Antepartum Fetal Testing

Question 1

The most common reasons for fetal testing are

Answer 1

decreased fetal movements, diabetes, post dates, chronic hypertension, and IUGR.

Question 2

This test assesses the frequency of fetal movements using an external fetal heart rate (FHR) monitoring device to detect the presence or absence of accelerations.

Answer 2

NONSTRESS TEST (NST)

Question 3

Criteria for NST

Answer 3

<32 weeks, the increase should be ≥10 beats/min lasting ≥10 s
• >32 weeks, the increase should be ≥15 beats/min lasting ≥15 s

Question 4

Reactive NST requires _______

Answer 4

the presence of 2 accelerations in a 20-min window of time meeting the above criteria.

This is reassuring and highly predictive for fetal well-being

Question 5

Fetal death rate for reactive NST

Answer 5

Fetal death rate is only 3 per 1,000 in the next week

Question 6

_____percent of nonreactive NSTs are false positives (meaning the fetus is not hypoxemic).

Answer 6

Eighty

Question 7

Nonhypoxemic causes of non-reactive NST include

Answer 7

fetal sleep, prematurity, drug effects, and CNS anomalies.

Question 8

Mx of non-reactive NST

Answer 8

fetal vibroacoustic stimulation to see whether this results in reactivity

Question 9

If the NST is persistently nonreactive, perform _______

Answer 9

a biophysical profile

Question 10

The 4-quadrant amniotic fluid index test assesses in centimeters the______

Answer 10

deepest single vertical amniotic fluid pocket in each of the 4 quadrants of the uterus

Question 11

Interpretation of AFI

Answer 11

<5 cm—oligohydramnios
5–8 cm—borderline
9–25 cm—normal
>25 cm—polyhydramnios

Question 12

Components of BPP

Answer 12

NST, amniotic fluid volume, fetal gross body movements, fetal extremity tone, and fetal breathing movements

Question 13

BPP Score 8-10 interpretation

Answer 13

Highly reassuring of fetal well-being.

Management is to repeat the
test weekly or as indicated. Fetal death rate is only 1 per 1,000 in the next week.

Question 14

BPP Score 4-6 interpretation

Answer 14

Worrisome. Management is delivery if the fetus is >36 weeks or repeat
the biophysical profile in 12–24 h if <36 weeks. An alternative is to perform a CST

Question 15

BPP Score 0-2 interpretation

Answer 15

Score of 0 or 2—highly predictive of fetal hypoxia with low probability of false positive.
Management is prompt delivery regardless of gestational age.

Question 16

A modified BPP includes only the _______ and ______Its predictive value is
almost as high as a complete BPP

Answer 16

NST and amniotic fluid volume.

Question 17

All EFM tracings should be evaluated for the ______ and ______

Answer 17

nonstress test (NST) and the contraction stress test (CST).

Question 18

If 3 or more uterine contractions (UCs) are present in 10 minutes, the ______components can be assessed as negative or positive.

Answer 18

CST

Question 19

This test assesses the ability of the fetus to tolerate transitory decreases in intervillous blood flow that occur with uterine contractions

Answer 19

CONTRACTION STRESS TEST (CST

Question 20

The most common indication for CST is a ______

Answer 20

BPP of 4 or 6.

Question 21

Negative CST requires ______

Answer 21

requires absence of any late decelerations with contractions.

This is reassuring and highly reassuring for fetal well-being.

Question 22

Mx of negative CST

Answer 22

Management is to repeat the CST

weekly. Fetal death rate is only 1 per 1,000 in the next week.

Question 23

Positive CST is worrisome. This requires ________

Answer 23

the presence of late decelerations associated with at least 50% of contractions

Question 24

CST should not be performed whenever ________

Answer 24

contractions would be hazardous to the mother or fetus

Question 25

This test measures the ratio of systolic and diastolic blood flow in the umbilical artery

Answer 25

UMBILICAL ARTERY DOPPLER

Question 26

The umbilical circulation normally has _______, so significant diastolic blood flow is expected

Answer 26

low resistance

Question 27

The systolic/diastolic (S/D) ratio normally ______ throughout pregnancy.

Answer 27

decreases