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Fetal Evaluation (UPenn) > Antepartum Fetal Surveillance > Flashcards

Antepartum Fetal Surveillance Flashcards

1
Q

Risk factors for fetal death

A

Maternal

  • Antiphospholipid syndrome
  • Hyperthyroidism
  • Hemoglobinopathies
  • Cyanotic heart disease
  • Lupus
  • Chronic renal disease
  • Type 1 diabetes mellitus
  • Hypertensive disorders

Pregnancy-related complications

  • GHTN/ pre-eclampsia*
  • Oligohydramnios
  • Polyhydramnios
  • Decreased fetal movement
  • Intrauterine (fetal) growth restriction
  • Post-term pregnancy
  • Isoimmunization
  • Previous fetal demise
  • Multiple gestation with growth discordancy
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2
Q

Maternal → fetal oxygen transfer

A

Environment → Lungs → Heart → Vasculature → Uterus → Placenta → Umbilical Cord → Fetus

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3
Q

Fetal effects of oxygen pathway interruption

A

Hypoxemia → Hypoxia → Metabolic Acidosis → Metabolic Acidemia → Hypotension

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4
Q

Fetoplacental circulation key points

A
  • Umbilical vein carries oxygenated blood to fetus
  • Umbilical arteries carry deoxygenated blood to placenta
  • Blood is shunted via the:
    • Ductus venosus - shunts blood away from the liver (portal vein) to IVC
    • Ductus arteriosus - shunts blood away from lungs (via pulmonary artery) to aorta
    • Foramen ovale - shunts blood across the atrial septum (RA → LA) → more oxygenated blood to body
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5
Q

What is the difference between hypoxia and hypoxemia?

A

Decreased O2 concentration in the

  • Hypoxia - tissue
  • Hypoxemia - blood
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6
Q

Hypercapnia

A

More than the normal level of carbon dioxide in the blood

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7
Q

What is the difference between acidosis and acidemia?

A

Increased hydrogen ion concentration:

  • Acidemia - blood
  • Acidosis - tissue
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8
Q

Glucose metabolism

(aerobic vs anaerobic, biproducts)

A
  • Glucose → pyruvate, no O2 needed
  • Pyruvate → ATP +
    • CO2 (aerobic) or
    • lactic acid (anaerobic)
      • does not cross placenta easily
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9
Q

Fetal metabolic acidemia

A
  • Pyruvic acid → lactic acid + ATP
  • Buffer base consumed (HCO3, plasma proteins, Hgb, inorganic phosphate) → base deficit
  • Cure: increase fetal oxgenation
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10
Q

Complications of fetal acidemia

A
  • Seizure disorders
  • Developmental delays
  • Cerebral palsy
  • Fetal/neonatal death
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11
Q

Neonatal encephalopathy

A

Clinically defined syndrome of disturbed neurological function in term and near term infants

  • Respiratory difficulty
  • Depression of tone, reflexes
  • Subnormal LOC
  • Often seizures

Hypoxic-ischemic encephalopathy

  • a subset of neonatal encephalopathy
  • result of a hypoxic/anoxic episode
  • accumulation of lactic and carbonic acids (H+ ions) in the blood
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12
Q

Uterine tachsystole

A
  • > 5 contractions in 10 minutes averaged over 30 minutes
  • Abnormal contraction pattern
  • Can affect fetal oxygen exchange
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13
Q

Fetal heart rate baseline

A
  • FHR during a 10 minute segment rounded to nearest 5 beats, excluding periods of marked variability/periodic/episodic changes
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14
Q

Normal fetal heart rate range

A

110 - 160 bpm

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15
Q

Fetal tachycardia

A

Baseline > 160 bpm

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16
Q

Fetal bradycardia

A

Baseline < 110 bpm

17
Q

Baseline heart rate variability

A
  • Fluctuations in the FHR that are irregular in amplitude and frequency, in response to fetal environment and stimuli
  • Most significant predictor of fetal well being
  • Classification
    • Absent - 0 bpm, or undetectable
    • Minimal - detectable, 5 bpm or less
    • Moderate - 6 - 25 bpm
    • Marked - >25 bpm
18
Q

Sinusoidal rhythm

A
  • Smooth, sine wave-like undulating pattern, usually 3-5 bpm (but can be higher) over 20 minutes.
  • Not considered variability
  • Reflects fetal anemia/chronic or acute bleed.
  • Certain drugs can mimic.
  • Rare and not good.
19
Q

Qualification of waveform

(abrupt vs gradual)

A
  • Abrupt - peak to nadir is < 30 seconds
  • Gradual - peak to nadir is > (or =) 30 seconds
20
Q

Periodic vs episodic FHR changes

A
  • Periodic = associated with contractions
    • ie early, variable, or late decelerations
  • Episodic = not associated with contractions
    • ie accelerations, prolonged late decels, variable decelerations
21
Q

Variable decelerations

A
  • Abrupt decrease (onset to nadir < 30 sec)
  • Decrease at least 15 bpm x 15 sec (up to 2 min)
    • 10 bpm by 10 sec if < 32 weeks
  • Baroreceptor mediated
  • Umbilical cord compression (most common in labor)
    • Umbilical vein compressed → less blood returning to fetal heart → decreased preload
    • Umbilical arteries compressed → higher pressure fetal heart is pumping against → increased afterload
22
Q

Late decelerations

A
  • Gradual onset > or = 30 seconds
  • Usually after beginning, peak and ending of contraction
  • Utero-placental insufficiency → transient hypoxia during contraction → chemoreceptor → alpha adrenergic vasoconstriction → central hypertension → baroreceptor → decreased FHR
    • Marginal placental O2 reserve
23
Q

Prolonged decelerations

A
  • Decrease of > 15 beats/min from baseline that has a duration of > 2 minutes but < 10 minutes
  • Onset may be gradual or abrupt
  • Duration of > 10 minutes is considered a change in baseline
24
Q

Fetal behavioral states

(name/describe 4)

A
  • Quiet sleep → stable FHR, absent to minimal variability, isolated accels w/o movement. Lasts 20 - 40 minutes
  • Active sleep → wider FHR baseline and frequent accels with movement
  • Quiet awake → stable, wider FHR, no accels
  • Active awake → unstable FHR, large long-lasting accels, coalescence of accels/tachycardia
25
Q

Quantification of decelerations

A
  • Quantified by depth in beats/min and duration in minutes and seconds
  • Classified as:
    • Recurrent - occur with > 50% of contractions in a 20 minute window
    • Intermittent - occur with < 50% of contractions in 20 minutes
  • Bradycardia and tachycardia are quantitated in beats/min or in a range if the FHR is not stable
26
Q

Non stress test (NST)

(term vs preterm)

A

Term

  • At least 2 accelerations of the FHR of 15 bpm x 15 seconds in 20 minutes of monitoring (can be as long as 40-80)

Preterm

  • 24-28 wks 50% are non-reactive
  • 28-32 wks – reactive = 10 bpm x 10 sec
    • 15% non-reactive
  • 32 weeks – reactive = 15 bpm x 15 sec (like term)
  • Once reactive should stay reactive
27
Q

Category I FHR tracings

A
  • Normal
  • Predictive of good acid/base status
  • Include all of the following:
    • Baseline FHR rate: 110–160 bpm
    • Baseline FHR variability: moderate
    • Accelerations: present or absent
    • Late or variable decelerations: absent
    • Early decelerations: present or absent
28
Q

Category II FHR tracings

A
  • Indeterminate
  • Not predictive of acid/base status
  • Baseline rate:
    • Bradycardia not accompanied by absent variability
    • Tachycardia
  • Baseline FHR variability:
    • Minimal baseline variability
    • Absent baseline variability not accompanied by recurrent decelerations
    • Marked baseline variability
  • Accelerations:
    • Absence of induced accelerations after fetal stimulation
  • Periodic or Episodic Decelerations:
    • Recurrent variable declerations accompanied by minimal or moderate baseline variability
    • Prolonged deceleration ≥2 minutes but <10 minutes
    • Recurrent late decelerations with moderate FHR baseline variability
    • Variable decelerations with other characteristics, such as slow return to baseline, “overshoots,” or “shoulders.”
29
Q

Category III FHR tracings

A
  • Abnormal
  • Predictive of abnormal fetal acid-base status at time of observation
  • Absent variability with:
    • Recurrent late or variable decelerations
    • Bradycardia
  • Sinusoidal pattern
30
Q

Potential causes of fetal tachycardia

A
  • Maternal
    • Fever
    • Chorioamnionitis
    • Dehydration
    • Hyperthyroid
    • Illicit substance use
    • Medications: betasympathomimetics and parasympatholytics
  • Fetal
    • Anemia
    • Heart failure
    • Hypoxia
    • Infection or sepsis
    • Tachyarrhythmia

Fetal Evaluation (UPenn) (5 decks)

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