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OBGYN > Assessment of fetal wellbeing > Flashcards

Assessment of fetal wellbeing Flashcards

1
Q

Assessment of fetal wellbeing
- Definition
- Types

A

process whereby healthy and high-risk women are identified for fetal abnormalities,
disorders, suspicious findings and healthy state.

This process is undertaken by risk factors, ultrasound, blood sampling and various monitoring.

  • Early
    pregnancy
  • Late
    pregnancy
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2
Q

Early pregnancy

Assessment of fetal wellbeing

A
  1. Maternal age (e.g. 1:6 pregnancies result in down’s syndrome at the age of 50)
  2. Maternal drugs
  3. Anticonvulsant drugs (phenytoin, carbamazepine etc.)

a. Cytotoxic agents - such as in cancer therapy or immunosuppressors

b. Warfarin – teratogenic when used in 1st semester

  1. Previous history of fetal abnormality – previous down’s syndrome
  2. Maternal disease
    a. Diabetes
    b. Congenital heart disease
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3
Q

Late pregnancy

Assessment of fetal wellbeing

A
  1. Persistent breech presentation or abnormal lie
  2. Vaginal bleeding
  3. Abnormal fetal movements - either increased or decreased
  4. Abnormal amniotic fluid volume
  5. Polyhydramnios – associated with GI abnormalities
  6. Oligohydramnios – associated with renal tract and urethral valve abnormalities
  7. IUGR
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4
Q

Name the type of specific risks

A
  • Maternal vascular disease
  • Maternal diabetes
  • Twins
  • Rhesus antibodies
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5
Q

Name the type of non- specific risks

A

Previous fetal death or growth restriction,
maternal perception of reduced fetal
movements, vaginal bleeding, abdominal
pain

Abnormal uterine size
and/or growth (large or
small fetus)

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6
Q

Maternal vascular
disease

  • Pathophysiology
    -Surveillance
A

Pathophysiology:
Uteroplacental vascular disease (UPVD) with
poor blood flow within placenta and insufficient gas and nutrients

Surveillance
Fetal movements, umbilical artery
doppler, biophysical profile (BPS), fetal
growth

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7
Q

Twins
- Pathophysiology
- Surveillance

A

Pathophysiology
Twin - fetal growth
restrictions from UPVD
Monochorionic twins –
TTTS

Surveillance:
AFV and urine in the
fetal bladders.

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8
Q

Rhesus antibodies
- Pathophysiology
- Surveillance

A

Transplacental passage
of maternal antibodies
leading to anemia.

  • Surveillance :
    Middle cerebral artery
    measurement and fetal
    blood sampling (FBS)
    ultrasound guided with
    needle cord sampling
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9
Q

Previous fetal death or growth restriction,
maternal perception of reduced fetal
movements, vaginal bleeding, abdominal
pain

A

Variety of pathologies resulting in fetal death
or growth restriction.

Unless cause is known the assumption is
UPVD.

Surveillance :
Fetal movements, umbilical artery
doppler, BPS, fetal growth

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10
Q

Ultrasound examimation

  • Name the time-points
A

“Examination 0” (first prenatal visit)
Weeks 11-13 (+6 days)
Weeks 18-20 (+6 days)
Weeks 30-31 (+6 days)
Weeks 36-37 (+6 days)

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11
Q

“Examination 0” (first prenatal visit) US

A

a. Pregnancy verification (gestational sac and embryo)

b. Gestational age (size of gestational sac and CRL)

i. Importance of establishing gestational age before week <12 is
because CRL measurments do not really change in during these
first weeks – most accurate at early pregnancy.

Once the estimated due date (EDD) is established, it should not be changed.

c. Missed abortion
d. Ectopic pregnancy
e. Multiple gestations

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12
Q

Weeks 11-13 (+6 days) US

A

a. Sometimes this is the first prenatal visit, in that case, you need to
preform also the checkups of the “examination 0”.
b. Fetal viability
c. Biometry (CRL, BPD, AC, FL)
d. Nuchal translucency (NT)
e. Nasal bone
f. Ductus venosus flow
g. Placenta
h. Kidneys and bladder
i. Heart (4 chambers

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13
Q

Weeks 18-20 (+6 days)

A

a. Confirmation of fetal viability
b. Amniotic fluid volume
c. External genitalia differentiation (not screening but good to know)
d. Anatomical survey – confirming normal appearance and biometry
i. Skull (HD and OFD)
ii. Limbs (FL)
iii. Abdomen (AC and AD)
iv. Face
v. Spine
vi. Placenta and umbilical cord
vii. Urogenital tract

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14
Q

Weeks 30-31 (+6 days)

A

e. Late onset malformation (corpus callosum agenesis)
f. Amniotic fluid volume
g. Placental localization
h. Biometry (BPD, OFD, HC, AC, FL) – IUGR

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15
Q

Weeks 36-37 (+6 days)

A

i. Fetal presentation
j. Biometry
k. Amniotic fluid volume
l. Placental localization and maturity
m. Previous C-section scar (with full bladder)

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16
Q

Biometry US

A

Biometry – assessing fetal size and weight

  1. Biparietal diameter (BPD)
  2. Occipitofrontal diameter (OFD)
  3. Head circumference (HC) – calculated from BPD and OFD or measured using ellipse caliper
  4. Abdominal diameter (AD)
  5. Abdominal circumference (AC) – calculated from two AD or measured with an ellipse caliper.
  6. Femoral length (FL) – length of femur diaphysis
17
Q

Blood tests and amniocentesis

A
  1. Sampling is done by
    a. Chorionic villus sampling (CVS)
    b. Amniocentesis
  2. Combined screening test
    a. Between weeks 11-13
    b. Nuchal translucency (NT) – see criteria for measurement and also needed CRL measures
    are 45-84mm
    c. Biochemical markers hCG and pregnancy-associated plasma protein A (PPPA)
  3. Quad test
    a. Between weeks 14-20
    b. Biochemical markers – hCG, inhibin-A, AFP and unconjugated estradiol (uE3)
18
Q

Doppler examinations

A
  1. Normal fetal recording (A)
  2. Absent end-diastolic velocity (AEDV) is a typical type UPVD. Usually fatal but early recognition and monitoring until elective term can be performed at 34 weeks (B).
  3. Reverse end diastolic velocity (REDV) – leads to fetal death but elective pre-term at 26 weeks or
    more may be done (C)
19
Q

Fetal growth

A
  1. Definition: ultrasound measurements of the head (HC) and abdominal (AC) circumferences.
  2. Small fetus – suboptimal fetal growth with values below the lowest centile range.
  3. Typical – not high risk for complications and seen usually in short or Asian ethnicity woman.
  4. Atypical asymmetric – tends to occur at later pregnancy and associated and associated with
    UPVD.
  5. Atypical symmetric – tends to occur in early pregnancy and associated with severe early onset of pre-eclampsia.
  6. Large fetus
  7. Typical – usually seen in tall women or Afro-Caribbean ethnicity.
  8. Atypical – accelerated growth above the upper limit of the central range. Mostly seen in diabetic women.
20
Q

Amniotic fluid volume (AFV)

A
  1. Accurate measurement is done with US and two method are used:

a. Single deepest pocket – normal range is 2-8 cm. The deepest longest vertical diameter
of echo-free pocket between the fetus and uterus. Less than 2 is oligohydramnios and
more than 8 is polyhydramnios.

b. Amniotic fluid index (AFI) – sum of measurements of the largest pocket in each of the
four quadrants. Normal range is 6-24.

21
Q

Biophysical profile scoring (BPS)

A
  1. Definition: prenatal evaluation of the fetal well-being involving a scoring system. Normal score is a fetus presenting at least 4 of the following parameters in a period of 40 minutes.

Parameters
are:
a. Fetal heart rate
(FHR) – recorded with cardiotocograph (CTG) maximum recording of 40
minutes. At least 2 accelerations of 15 bpm lasting for at least 15 seconds. Normal FHR
is 110-160 bpm.

b. Fetal movements – maximum of 40 minutes fetal observation in ultrasound. At least 3
separate distinct movements

c. Fetal tone – one of the fetal movements demonstrates full 90-degree flexion-extensionflexion cycle of the limb or opening and closing of the hand.

d. Fetal breathing – maximum of 40 minutes fetal observation in ultrasound. At least one
episode of 30 seconds regular fetal breathing movements.

e. AFV - at least 1 vertical measurement between 2 – 8 cm

22
Q

Fetal heart rate (FHR)

A

recorded with cardiotocograph (CTG) maximum recording of 40
minutes. At least 2 accelerations of 15 bpm lasting for at least 15 seconds. Normal FHR
is 110-160 bpm.

23
Q

Fetal movements

A

– maximum of 40 minutes fetal observation in ultrasound. At least 3
separate distinct movements

24
Q

Fetal tone

A

– one of the fetal movements demonstrates full 90-degree flexion-extensionflexion cycle of the limb or opening and closing of the hand.

25
Q

Fetal breathing

A

maximum of 40 minutes fetal observation in ultrasound. At least one
episode of 30 seconds regular fetal breathing movements.

26
Q

AFV

A
  • at least 1 vertical measurement between 2 – 8 cm.
27
Q

Management in Normal labour

A
  1. When fetal risk is proven real by fetal surveillance methods mentioned above, there are only
    two intervention that are in value:\
  2. Elective delivery
    a. ≥34 weeks elected delivery is performed.
    b. <34 weeks if acute measures of health are abnormal then delivery is performed. If
    normal continuous monitoring to gain time.
  3. Maternal steroids
    a. In case of elective delivery is set in a high-risk pregnancy and the chronic fetal measures
    are abnormal then betamethasone is given.

OBGYN (45 decks)

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