FETAL ASSESMENT Flashcards
1
Q
Techniques employed today to forecast fetal wellbeing focus on fetal biophysical indings that include heart rate,
movement, breathing, and amnionic luid production. These
Findings aid __________ to prevent fetal death
and avoid unnecessary interventions.
A
antepartum fetal surveillance
2
Q
Indeed, ___________ -a true negative test-for
most of the tests described are 99.8 percent or higher.
A
negative-predictive values
3
Q
In
contrast, estimates of the ___________ -a true
positive test-for abnormal test results are low and range
between 10 and 40 percent.
A
positive-predictive values
4
Q
Passive unstimulated fetal activity commences as early as
_________ and becomes more sophisticated and coordinated by the end of pregnancy
A
7 weeks’ gestation
5
Q
Indeed, beyond __________, fetal body movements are
never absent for periods exceeding 13 minutes
A
8 menstrual weeks
6
Q
Between _____________, general body movements
become organized, and the fetus starts to show rest-activity
cycles
A
20 and 30 weeks’ gestation
7
Q
Fetal movement maturation continues
until approximately ________, when behavioral states are established in most normal fetuses
A
36 weeks
8
Q
_______ is a quiescent state-quiet sleep-with a narrow
oscillatory bandwidth of the fetal heart rate
A
State 1F
9
Q
_______ includes frequent gross body movements, continuous eye movements, and wider oscillation of the fetal heart rate.
A
State 2F
10
Q
This state is analogous to rapid eye movement (EM)
or active sleep in the neonate.
A
State 2F
11
Q
________ includes continuous eye movements in the absence
of body movements and no heart rate accelerations
A
State 3F
12
Q
_______ is one of vigorous body movement with continuous
eye movements and heart rate accelerations. his state corresponds to the awake state in newborn
A
State 4F
13
Q
Fetuses spend most of their time in ______ and _______.
A
states IF and 2F
14
Q
At _______, 75 percent of time is spent in these two
states (State 1F and 2F).
A
38 weeks
15
Q
These behavioral states-particularly IF and 2F, which correspond to _______ and ______ -have been used to develop
an increasingly sophisticated understanding of fetal behavior
A
quiet sleep and active sleep
16
Q
In a
study of fetal urine production, bladder volumes increased during
___________.
A
state IF quiet sleep
17
Q
During ______, the fetal heart rate
baseline bandwidth increased appreciably, and bladder volume
was significantly diminished due to decreased urine production
and infrequent fetal voiding.
A
State 2F
18
Q
An important determinant of fetal activity appears to be
__________, which are independent of maternal ones.
A
sleep-awake cycles
19
Q
Fetal sleep cyclicity varies from approximately _________ to
as much as _________
A
20 minutes
75 minutes
20
Q
In one study, the mean length of the
quiet or inactive state for term fetuses was _________.
A
23 minutes
21
Q
___________ is another
important determinant of fetal activity
A
Amnionic fluid volume
22
Q
Sadovsky and coworkers ( 1 979b) classified fetal movements into three categories according to both maternal perceptions and independent recordings using ________.
A
piezoelectric
sensors
23
Q
_____, _____ and ________ were described,
and their relative contributions to total weekly movements
throughout the last half of pregnancy were quantified.
A
Weak, strong, and rolling movements
24
Q
________ may be a harbinger of impending fetal
death
A
Diminished fetal activity
25
To quantfiy fetal movement, clinical
| methods include use of:
uterine contraction tocodynamometer
visualization with sonography
maternal subjective
perceptions.
26
Fetal motions lasting more than _________ were more likely to be identified than shorter episodes
20 seconds
27
Commonly, women may present in the ________ complaining of subjectively
reduced fetal movement
third trimester
28
_________ were employed if sonographic scans for
| fetal growth or Doppler velocimetry were abnormal.
Fetal heart
| rate monitoring tests
29
Another interesting feature of fetal respiration was _______________.
paradoxical chest wall movement
30
One interpretation of the paradoxical respiratory motion might be ________ to clear amnionic fluid debris.
coughing
31
During inspiration, the chest wall paradoxically ______ and the abdomen ______.
collapses
| protrudes
32
During expiration, the chest wall _______
expands
33
The first are gasps or sighs which occurred at a frequency of ____ per minute.
1 to 4
34
The second ___________, occurred at rates up to ______ cycles per minute.
Irregular bursts of breathing
| 240
35
These rapid respiratory movements
| were associated with rapid eye movement.
Irregular bursts of breathing
36
They suggested that
fetal respiratory rate declined in conjunction with increased
respiratory volume at _________ and coincidental with
lung maturation.
33 to 36 weeks
37
Many investigators have examined fetal breathing movements using _________ to determine whether chest wall movements might reflect fetal health.
sonography
38
Several variables in addition
to hypoxia were found to afect fetal respiratory movements.
These included: -during which it is normal
for respiration to cease.
```
hypoglycemia
sound stimuli
cigarette smoking
amniocentesis
impending preterm labor
gestational age
fetal heart rate
labor (normal for respiration to cease)
```
39
Because fetal breathing movements are ______, interpretation of fetal health when respirations are absent may be tenuous
episodic
40
Total
absence of breathing was observed in some of these normal fetuses
for up to ________, indicating that fetal evaluation to diagnose
absent respiratory motion may require long periods of observation
122 minutes
41
Most clinical
| applications have included assessment of other fetal biophysical indices, such as __________.
heart rate
42
Fetal breathing has become a component of the __________.
biophysical profile
43
Contractions
also may produce a pattern of variable decelerations as a result of cord compression, suggesting __________, which is often a
concomitant of placental insufficiency.
oligohydramnios
44
Ray and colleagues ( 1972) used this concept in 66 complicated pregnancies and developed the oxytocin challenge test, which
was later called the ___________.
contraction stress test
45
_________ is
| used to stimulate contractions
Intravenous oxytocin
46
The criterion for a positive test result that is an abnormal result is ____________.
uniform repetitive late fetal heart rate decelarations
47
A major disadvantage is that the average contraction
| stress test requires _________ to complete.
90 minutes
48
If at least _____ spontaneous contractions of _________ are
| present in ________, no uterine stimulation is necessary.
three
40 seconds or longer
10 minutes
49
Contractions are induced with either _________ or ________
| if there are fewer than three in 10 minutes.
oxytocin or nipple stimulation
50
For oxytocin use, a
dilute intravenous infusion is initiated at a rate of _______ and
doubled every _________ until a satisfactory contraction pattern is
established
0.5 mU/min
20 minutes
51
____________ to induce uterine contractions is usually successful for contraction stress testing.
Nipple stimulation
52
This
__________ ideally will induce a pattern of
three contractions per 10 minutes
2-minute nipple stimulation
53
If not, after a ________
interval, she is instructed to retry nipple stimulation to achieve
the desired pattern. I
5-minute
54
Freeman (1975) and Lee and colleagues (1975) introduced the
_________ to describe fetal heart rate acceleration in response to
fetal movement as a sign of fetal health.
nonstress test
55
This test involved the use
of Doppler-detected fetal heart rate acceleration coincident with
fetal movements perceived by the mother.
nonstress test
56
no late or significant variable decelerations
Negative
57
late decelerations following 50% or more of contractions (even if the contraction frequency is fewer than three in
10 minutes)
Positive
58
Intermittent late decelerations or significant variable decelerations
Equivocal-suspicious
59
fetal heart rate decelerations that occur in the presence of contractions more frequent than
every 2 minutes or lasting longer than 90 seconds
Equivocal-hyperstimulatory
60
fewer than three contractions in 10 minutes or an uninterpretable tracing
Unsatisfactory
61
he nonstress test was easier to perform, and normal results
| were used to further discriminate __________.
false-positive contraction stress
| tests
62
the nonstress test is primarily a test of ________ and it differs from the contraction stress test, which is
considered a test of _________
fetal condition
uteroplacental function
63
Currently, ________ is the most widely used primary testing method for assessment of fetal well-being.
nonstress testing
64
__________ is also under the control of the autonomic nervous system.
Beat-to-beat variability
65
Consequently, pathological loss of fetal heart rate acceleration
may be seen in conjunction with significantly ______ beat-to-beat variability
decreased
66
Loss of such reactivity,
however, is most commonly associated with ________. It also
may be caused by __________ from medications or __________.
sleep cycles
central depression
cigarette smoking
67
The nonstress test is based on the hypothesis that the heart
rate of a fetus that is not acidemic as a result of hypoxia or
neurological depression will temporarily accelerate in response
to _________.
fetal movement
68
Fetal movements during testing are identified by ___________ and recorded.
Maternal perception
69
As ________ develops,
| these fetal heart rate accelerations diminish
hypoxia
70
_________ influences acceleration or reactivity of the fetal heart rate.
Gestational age
71
In fetuses at or beyond _____ weeks' gestation, the acceleration acme is ____ bpm or more
above the baseline rate, and the acceleration lasts _________ or longer but less than __________.
32
15
15 seconds
2 minutes
72
```
Before 32 weeks,
normal accelerations are defined as
having an acme that is ____ bpm or
more above baseline for _______
or longer.
```
10
10 seconds
73
Criteria to define normal nonstress test results differ. They vary regarding the _______, ________, __________, _________.
number
amplitude
duration of accelerations
test duration
74
The definition recommended
by the American College of Obstetricians and Gynecologists
(20 1 6) requires two or more accelerations peaking at _____ bpm
or more above baseline, each lasting ____ seconds or more, and all
occurring within _______ of beginning the test
15
15
20 minutes
75
It is also recommended that accelerations with or without fetal
movements be accepted, and that a ________ or longer tracing-to account for fetal sleep cycles-should be performed
before concluding that fetal reactivity is insufficient
40-minute
76
```
Because healthy fetuses
may not move for periods of up to 75
minutes, some have considered that a
longer duration of nonstress testing might
increase the _________ of
an abnormal, that is, nonreactive, test
```
positive-predictive value
77
In this scheme, either the test became ______ during a period up
to 80 minutes or the test remained ________ for 1 20 minutes, which indicated
that the fetus was very ill.
reactive
nonreactive
78
An ____________ is not always ominous and
| can be seen with a sleeping fetus.
abnormal nonstress test
79
Importantly, a normal nonstress test can become
| abnormal if the fetal condition _________.
deteriorates
80
Devoe and coworkers (1985) concluded
that nonstress tests that were nonreactive for _______ were
almost invariably - 93 percent-associated with significant perinatal pathology.
90 minutes
81
This pattern consisted of a fetal heart
rate baseline that oscillated less than 5 bpm and presumably
indicated absent acceleration and beat-to-beat variability.
silent oscillatoy pattern
82
Visser and associates ( 1 980) described a terminal cardiotocogram which included:
(1) baseline oscillation of less than 5 bpm
(2) absent accelerations
(3) late decelerations with spontaneous uterine contractions
83
Fetal-growth restriction
75%
84
Oligohydramnios
80%
85
Fetal acidemia
40%
86
Meconium
30%
87
Placental infarction
93%
88
Set originally rather arbitrarily at ______, the interval between
tests appears to have been shortened as experience evolved
with nonstress testing.
7 days
89
According to the American College of
Obstetricians and Gynecologists (20 1 6), more frequent testing
is advocated by some investigators for women with:
```
postterm pregnancy
multifetal gestation
pregestational diabetes
fetal-growth restriction
or
pregnancy hypertension
```
90
_________ commonly produce heart rate decelerations
Fetal movements
91
Variable decelarations if NONREPETITIVE AND BRIEF - less than _________ - do not indicate fetal compromise or the need for obstetrical intervention.
30 seconds
92
REPETITIVE variable decelerations - at least ______ in ________ - even if mild, have been associated with a greater risk of cesarean delivery.
3
20 minutes
93
Decelerations lasting ________ or longer have been reported to have an even worse prognosis.
1 minute
94
Severe variable decelerations during a nonstress test plus an amniotic fluid index (AFI) _______ resulted in a 75% cesarean delivery.
>5 cm
95
Smith and associates (1987) performed a detailed analysis of the causes of fetal death within 7 days of normal nonstress tests. The most common indication for testing was _________.
postterm pregnancy
96
The mean interval between testing and death was _____ with a range of 1 to 7 days.
4 days
97
The single most common autopsy finding was ____________, often associated with some type of umbilical cord abnormality.
Meconium aspiration
98
They concluded that an ___________ had provoked fetal gasping.
Acute asphyxial insult
99
Other ascribed frequent causes of fetal death included:
1. intrauterine infection
2. abnormal cord position
3. malformations
4. placental abruption
100
Loud external sounds have been used to startle the fetus and thereby provoke heart rate acceleration - an ______________.
acoustic stimulation nonstress test
101
A commercially available acoustic stimulator is positioned on the maternal abdomen, and a stimulus of __________ is applied. This may be repeated up to ____ times for up to ____ seconds.
1 to 2 seconds
3
3
102
A ________ response is defined as the RAPID appearance of a qualifying acceleration following stimulation.
Positive
103
In a randomized trial of 113 women undergoing nonstress testing, __________ shortened the average time of testing from _______ minutes.
Vibroacoustic stimulation
| 24 to 15 minutes
104
Laventhal and colleagues (2003) reported that _______ could be provoked with vibroacoustic stimulation.
fetal tachyarrhythmia
105
Manning and colleagues (1980) proposed the combined use of five fetal biophysical variables as a more accurate means of assessing fetal health than a single element. Typically, these tests require __________ of examiner time.
30 to 60 minutes
106
The five fetal biophysical components assessed:
(1) heart rate acceleration
(2) breathing
(3) movements
(4) tone
(5) amnionic fluid volume.
107
NORMAL variables were assigned a score of ____ each and ABNORMAL variables were given a score of ____.
2
| 0
108
Thus, the highest score possible for a normal fetus is _____.
10
109
Maternal medications such as _____ and ______ can significantly lower the score.
Narcotics
| Sedatives
110
Ozkaya and associates (20 1 2) found that biophysical test scores were higher if a test was performed in ___________ - 20:00 to 22:00 hours - compared with 08:00 to 1 0:00 hours.
late evening
111
Score 2 Nonstress test
>2 accelerations of > 15 beats/m in for >15 sec with in 20-40 min
112
Score 0 Nonstress test
o or 1 acceleration with in 20-40 min
113
Score 2 Fetal breathing
>1 episode of rhythmic breathing lasting >30 sec with in 30 min
114
Score 0 Fetal breathing
<30 sec of breathing with in 30 min
115
Score 2 Fetal movement
>3 discrete body or limb movements with in 30 min
116
Score 0 Fetal movement
<3 discrete movements
117
Score 2 Fetal tone
>1 episode of extremity extension and subsequent return to flexion
118
Score 0 Fetal tone
0 extension/flexion events
119
Score 2 Amniotic fluid volume
A pocket of amnionic fluid that measures at least 2 cm in two planes perpendicu ar to each other (2 x 2 cm pocket)
120
Score 0 Amniotic fluid
Largest single vertical pocket <2 cm
121
Further evaluation warranted, regardless of biophysical composite score, if largest vertical amnionic fluid pocket _____.
< 2 cm
122
Defined by an antepartum death of a structurally normal fetus of approximately 1 per 1000.
False - normal test rate
123
The most common identifiable causes of fetal death after
| a normal biophysical profile include:
fetomaternal hemorrhage
umbilical cord accidents
and placental abruption
124
A biophysical score of 0 was almost invariably associated with significant _______.
fetal acidemia
125
A normal score of 8 or 10 was associated with _______.
Normal pH
126
An equivocal test result - a score of ____ - was a poor predictor of abnormal outcome.
6
127
As the abnormal score dropped from 2
| or 4 down to 0, this decline was a more accurate predictor of ______.
Abnormal fetal outcome
128
Biophysical profile score 10 interpretation
Normal, nonasphyxiated fetus
129
Biophysical profile score 10 recommended management
No fetal indication for intervention; repeat test weekly except in diabetic patients and postterm pregnancy
(twice weekly)
130
8/10 (Normal AFV) interpretation
Normal, nonasphyxiated fetus
131
8/8
(NST not done)
132
8/10 (decreased AFV) interpretation
Chronic fetal asphyxia suspected
133
8/10 (decreased AFV) recommended management
Deliver
134
6 interpretation
Possible fetal asphyxia
135
6 recommended management
If amnionic fluid volume abnormal, deliver
If normal fluid at > 36 weeks with favorable cervix, deliver
If repeat test <6, deliver
If repeat test >6, observe and repeat per protocol
136
4 interpretation
Probable fetal asphyxia
137
4 recommended management
Repeat testing same day; if biophysical profile score <6, deliver
138
0 to 2 interpretation
Almost certain fetal asphyxia
139
0 to 2 recommended management
Deliver
140
This abbreviated biophysical profile required approximately ________ to perform, and they
concluded that it was a superb antepartum surveillance method
because there were no unexpected fetal deaths
10 minutes
141
The American College of Obstetricians and Gynecologists
(2016) has concluded that the ___________
is as predictive of fetal well-being as other approaches to biophysical fetal surveillance
modified biophysical profile test
142
The importance of _________ is indicated by its inclusion into virtually all schemes in which fetal health is assessed
amnionic fluid volume estimation
143
_________ measured by Doppler ultrasound reflects
| downstream impedance
Blood flow velocity
144
For growth restricted fetuses, several fetal vascular circuits including the
_________, ________ and __________
have been evaluated as diagnostic tools for fetal well-being.
umbilical artery
middle cerebral artery
ductus venosus
145
____________ has also been assessed as a modality to predict placental
dysfunction, with the goal to balance stillbirth against the
risks of preterm delivery
Maternal uterine artery Doppler velocimetry
146
The rationale is that ______
would improve placental blood low in the presence of placental insufficiency. This proved untrue, as ______ was associated
with detrimental efects on fetal cardiovascular dynamics.
sildenafil
147
Waveforms were first studied in the umbilical arteries late in pregnancy, and abnormal waveforms correlated with _____________.
placental villous
| hypovascularity
148
According to
Trudinger (2007), because more than 40 percent of the combined
fetal ventricular output is directed to the placenta, obliteration of
placental vascular channel increases afterload and leads to fetal
hypoxemia. This in turn leads to ventricular dilation and redistribution of ___________ blood low
middle cerebral artery
149
Ultimately, pressure
rises in the ductus venosus due to afterload in the ______ side of the
fetal heart.
right
150
Clinically, abnormal Doppler wave forms in the ductus venosus are a late finding in the progression
of fetal deterioration due to ____________.
chronic hypoxemia
151
The umbilical artery systolic-diastolic (SID) ratio is considered abnormal if it is _________ for gestational age or
if diastolic flow is either absent or reversed
>95th percentile
152
Absent or reversed end- _________ signifies greater impedance to umbilical artery blood flow
diastolic flow
153
_________ has not proved valuable as a
screening test for fetal compromise in the general obstetrical
population.
velocimetry
154
Various other fetal-maternal Doppler indices have been
| studied, including the :
fetal middle cerebral artery
ductus venosus
the uterine arteries
155
Still, the technology has received particular attention because of observations that the hypoxic fetus
attempts ________ by reducing cerebrovascular impedance
and thus increasing blood flow.
brain sparing
156
Middle cerebral artery Doppler velocimetry has proven valuable to detect severe ________ in 165 fetuses with D-antigen
alloimmunization.
fetal anemia
157
These investigators concluded that ______ could
safely replace amniocentesis in the management of alloimmunized
pregnancies.
Doppler
158
They concluded that _________ was the best predictor of perinatal outcome.
ductus venosus velocimetry
159
Also, _________ at delivery was a major determinant of perinatal outcome independent of ductus venosus flow.
gestational age
160
Specifically, absent or reversed flow in the ductus venosus
| was associated with profound generalized ____________.
fetal metabolic collapse
161
They too reported that gestational age was a powerful
cofactor in ultimate perinatal outcome for growth-restricted
fetuses delivered before ______.
30 weeks
162
Vascular resistance in the uterine circulation normally decreases
in the first half of pregnancy due to invasion of maternal uterine vessels by ___________.
trophoblastic tissue
163
This process
can be detected using Doppler flow velocimetry, and ______________ may be most helpful in assessing pregnancies at high risk of utero placental insufficiency
uterine artery Doppler
164
The risk of fetal death before 32 weeks when associated with: was significantly linked to high-resistance flow.
abruption, preeclampsia, or fetal-growth
| restriction
165
This has led to suggestions for continued research of ____________ as a screening tool to detect pregnancies
at risk for stillbirth.
uterine artery
| Doppler velocimetry
166
a _________________ is highly reassuring that a stillbirth will not occur within 1 week
normal antepartum fetal test result
167
The most important
consideration in deciding when to begin antepartum testing is
the prognosis for __________.
neonatal survival
168
The severity of maternal disease is another. In general, with
most high-risk pregnancies, testing begins by _______ weeks'
gestation
32 to 34
169
Pregnancies with severe complications might require
| testing as early as _________ weeks.
26 to 28
170
he frequency for repeating
tests has been arbitrarily set at ______ but more frequent testing
is often done.
7 days,
