Exam 3

Question 1

what is a midwife?

Answer 1

• Certified Nurse Midwife (CNM)
• Certified Professional Midwife (CPM)
• Other midwives (non-certified)

Question 2

what is a physician?

Answer 2

• Family Practitioner
• Obstetrician/Gynecologist (OB/GYN)
• Perinatologist, Maternal-Fetal Medicine Doctor

Question 3

Why are Midwives important?

Answer 3

• Decrease deaths in pregnant person and babies
  during delivery
• Lowers rate of c-sections, epidurals, instrument
  assisted births
• Improves satisfaction and maternal psychosocial
  well-being
• Provide support

Question 4

what are the Types of Fetal Assessment?

Answer 4

• Fetal Kick Counts
• Non-Stress Test
• BioPhysical Profile
• Contraction Stress Test

Question 5

Why is Fetal Assessment Done?

Answer 5

To assess fetal well-being if
pregnancy complications or
health risks

Question 6

What is Assessed?

Answer 6

• Fetal heart rate (110-160 bpm)
• Fetal movement reflects adequate fetal oxygenation. Decreased activity may indicate inadequate oxygenation.
• Uterine activity aka contractions: not always included, depends on type and purpose of test.)

Question 7

what is a Fetoscope?

Answer 7

horn or stethoscope-like instrument

Question 8

what is a Fetal Doppler?

Answer 8

small, high frequency sound waves are reflected off fetal heart to calculate rate

Question 9

what is a Normal fetal heart rate?

Answer 9

(FHR) = 110-160

Question 10

Fetal Kick Counts?

Answer 10

• Assess fetal well-being (after 28 weeks)
• 10 fetal movements “kicks” in < 2 hours
• Decreased fetal movement = decreased oxygenation

Question 11

how is fetal kick counts done?

Answer 11

• Pregnant person rests on left side, stays aware
• Same time each day and after activity/exercise
• Begin time with first fetal movement.
• Stop when 10 movements are felt.
• Safe, easy, cheap (free!)

Question 12

how to tell if adequate or decreased?

Answer 12

if adequate fetal movement
(10 kicks in < 2 hrs):
* Reassuring for fetal well being.
* Next step: No additional tests needed.
* Continue Daily Fetal Kick Counts.
If decreased/absent fetal movement:
* May indicate decreased oxygenation
and compromised fetus.
* Next step: Non-Stress Test (NST)

Question 13

NST: Non-Stress Test?

Answer 13

Most common fetal assessment
* Measures fetal heart rate in response to
fetal movement
* Usually performed after 32 weeks gestation

Question 14

Reasons for NST?

Answer 14

Failed Fetal Kick Counts
* Pregnancy complications or risks
* Intrauterine Growth Restriction (IUGR)
* Post-dates (overdue)
* Trauma
* Others…

Question 15

NST HOW?

Answer 15

EFM x 20-30 minutes to assess:
* Fetal Heart Rate (FHR)
* fetal movement
* uterine activity (if applicable)

Question 16

NST Results?

Answer 16

Reactive NST (GOOD!)
* 2 or more FHR accelerations in 20 minutes
* Rate increase by 15 beats for 15 seconds
* Related to fetal movement
* Non-reactive NST
* Monitoring for two 20-minute periods
* Neither period yields adequate accelerations
* Interventions to increase fetal activity fail

Question 17

Inaccurate NST results?

Answer 17

fetal immaturity (less than 32 weeks)
* fetal sleep (20-75min wake/sleep cycles)
* maternal sedation (drugs may pass to fetus)

Question 18

What happens next?

Answer 18

Reactive NST
* Adequate FHR accelerations above baseline.
* Reassuring for fetal well being.
* Next step: no additional assessment needed.
* May continue Daily Fetal Kick Counts.
* Non-Reactive NST
* Inadequate or absent FHR accelerations.
* Next step: BioPhysical Profile.
* * may also do CST afterward.