, 3F, and 4F

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6
Q

The quiescent state with a narrow oscillatory bandwidth of the fetal heart rate

A

State 1F

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7
Q

Includes frequent gross body movements, continuous eye movements, and wider oscillation of fetal heart rate

A

State 2F

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8
Q

This states is analogous to rapid eye movement or active sleep in the neonate

A

State 2F

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9
Q

Includes continuous eye movements, absence of body movements and NO accelerations of fetal heart rate

A

State 3F

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10
Q

The existence of this state is disputed

A

State 3F

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11
Q

One of the vigorous body movement with continuos eye movements and fetal heart rate accelerations

A

State 4F

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12
Q

This state corresponds to the awake state in infants

A

State 4F

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13
Q

Fetuses spend most of their time

A

States 1F and 2F

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14
Q

The sleep awake cycles of infants are ____ of the maternal sleep awake state

A

Independent

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15
Q

This has been described as varying from 20 minutes to as much as 75 minutes

A

Sleep cyclicity

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16
Q

The mean length of sleep cyclicity for the quiet or inactive state for term fetuses

A

23 minutes

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17
Q

As pregnancy advances, weak movements are superseded by more ____ movements, which increase from several weeks then subside at term.

A

Vigorous movement

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18
Q

Methods to quantify fetal movements:

A

Tocodynameter
Ultrasound
Maternal perception

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19
Q

The American College of obstetricians and gynecologist suggest that:
At ___ weeks all women must be able to count ___ distinct fetal movements daily in ___ hours

A

28 weeks
10 distinct fetal movements
2 hours

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20
Q

If a pregnant woman complains of reduced fetal movement:

Evaluate pregnancy either with (2)

A

Fetal heart rate monitoring

Ultrasound examination

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21
Q

Characteristics of fetal breathing:

A

Discontinuous

Paradoxical chest wall movement

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22
Q

Paradoxical chest movement is due to ____ of _____ such exchange appears to be essential for normal lung development

A

Coughing of clear amniotic fluid debris

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23
Q

Two types of respiratory movements

A

Gasps or sighs

Irregular burst of breathing

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24
Q

Gasps or sigh which occurred frequently of ____ per minute

A

1-4 per minute

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25
Q

Irregular bursts of breathing occurred at rates up to _____

A

240 cycles per minute

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26
Q

Variables that may affect fetal breathing:

A 
Hypoxia
Labor
Hypoglycemia
Impending preterm labor
Gestational age
Cigarette smoking
Amniocentesis
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27
Q

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

A

Contraction stress test

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28
Q

If the fetus is normal, in the contraction stress test, the brief periods of impaired oxygen exchange is well ___

A

Tolerated

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29
Q

In the presence of late fetal heart rate decelerations indicates:

A

Uteroplacental insufficiency

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30
Q

In the presence of variable decelerations in a contraction stress test this indicates:

A

Oligohydramios

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31
Q

In the presence of an early fetal heart rate decelerations in contraction stress test this indicates:

A

Head compression

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32
Q

In order to perform contraction stress test there must be at least __ contractions that last for ___ in a ____ minutes observation

A

3 - 40sec -10 minutes

33
Q

Contractions may be induced by either a ____ or ____

A

Nipple stimulation

Oxytocin

34
Q

Criteria for interpretation of the contraction stress test:

No late or significant variables decelerations

A

Negative

35
Q

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

A

Positive

36
Q

Criteria for interpretation of the contraction stress test:

Intermittent late decelerations or significant variable decelerations

A

Equivocal suspicious

37
Q

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

A

Equivocal hyperstimulatory

38
Q

Criteria for interpretation of the contraction stress test:

Fewer than three contractions in 10 mins or an uninterpretable tracing

A

Unsatisfactory

39
Q

This test uses this principle:

Normal fetuses will respond with fetal heart rate acceleration in response to fetal movement

A

Non stress testing

40
Q

This is the most widely used primary testing method for assessment of fetal well being

A

Nonstress testing

41
Q

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

A

Nonstress testing

42
Q

This is a test of fetal well being

A

NST

43
Q

Test of uteroplacental function

A

CST

44
Q

This factors can cause loss of fetal heart rate reactivity

A

Fetal sleep
Magnesium sulfate
Cigarette smoking

45
Q

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

A

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

46
Q

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

A

40 minutes

47
Q

This pattern consisted of a fetal heart rate baseline that oscillates less than ___ bpm and presumably indicate absent acceleration and beat to beat variability

A

Silent oscillatory pattern

5 bpm

48
Q

Terminal cardiotocogram indicates the following:

A

Baseline oscillation less than 5 bpm
Absence acceleration
Late decelerations with spontaneous uterine contractions

49
Q

Lack fetal heart rate acceleration when not due to maternal sedation or fetal sleep is an ___ finding

A

Ominous

50
Q

The interval between tests is arbitrary set at __ days

A

7 days

51
Q

More frequent testing using NST is done in:

A

Post term pregnancy
Type 1 Diabetes myelitis
Fetal growth restriction
Gestational hypertension

52
Q

Variable decelerations, if nonrepetitive and brief during NST are ___

A

Not an indicative of fetal compromise

53
Q

Repetitive variable decelerations in at least ___ in ___ minutes or decelerations lasting for more than __ minute is a WORST PROGNOSIS

A

3 within 20 minutes

Lasting for more than 1 minute

54
Q

If there is an indication of worst prognosis in NST you will do:

A

Ultrasound to check the amount of amniotic fluid volume

55
Q

False normal Nonstress test can cause fetal death within _ week of a reactive test, what are the causes?

A

1 week

Meconium aspiration 
Intrauterine infection
Cord accident
Congenital malformation
Placental abruption
56
Q

This test use loud external sounds used to startle the fetus to provoke acceleration of the heart rate

A

Acoustic stimulation test

57
Q

What is the positive response in an acoustic stimulation test

A

Rapid appearance of fetal heart accelerations following acoustic stimulation

58
Q

5 biophysical components:

A 
Fetal heart rate accelerations (NST)
Fetal breathing
Fetal movement
Fetal tone
Amniotic fluid volume
59
Q

What are the biophysical components detected by the ultrasound

A

Fetal breathing
Fetal movement
Fetal tone
Amniotic fluid volume

60
Q

NST may be omitted if the _____ parameters are all normal

A

4 ultrasound

61
Q

NST score of 2:
__ accelerations of ___ beats/min for ____ sec in ___ min

NST score of 0:
__ accelerations in ___ min

A

≥2 accelerations of ≥15 beats/min for ≥15 sec in 20–40 min

0 or 1 acceleration in 20–40 min

62
Q

Fetal Breathing score of 2:
___ episode of rhythmic breathing lasting ___ sec within ___ min

Fetal Breathing score of 0:
___ sec of breathing in ___ min

A

≥1 episode of rhythmic breathing lasting ≥30 sec within 30 min

< 30 sec of breathing in 30 min

63
Q

Fetal movement score of 2:
__ discrete body or limb movements within ___ min

Fetal movement score of 0:
__ discrete movements

A

≥3 discrete body or limb movements within 30 min

< 3 discrete movements

64
Q

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

A

≥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

65
Q

Amniotic volume score of 2:
___ HORIZONTAL/VERTICAL pocket ___ cm

Amniotic volume score of 0:
Largest ___ HORIZONTAL/VERTICAL pocket ___ cm

A

Single vertical pocket > 2 cm

Largest single vertical pocket ≤ 2 cm

66
Q

The biophysical score:
Normal variable
Abnormal variable
Highest score

A

2
0
10

67
Q

What BPS indicates a normal pH
What BPS indicates significant fetal acidemia
What BPS is a POOR PREDICTOR OF ABNORMAL OUTCOME

A

8 or 10
0
6

68
Q

This BPS score is a progressively more accurate predictor of abnormal outcome:

A

2 or 4

69
Q

The Normal Amniotic fluid index

A

5-24 cm

70
Q

The deepest vertical pocket normal value

A

2-8 cm

71
Q

What is the significance of a AFI <5cm

A

Increased risk of CS for fetal distress
Low five minutes Apgar score
Increase perinatally morbidity and mortality

72
Q

This is a non-invasive technique to assess fetal and maternal blood flow

A

Doppler velocimetry

73
Q 
Doppler would detect the blood flow in this arteries:
Fetal vessels (3)
Maternal vessel (1)
A

Umbilical artery
Middle cerebral artery
Ductus venosus

Uterine artery

74
Q

What is the goal of a Doppler velocimetry

A

To optimize time of delivery

75
Q

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

A

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

76
Q

To detect fetal anemia this vessel should be monitored

A

Middle cerebral artery

77
Q

Uterine blood flow increases from ____ early in gestation to ____ by term

A

50 mL/min early in gestation

500 to 750 mL/min by term

78
Q

Increased resistance to flow and development of a ___ have been associated with ___

A

Diastolic notch

Pregnancy-induced hypertension

79
Q

increased impedance of uterine artery velocimetry at _____ weeks was predictive of superimposed preeclampsia developing in women with chronic hypertension

A

16 to 20 weeks

80
Q

2 points to consider in deciding when to begin Antepartum testing:

A

Prognosis of neonatal survival

Severity of maternal disease

81
Q

Antepartum testing must begin:
Most high risk pregnancies:
With severe complications:

A

32-34weeks

26-28 weeks

OB GYN (11 decks)

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