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Gyne > Antepartum assessment > Flashcards

Antepartum assessment Flashcards

1
Q

what are the types of fetal surveillance?

A
  • Antenatal: maternal self-assessment, NST, US, doppler.

- intrapartum: auscultation of fetal heart rate, electrical fetal monitoring, fetal blood scalp sampling

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2
Q

What is the maternal self-assessment of fetal wellbeing?

A

Kick counting (10movement in 1hr)

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3
Q

What is a normal fetus NST finding?

A

Normal fetus respond to fetal movement with
- HR >15 Bpm
- for 15 sec
(Acceleration)

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4
Q

What is non-stress test vs stress test?

A

NST: HR without any external stress (medications, uteine contraction, illness)

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5
Q

How many accelerations is considered normal in a reactive NST?

A

2 acceleration

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6
Q

BPP is usually taken at which week?

A

After 28 weeks.

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7
Q

What is the normal profile for BPP

A

10 (each score is given 2)

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8
Q

What are the component of biophysical profile?

A 
1- fetal breathing movement 
2- gross body movement 
3- fetal tone 
4- amniotic fluid volume 
5- NST
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9
Q

What is the normal fetal breathing movement?

A

within 30 min:

One or more fetal breathing lasting 30 sec

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10
Q

What is the normal gross body movement in BPP

A

within30 min: 3 or more body\limb

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11
Q

What is the normal fetal tone in BPP

A

Within 30 min: 1 or more active extension\flexsion - OR - opening\closing of the hand

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12
Q

What is the normal amniotic fluid volume

A

deepest vertical pocket: Greater than 2cm

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13
Q

When do we proceed with doppler assessment of the umbilical artery?

A

Decreased fetal fluid, tone, or BPP less than 10

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14
Q

How can we determine blood flood, from which arteries?

A

1- umbilical artery
2- uterine artery
3- ductus venosus

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15
Q

What is the most problematic cause for fetal hypoxia

A

Placental insufficency measured by fetal umbilical artery

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16
Q

What does absent diastole mean in doppler assessment of umbilical artery?

A

Compromised blood flow

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17
Q

What does reversed diastole mean in doppler assessment of umbilical artery?

A

At risk of fetal death and need to be delivered immediately

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18
Q

What are the causes for compromised blood flow to the fetus?

A

1- umbilical cord: one artery, vasa previa
2- placenta: infarction, abruptio
3- maternal: HTN, Hypo, anemia, seizure
4- fetal: anemia, infection, twin, IUGR
5- uterine: hyperstimulation, tetanic contraction

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19
Q

What are the chain of events after decreased perfusion to fetus?

A

Hypoxic acedemia > resp acidosis > met acidosis >encephalopathy > CP

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20
Q

how to auscultate for fetal heart rate intrapartum?

A

beginning
of 1 contraction to the beginning of other.

Using doppler or stethoscope

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21
Q

What is the duration of listening to fetal heart rate intrapartum?

A

Every 30 min (1st stage)

Every 15 min (2nd state)

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22
Q

How to measure fetal heart rate in high risk patients?

A

Using continues electrical fetal heart rate monitoring

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23
Q

What does EFM report?

A

FHR, MHR, uterine contractions,

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24
Q

How to interpret fetal heart rate?

A

DR C BRAVADO

  • Determine risk
  • contraction
  • baseline rate
  • variability
  • acceleration & deceleration
  • overall assessment
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25
Q

How to determine the risk?

A

Patients history, fetal reserve, and labor progression

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26
Q

How to assess the uterine activity pattern?

A

either by extranal toco or IUPC or palpation

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27
Q

What to assess in uterine activity

A

1- frequency
2- duration
3- intensity
3- resting tone

28
Q

How to measure the frequency of contraction in external toco?

A

From peak to peak

Adquate: in 10 min we have 3 or more

29
Q

How to measure the duration of contraction in external toco?

A

Every red line is a minute

30
Q

How to measure the intensity of contraction in external toco? s

A

Substracting the peak from the baseline

Adquate: 200 or more

31
Q

What unit used in IUPC to assess uterine activity?

A

MVU which is indicative of intensity

32
Q

IUPC is a

Quantative vs Quallitative

A

Quantitative

33
Q

When is IUPC is more useful?

A
  • Obesity

- dysfunctional labor

34
Q

What is the normal FHR baseline range

A

110-160

35
Q

How to measure the baseline heartrate

A

Any 2 minutes in 10 minutes

That is NOT
1- changes (periodic\episodic)
2- variability
3- segment differ by >25bpm

36
Q

What is bradycardia in baseline rate

A

<110 in 2minutes

37
Q

What are the causes of bradycardia in fetus?

A
  • magnesium sulfate
  • prematurity
  • fetal heart problem (AV block)
38
Q

What are the cause of tachycardia?

A

Chorioamionitis, maternal fever, fetal heart problem

39
Q

Whay is variability

A

Fluctuation in baseline heart rate

40
Q

How to measure variability in heart rate?

A

Choosing 1 minute of 10 min section
(Free from accelration\decelration)
Measureing the difference between higest and lowest

41
Q

What does variability indicate

A

The baby wellneing

Normallly: 2-25

42
Q

What if the variability is:
<3:
3-5:
>25:

A
  • absent (compromised if >40min)
  • Decreased (problem)
  • increased (problem or fetal movement)
43
Q

Name pathological causes of increased variability > 25 bpm

A

1- mild hypoxia
2- fetal gasping
3- unknown

44
Q

How to intervene in marked variability

A

Attach fetal scalp electrode and measure PH

45
Q

differentiate between acceleration\deceleration and variability

A

Variability is still within the baseline

Wheras the acceleration\deceleration is any increase or decrease beyond the baseline

46
Q

What is prolonged acceleration

A

More than 2 minutes

Less than 10 minutes

47
Q

What is tachycardia in terms of acceleratio

A

> 10 minutes

48
Q

Differentiate the normal acceleration at <32 and 32 + beyond

A
  • <32: 10bpm for 10sec
  • 32 & beyond: 15bpm for 15sec

All should be less than <2 min

49
Q

What could be the causes for absent accelration

A

Hypoxic acidemia or fetal abnormality

50
Q

What are the types of deceleration?

A

1- early
2- variable (uncomplicated or complicated)
3- late

51
Q

What is early deceleration

A

Decerlation that concide with contractions

Onset deceleration= begining of contractio
Ending \ = ending
Peak = peak

52
Q

Fetal head compression gives an image of which type of deceleration

A

Early deceleration

53
Q

What is late deceleration usually associated with

A

Uteroplacental insufficency

Fetal acdemia

54
Q

How is late deceletion

A

Peak of contraction = start of deceleration

55
Q

Variable deceleration is commonly caused by

A

Vagal stimulation due to cord compression

Could be associated with fetal acidemia

56
Q

What causes prolonged deceleration

A

Cord compression or prolapse - oligohydaminos

57
Q

What is the action taken in prolonged deceleration

A

Vaginal exam to rule out cord prolapse - prepare for delivery

58
Q

Where do we commonly see variable deceleration

A

Late stages of labor

59
Q

What does variable decleration mean

A

Deceleration not associated with uterine contraction

60
Q

How to manage oligohydraminos?

A
  • Change position of mother
  • give IV fluid
  • oxygenate
  • scalp PH
61
Q

Sinusoidal pattern is associated with

A

Severe fetomaternal anemia, hemorrhage, abruptio placenta

Severe blood insufficency

62
Q

What should be the next step after diagnosing sinusoidal pattern?

A

Should be delivered immediately

63
Q

In which cases should we immidiately plan for delivery

A

1- absent variability (+late or variable deceleration or bradycardia)
2- sinusoidal pattern

64
Q

What are the benifits of fetal scalp blood

A

Reduce the increased operative intervention

65
Q

At which week is fetal scalp blood sampling approrpriate?

A

> 34

66
Q

What are the contraindications for fetal scalp sampeling

A
  • Family history of hemophilia or bleeding disorder
  • face presentation
  • maternal infection or intrauterine sepsis
67
Q

When is delivery indicated

A

PH <7.2

Or 7.21-7.24 if rapid fall since last sample

Gyne (18 decks)

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