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Summer Advanced Principles I > EXAM 1 > Flashcards

EXAM 1 Flashcards

1
Q

carrying a baby to term is defined as?

A

the period from 37 weeks to 42 weeks (optimal time for delivery)

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2
Q

What are the times associated with pre-term and post-term?

A

delivery before 37 weeks and then after 42 weeks.

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3
Q

The weeks associated with early term, full term, and late term?

A

Early term 37 to 38 weeks
Full term 39 to 40 weeks
Late term 41 to 42 weeks

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4
Q

Determinations of gestational age is most accurate when what is used and at what time periods?

A

ultrasonographic measurement of the fetus or embryo is performed in the first trimester (up to and including 14 weeks)

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5
Q

What most accurately determines gestational age?

A

Ultrasonography

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6
Q

What is the formula for finding gestational age using your period?

A

Reported date of last menstrual period (estimated due date can be calculated by subtracting 3 months and adding 7 days to the first day of the last normal menstrual period [Naegele’s rule])

first day last period - 3 months + seven days!

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7
Q

When does quickening usually occur?

A

at 18 to 20 weeks in nulliparous (no prev. children) women and at 16 to 18 weeks in parous women.

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8
Q

When can you detect FHR with a non electronic fetal stethoscope and a Doppler ultrasongraphy?

A

Non electric fetal stethoscope = 18-20 weeks.

Doppler ultra = 10-12 weeks.

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9
Q

Fundal height at 20 weeks?

A

20 cm above the pubic symphysis approx. (umbilicus)

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10
Q

Ultrasonography is recommended for all pregnancies given its ability to? (5 answers)

A

Accurately determine gestational age

Viability

Fetal number –how many babies there

Placental location –( proper location for a full term baby, or a location that may make mom hemorrhage.)

Screen for fetal structural abnormalities in the second trimester

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11
Q

what issues are associated with low maternal gestational weight gain?

A

increased risk for delivering a small-for-gestational age baby and/or having a preterm delivery

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12
Q

what issues are associated with excessive gestational weight gain?

A

Higher risk for delivering a large-for-gestational age baby and/or cesarean delivery

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13
Q

Recommended weight gain for normal weight, overweight, and obese women?

A

normal weight = 25-35lb
overweight = 15-25lb
obese = 11-20lb

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14
Q

The abdominal examination for evaluating fetal growth has many limitations, tell me what they are? (5 answers)

A

small fetus, maternal obesity, multiple pregnancy, uterine fibroids, or polyhydramnios

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15
Q

Even though abdominal examination for evaluating fetal growth has many limitations, what are the good things about it?

A

it is safe, is well tolerated, and may add valuable information to assist in antepartum (not long before birth) management.

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16
Q

Leopold maneuvers are designed to tell you what?

A

Each maneuver is is designed to

IDENTIFY SPECIFIC FETAL LANDMARKS or to reveal a specific relationship between the fetus and the mother.

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17
Q

1st maneuver - tell me about it?

A

measurement of fundal (uterus) height, uterus can be palpated above the pelvic brim at approximately 12 weeks’ gestation then should increase 1 cm per week, reaching the umbilicus at 20-22 weeks.

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18
Q

Fundal height between 20-32 weeks according to leopold maneuvers?

A

Fundal height between 20 and 32 weeks gestation (in cm) is approximately equal to the gestational age ( in weeks) in a healthy women of average weight with an appropriately growing fetus.

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19
Q

Maximal fundal height occurs when according to Leopold Maneuvers?

A

Maximal fundal height occurs at approximately 36 weeks’ gestation, after which time the fetus drops into the pelvis in preparation for labor.

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20
Q

What is the problem with relying on fundal height measurements alone?

A

Reliance on fundal height measurements alone fail to identify more than 50% of fetuses with fetal growth restriction.

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21
Q

What can be done to make fundal height measurements more accurate, especially in relation to fetal growth restrictions?

A

Serial measurements by by an experienced obstetric care provider are more accurate than a single measurement and will lead to better diagnosis of fetal growth restriction, with reported sensitivities as high as 86%

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22
Q

Fetal Growth Restriction is associated with a number of significant adverse perinatal outcomes? (5 answers)

A

Intrauterine Demise

Neonatal Morbidity

Neonatal Mortality

Cognitive Delay in Childhood

Chronic Diseases (Obesity, Type II Diabetes, CAD, Stroke in Adulthood

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23
Q

What is the definition for fetal growth restriction in comparison to small for gestational age?

A

The definition of fetal growth restriction is an estimated fetal weight less than the 10th percentile for gestational age; by contrast, the term small for gestational age (SGA) is reserved for newborns with a birth weight less than the 10th percentile for gestational age.

SGA means already born and in teh 10th percentile.

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24
Q

In general what causes fetal growth restrictions?

A

Fetal growth restriction results from suboptimal uteroplacental perfusion and fetal nutrition caused by different conditions that can be divided into: Maternal, Fetal, and Placental.

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25
Q

Fetal conditions that may result in growth restrictions include?

A

teratogen exposure, including certain medications

intrauterine infection

aneuploidy, (most often trisomy 13 and trisomy 18)

and some structural malformations (such as abdominal wall defects and congenital heart disease.)

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26
Q

Most significant outcome associated with fetal growth restriction?

A

Fetal growth restriction is associated with an increased risk for stillbirth.

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27
Q

If fetal growth restriction occurs as a result of these two conditions then the chances for stillbirth further increases?

A

oligohydramnios (deficient volume of amniotic fluid) or abnormal diastolic blood flow in the umbilical artery.

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28
Q

Early and accurate diagnosis of fetal growth restriction coupled with appropriate intervention leads to an improvement in perinatal outcome. If fetal growth restriction is suspected clinically and on the basis of ultrasonography, a thorough evaluation of the mother and fetus is indicated. Monitoring should include?

A

serial ultrasonographic examinations for growth and amniotic fluid volume
and antenatal surveillance with umbilical artery velocimetry and antepartum testing (nonstress tests or biophysical profiles).

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29
Q

Definition of fetal macrosomia?

A

growth beyond an absolute birth weight of 4000 g to 4500 g regardless of gestational age.

30
Q

How is fetal macrosomia different from large for gestational age (LGA)?

A

LGA implies a birth weight greater than or equal to the 90th percentile for a given gestational age.

31
Q

What birth weights are associated with risk for labor abnormalities, increased newborn and maternal morbidity, and perinatal mortality? (3 different weights)

A

labor abnormalities increases with birth weights between 4000 and 4499 g.

newborn and maternal morbidity increases significantly with birth weights between 4500 and 4999 g.

and perinatal mortality (e.g., stillbirth and neonatal mortality) increase with birth weights greater than 5000 g.

32
Q

What is the most serious consequence of fetal macrosomia?

A

Shoulder dystocia

defined as a failure of delivery of the fetal shoulder(s) after initial attempts at downward traction

33
Q

What fetal injuries associated with shoulder dystocia?

A

fracture of the clavicle and damage to the nerves of the brachial plexus, resulting in Erb-Duchenne paralysis.

(Compared with a prevalence of 0.2% to 3.0% for all vaginal deliveries.)

34
Q

the risk for shoulder dystocia at birth weights of 4500 grams or more is 9% to 14%, but increases further in the setting of what maternal disease?

A

maternal diabetes will increase the chances of shoulder dystocia at birth to 20% to 50%.

35
Q

Damage to the nerves of the brachial plexus, resulting in Erb-Duchenne paralysis, will typically resolve by when?

A

1 year of age

thus if a 2 year old is having shoulder issues it should be caused by something else

36
Q

Estimated fetal weight measurements are less accurate in macrosomic fetuses than in normally grown fetuses, what factors compound these inaccuracies?

A

low amniotic fluid volume,
advancing gestational age,
maternal obesity,
and fetal position

37
Q

What are some of the alternatives to ultrasound that have been proposed to better identify macrosomic fetus? (they all remain investigational)

A

fetal abdominal circumference alone

umbilical cord circumference

cheek-to-cheek diameter

and subcutaneous fat in the mid humerus, thigh, abdominal wall, and shoulder.

38
Q

EFW should be documented in all high risk women at approx. what week gestation (even though it could be inaccurate)
(key word above is high risk women)

A

38 weeks

39
Q

Why is suspected fetal macrosomia NOT an indication for induction of labor?

A

because induction does not improve maternal or fetal outcomes and may increase the risk for cesarean delivery.

40
Q

When is the performance of an elective C section recommended by the ACOG? (3 answers)

A

when the suspected birth weight exceeds 4500 g in a diabetic woman or 5000 g in a nondiabetic woman.

in laboring women when the suspected birth weight exceeds 4500 g in the setting of a prolonged second stage of labor or arrest of descent in the second stage.

41
Q

What is the heart disorder that needs to be excluded if the FHR is below 100bpm?

A

congenital complete heart block

42
Q

What is considered a FHR associated with an increased risk for pregnancy loss?

A

below 100 bmp

110-160 is normal
(MO- slides say 120 or above)

43
Q

The presence of fetal movements is strongly correlated with?

A

fetal health

44
Q

normal fetus exhibits an average of how many gross body movements per hour? when are movements less and more? (times of the day)

A

20-50 movements (range of 0-130) per hour.

fewer movements during the day and increased activity btwn 9pm and 1am

45
Q

Maternal factors that can make someone a high risk pregnancy?

A

Preeclampsia(gestational proteinuric hypertension)

Chronic Hypertension

Diabetes mellitus (including gestational diabetes)

Maternal cardiac disease

Chronic Renal Disease

Chronic pulmonary disease

Active thromboembolic disease

46
Q

Fetal factors that can create a high risk pregnancy?

A

Nonreassuring fetal testing (fetal compromise)

Fetal growth restriction

Isoimmunization (development of antibodies against the antigens of another individual of the same species)

Intra-amniotic infection

Known fetal structural anomaly

Prior unexplained stillbirth

Multiple pregnancy

47
Q

Uteroplacental factors that can make for a high risk pregnancy?

A

Premature rupture of fetal membranes

Unexplained oligohydramnios

Prior classic (high vertical hysterotomy) (hysterotomy is incision in the uterus)

Placenta previa

Placental abruption

Vasa previa

48
Q

What is placenta previa?

A

when a baby’s placenta partially or totally covers the mother’s cervix — the outlet for the uterus. Placenta previa can cause severe bleeding during pregnancy and delivery.

49
Q

What is Placenta abruption?

A

when the placenta partly or completely separates from the inner wall of the uterus before delivery. This can decrease or block the baby’s supply of oxygen and nutrients and cause heavy bleeding in the mother.

50
Q

What is Vasa previa?

A

condition in which fetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue.

51
Q

What is a Non Stress Test?

A

The fetal NST, also known as fetal cardiotocography, investigates changes in the FHR pattern with time and reflects the maturity of the fetal autonomic nervous system; for this reason, it is less useful in the very preterm fetus (< 28 weeks’ gestation). The NST is noninvasive, simple to perform, inexpensive, and readily available in all obstetric units. However, interpretation of the NST is largely subjective.

52
Q

Vibroacoustic Stimulation, what is it?

A

Stimulating the baby with vibroacoustic stimulus and watching for an increase in HR, an increase in HR is a good response.

(1-2 sec. for up to 3 sec.)

53
Q

Biophysical Profile, what is it?

A

Combines NST with ultrasound scoring system pereformed over 30 min. (NOT USED DURING ACTIVE LABOR)

54
Q

The five variables described by the original BPP were?

A

(1) gross fetal body movements, (2) fetal tone (i.e., flexion and extension of limbs), (3) amniotic fluid volume, (4) fetal breathing movements, and (5) the NST.

More recently, the BPP has been interpreted without the NST.

55
Q

Contraction Stress Test, What is it?

A

Also known as the oxytocin challenge test (OCT), the contraction stress test (CST) assesses the response of the FHR to uterine contractions induced by either intravenous oxytocin administration or nipple stimulation (which causes release of endogenous oxytocin from the maternal neurohypophysis). A minimum of three contractions for at least 40 seconds in a 10-minute period is required to interpret the test. A negative CST (no late or severe late decelerations with contractions) is reassuring and suggestive of a healthy, well-oxygenated fetus.

56
Q

What does a negative Contraction Stress Test mean?

A

A negative CST (no late or severe late decelerations with contractions) is reassuring and suggestive of a healthy, well-oxygenated fetus.

57
Q

Doppler Velocimetry, what is it?

A

Doppler velocimetry can be used for the noninvasive measurement of fetal circulation. The UA is frequently used bc it has diastolic flow.

58
Q

Factors that affect placental vascular resistance are?

A

gestational age, placental location, pregnancy complications, and underlying maternal dz.

59
Q

Women of advanced maternal age (> 35 years or older at EDD) are at higher risk for having a pregnancy complicated by what? and what kind of testing do they typically have done?

A

fetal aneuploidy and are routinely offered noninvasive prenatal screening and an invasive diagnostic procedure (either amniocentesis or chorionic villus sampling)
(down syndrome and others)

60
Q

What can amniocentesis tell you?

A

(amniocentesis) can be used to measure various substances such as lecithin and sphingomyelin for assessing fetal lung maturity, to look for pathogenic bacteria for confirmation of an intra-amniotic infection, and to obtain fetal cells for determination of fetal karyotype or performance of specific genetic analyses.

61
Q

Reasons for 2nd trimester amniocentesis?

A

Most Common: cytogenetic analysis of fetal cells.

On occasion: amniotic fluid AFP levels and acetylcholinesterase activity for the diagnosis of fetal open neural tube defects.

62
Q

Amniocentesis later in pregnancy is usually performed for what reasons? (nongenetic indications)

A

(1) documentation of fetal pulmonary maturity before elective delivery before 39 weeks’ gestation
(2) amnioreduction in pregnancies complicated by severe polyhydramnios
(3) to confirm preterm premature rupture of membranes (PROM) (amniodye test)
(4) to exclude intra-amniotic infection.

63
Q

Chorionic Villus Sampling issues? (3 things to know)

A

As with amniocentesis, the most serious complication of CVS is spontaneous abortion.

CVS appears to be associated with a higher risk for pregnancy loss than late amniocentesis

One complication unique to CVS involves the interpretation of the genetic test results.

64
Q

What is hydrops fetalis?

A

“edema of the fetus”

abnormal accumulation of fluid in more than one fetal extravascular compartment, including ascites, pericardial effusion, pleural effusion, subcutaneous edema, and/or placental edema.

65
Q

What has led to the decrease in incidence of immune hydrops?

A

the introduction of Rh0(D) immune globulin has led to a substantial decrease in the incidence of immune hydrops.

66
Q

Mortality rate in the setting of hydrops fetalis?

A

exceeds 50%, the prognosis depends on the underlying cause, severity, and gestational age.

67
Q

Intrauterine fetal demise is defined as?

A

), also known as stillbirth, is defined in the United States as demise of the fetus after 20 weeks’ gestation and before delivery

68
Q

Risk factors for stillbirth?

A 
extremes of maternal age
chromosomal disorders
congenital malformations
antenatal infection
multiple pregnancy 
prior unexplained IUFD
postterm pregnancy
fetal macrosomia
male fetus
umbilical cord and placental abnormalities
and underlying maternal medical conditions (e.g., chronic hypertension, pregestational or gestational diabetes mellitus, autoimmune disorders, inherited or acquired thrombophilia).
69
Q

Ideal case for fetal surgery would be?

A

a singleton pregnancy before fetal viability (i.e., before 23 to 24 weeks’ gestation) in which the fetus has a normal karyotype and an isolated malformation that, if untreated, will result in fetal or neonatal demise.

70
Q

What must take place before an in utero surgery can be recommended?

A

Thorough evaluation must be performed to

  1. precisely characterize the defect.
  2. exclude associated malformations.
  3. perform a fetal karyotype analysis
  4. eliminate the possibility that the condition can be treated using less aggressive technologies.
71
Q

What is something that will keep an in utero surgery from happening?

A

if it causes significant risk to mother.

72
Q

The mean duration of a singleton pregnancy?

A

280 days/40 weeks

Summer Advanced Principles I (5 decks)

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