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Gynecology > BPP > Flashcards

BPP Flashcards

1
Q

What are the 4 fetal biophyscial activities that can be identified on US?

A
  1. Gross body movements
  2. Breathing
  3. Fetal tone
  4. Amniotic fluid
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2
Q

What additional assessments are included in the BPP? (5)

A 
Biometry
Flow in umbilical vessels
Amniotic fluid volume or AFI
Placenta grade and position
Cord postion
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3
Q

What are the 2 main factors affecting BPP?

A
  1. Asphyxia (lack of oxygen)

2. Drugs

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4
Q

What is assessed in asphyxia?

A

Extent, duration and freq of insult

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5
Q

What sort of drugs can affect the BPD? (3)

A
  1. Sedatives (barbituates-opium)
  2. Analgesics (morphine)
  3. Anesthetics (halothane)
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6
Q

Which fetal activity develops first?

A

Fetal tone center

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7
Q

Which activity centre is the last affected by worsening asphyxia?

A

Fetal tone center

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8
Q

At what week does the heart rate reactivity develop?

A

28 weeks

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9
Q

Which activity centre is the first to be affect by asphyxia?

A

Heart rate reactivity

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10
Q

What should be seen within 30min of performing a BPP?

A
  1. Gross fetal development
  2. Fetal breathing
  3. Fetal tone (lips move, flexing, grabbing)
  4. Amniotic fluid pocket
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11
Q

Is a non stress test preformed by US?

A

No

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12
Q

What is the BPP used to assess?

A

Fetal hypoxia

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13
Q

For each criteria of the BPP the fetus is given a score, what is it?

A

2 for doing the required exercise

0 is not adequately preformed

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14
Q

What is the potential score for the BPP?

A

8

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15
Q

What is the potential score for the non stress test?

A

10

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16
Q

How many movements are required to be seen in 30min (For fetal movement)

A

3 or more

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17
Q

What is the score of the gross fetal movement when if there are 2 or less movements in 30min?

A

0

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18
Q

What is considered a gross body movement?

A

Head or trunk movement

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19
Q

How many seconds are required to get 2 points on fetal breathing movements?

A

30 seconds

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20
Q

Is the fetus allowed to take a breathing break within the 30 seconds? How long?

A

Yes and for 6 seconds

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21
Q

Do hiccups count in fetal breathing?

A

Yes

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22
Q

Is the score of zero a reliable indicator of poor fetal wellness?

A

No, the fetus may have long episodes of apnea and still be normal

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23
Q

Which is the most common element we do not see the fetus preform?

A

Fetal breathing movements

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24
Q

How many movements of fetal tone must be demonstrated to get a score of 2?

A

One episode of flexion and extension

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25
Q

What are examples of flexion and extension?

A

Arm, leg, toe movement or yawn

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26
Q

What is the required size of pocket of fluid seen when assessing the amniotic fluid?

A

> or equal to 2X2 cm

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27
Q

Do you include the spinal cord within in the measurement when assessing the amniotic fluid?

A

No

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28
Q

What is the amniotic fluid volume/index (AFI) used to assess?

A

Amount of fluid in the uterus

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29
Q

When is the AFI examined?

A

During the BPP assessment

30
Q

Does the AFI affect the BPP score?

A

No

31
Q

What does the AFI help assess?

A

Placental function

32
Q

Why would we want to know placenta function?

A

It is affected by maternal factors which can affect the amniotic fluid levels

33
Q

How is the AFI calculated?

A

The sum of all 4 quadrants

34
Q

What is it called when the AFI is < 5cm?

A

Oligohydramnios

35
Q

What is it called when the AFI is > 20-25cm

A

Polyhydramnios

36
Q

Where do you place the calibers when measuring the quadrants?

A

Vertical depth- measure top to bottom (to the floor)

37
Q

When do patients have to go for a NST?

A

When the fetus score is < 8

38
Q

When is the score of 6/8 concerning?

A

When theres an absent of amniotic fluid

If due date past delivery is recommended
If preterm bedrest is recommended

39
Q

What is a NST?

A

A tracing of the fetal heart via electrodes placed on maternal abdomen over the area of the fetal heart

40
Q

Where is the NST preformed?

A

Fetal assessment units or labour and delivery units

41
Q

Who preforms the NST?

A

Obstetrician or fetal assessment nurse

42
Q

What is a indication of good fetal health on the NST?

A

Increased HR with fetal motion, with a quick return to base

43
Q

What are signs of fetal distress in the NST? (3)

A
  1. Slow response of heart to return to normal
  2. No change in HR with activity
  3. HR decelerations
44
Q

What is assessed in the NST?

A
  • 2 episodes of acceleration of > 15b/m
  • 15sec duration associated with fetal movement
  • All in a 30min period
45
Q

What can cause the BPP score to be 4/10 or 6/10?

A

High risk pregnancies
maternal factors or dx must be considered (HBP & type 1 diabetes

Case per case conditions

46
Q

When do you repeat the scan when the BPP score is 4/10 or 6/10

A

Repeat scan in 24hrs

47
Q

When is the BPP scan done?

A

28weeks

48
Q

What are the factors that might affect amniotic fluid? (2)

A
  1. Premature rupture of membranes

2. Placenta insufficiency

49
Q

Why is premature rupture of the membranes concerning?

A

Concerning for infections of the fetus

50
Q

Why is insufficiency of placental function concerning?

A

Concerning for poor fetal growth and poor outcome

51
Q

US alone 8/8 includes…

A

Breathing, movement, tone and amniotic fluid > 2cm

52
Q

Is an 8/10 NST reactive?

A

Yes

53
Q

Is an 6/10 NST reactive?

A

Non, non-reactive

54
Q

When is fetal doppler preformed?

A

During the BPP scan

55
Q

What does fetal doppler used to assess?

A

Fetoplacental circulation

56
Q

What can fetal doppler detect? (3)

A
  1. IURG
  2. Twin to twin transfusion
  3. Maternal hypertension
57
Q

What is the most common vessel to doppler?

A

Umbilical artery

58
Q

Refer to pg 26 and 27 regarding doppler flow waveforms…

A

Refer to pg 26 and 27

59
Q

What does low or absent diastolic doppler flow indicate?

A

Difficultly for fetus to return blood to placenta or a high resistance bed

60
Q

What does a reversed diastolic doppler flow indicate?

A

Delivery is necessary depending on fetal age

Fetal demise within 24hrs if you see this waveform

61
Q

What are factors that affect doppler waveform? (3)

A
  1. Respirations
  2. HR
  3. Blood viscosity (hematocrit)
62
Q

What happens to the umbilical blood flow as the pregnancy advances?

A

The vessel becomes larger and less resistive

63
Q

What value is used in reporting fetal doppler values?

A

PI or pulsatility index

64
Q

Why should the placenta be assessed?

A

For abruption and grade

65
Q

What is a grade 3 placenta associated with?

A

Abnormal fetal heart rates and increased risk of abruption

66
Q

How should a normal placenta appear?

A

Should look like the liver

67
Q

What is the Apgar scoring?

A

A score given to the baby when born

68
Q

When are the best biophysical scores taken?

A

After the mother has eaten

69
Q

Explain the timing of the BPP

A
  • Observe the time you started
  • Assess fetal lie first
  • Second check for fetal HR
  • Third observe fetal breathing (if baby doesn’t breath right away cont. with exam)
70
Q

What are the measurements taken at fetal assessment? (4)

A
  1. BPD
  2. HC
  3. AC X 3
  4. FL
71
Q

What are other views taken besides the BPP views?

A
  • M-mode of the heart
  • Bladder/kidneys
  • Placenta
  • Assessment for any abnormalities previously documented (fetus with dilated kidneys or distended bowel)

Gynecology (4 decks)

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