Antepartum and Intrapartum fetal assessment

Question 1

WHat are the modalities of Assessing the fetus?

Answer 1

Fetal movement assessment
Nonstress test
Contraction stress test
Biophysical Profile
Umbilical artery doppler velocimetry
MCA doppler velicimetry
USE MULTIPLE

Question 2

What is the basis behind the fetal nonstress test?

Answer 2

Does the fetus Heart-rate increase with movement?
Reactive: 15bpm accel above baselinelasting 15sec. 2 accel in 20 min
Nonreactive: Above criteria not met within 40 min

Question 3

How is ultrasound used to assess the fetus in utero?

Answer 3

Placental Localization
Amniotic fluid index or volume
Eval Maternal Pelvic masses
Gestational dating
Anatomic Survey
etc

Question 4

What is Biophysicl Profile?

Answer 4

Fetal breathing
Ftal movement
Fetal tone
Amniotic fluid volume

Question 5

How is umbilical artery doppler used

Answer 5

Umbilical flow is fast during diastole
In IUGR there is a decrease of flow
Systolic/Diastolic Ratio

Question 6

How is IUGR screened for?

Answer 6

Measure Fundal heaght at ea visit

Unexplained elevated maternal Serum Alpha fetoprotein raises risk

Question 7

Who needs intrapartum testing?

Answer 7

Pre existing insulin requiring diabetes
Hx of IUF Demise
Post date Pregnancies
Chronic HTN
Dec Fetal Movement

Question 8

What are types of Fetal monitoring?

Answer 8

Fetal Oxygenation
Continuously or intermittenly
Auscultation or Electronic
Internal or External

Question 9

What is Extenal Monitoring of Fetus intrapartum?

Answer 9

Difficult to interpret if poor qual. (Obese)
Use When Cant rupture membranes
Auscultation or Elecronic

Question 10

What is Internal Monitoring of Fetus intrapartum?

Answer 10

Electrode attached to fetus’ head

Question 11

What is Tachysystole?

Answer 11

Rapid Rate of contraction

Question 12

What is the normal baseline HR in fetus?

Answer 12

110 to 160 BPM

Question 13

What are the ways that Uterine contractions can cause a decrease in fetal HR?

Answer 13

Compression of Fetal Head, Umbilical Cord

Uterine Myometrial Vessels

Question 14

What are the different types of Decelerations?

Answer 14

Early
Late
Variable

Question 15

What is an Early deceleration?

Answer 15

HR Drops and rises as a mirror image of Contraction
Not a sign of a problem
Vagal stim from head compression

Question 16

What is an Late deceleration?

Answer 16

Uteroplacental insufficiency

Compromised blood flow to the baby

Question 17

What is a variable deceleration?

Answer 17

ABRUPT decrease in HR

Cord Compression causing Vagus nerve stim

Question 18

What are the categories of

Answer 18

Category 1: OK
Cat 2: Needs monitoring
Cat 3: Need intervention

Question 19

What is the process of Intrauterine Resussitation?

Answer 19

Have mom change position
Stop Oxytocin
Give Fluids ESP before Anesthesia
Give Oxygen to Mom

Question 20

What does moderate FHR variability tell you?

Answer 20

It reliably predicts Absence of metabolic Acidemia at time of observation

Question 21

At what point does intrapartum interruption of fetal Oxygenation result in neuro injury?

Answer 21

When it progresses to significant metabolic Acidemia

Umb Art pH 12