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OB+GYN > Fetal Assessment > Flashcards

Fetal Assessment Flashcards

1
Q

2 components of Antepartum fetal assessment

A

1) Maternal perception of fetal movement
2) Electronic Fetal HR monitoring (EFM) - CTG, NST, CST

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2
Q

Adequate Fetal kick count measurement after 28 weeks:

A

5 movements in 1 hour, 10 movements in 2 hours

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3
Q

Normal FHR

A

110-160 bpm

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4
Q

Causes of Fetal bradycardia (<110 bpm)

A
  • Fetal congenital heart block/arrhythmias
  • Fetal hypoxia
  • Cord prolapse
  • Epidural/spinal anesthesia
  • Decrease in uterine blood flow (due to maternal HPN)
  • Maternal hypothermia
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5
Q

Causes of Fetal tachycardia

A
  • Maternal/fetal infection (most common)
  • Chorioamnionitis
  • 2nd stage of labor (activation)
  • Maternal hyperthyroidism
  • Drugs (betamimetics, methamphetamine, cocaine, tocolytic drugs, Parasympathetic drigs)
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6
Q

Single most important determinant of hypoxia or fetal acid base status

A

Variability

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7
Q

FHR Variability is a reflection of fetal _________ function

A

Autonomic system

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8
Q

Possible causes of decreased variability

A
  • Hypoxia
  • fetal sleep cycle (improves with VAS)
  • Metabolic acidosis/acidemia (does not improve with VAS)
  • congenital anomalies
  • prematurity
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9
Q

Value of Normal variability (moderate variability)

A

5-25 bpm Variability

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10
Q

Value of Minimal variability

A

< 5 bpm Variability

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11
Q

Value of Marked variability

A

> 25 Variability

(consider acidemia)

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12
Q

Value of Absent variability

A

Undetectable variability

(consider cerebral hypoxia)

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13
Q

Definition of Fetal HR Acceleration (for < 32 weeks, and for > 32 weeks)

A

< 32 weeks:
Peak of ≥ 10 bpm above baseline for ≥10s but < 2 min

> 32 weeks
Peak of ≥ 15 bpm above baseline for ≥ 15s but < 2 min

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14
Q

Definition of Fetal HR Deceleration

A

Temporary decrease in FHR baseline < 110 for < 2 min.

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15
Q

Type of Fetal HR Deceleration:

Symmetrical gradual decrease and return of FHR to baseline associated with uterine contraction; WHEREIN the nadir of deceleration occurs after the peak of contraction

A

Late deceleration

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16
Q

Type of Fetal HR Deceleration:

Symmetrical gradual decrease and return of FHR to baseline associated with uterine contraction; WHEREIN the nadir of deceleration occurs at the same time as the peak of contraction

A

Early deceleration

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17
Q

Type of Fetal HR Deceleration:

Abrupt decrease in FHR ≥ 15 from baseline lasting ≥ 15s until < 2 min beginning at onset of uterine contraction; has a V or W shape

A

Variable deceleration

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18
Q

Type of Fetal HR Deceleration:

FHR deceleration ≥ 15 bpm from baseline lasting > 2 min

A

Prolonged deceleration

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19
Q

Usual cause of early decelerations

A

Fetal head compression (Common in Stage 2 of labor - dilatation to fetal delivery)

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20
Q

Usual cause/s of late deceleration

A

Uteroplacental insufficiency
- maternal hypotension
- placental dysfunction

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21
Q

Usual cause/s of variable deceleration

A
  • Umbilical cord compression
  • Oligohydramnios
  • Placental insufficiency
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22
Q

Pathophysiology behind shouldering of V Waves in Variable deceleration

A

Uterine contraction > Umbilical vein compresses first > Slight increase in FHR > Umbilical artery compresses > Decrease in FHR > Umbilical artery decompresses first > Increase in FHR > Umbilical vein decompresses next > Normalization of HR to baseline

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23
Q

In a Non Stress test, FHR reactivity is measured by detecting ___________ in response to ____________

A

Fetal HR ; Fetal movement

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24
Q

Finding of a “Reactive NST”

A

≥ 2 accelerations in 20 minutes

*Acceleration: ≥15 increase in bpm above baseline for ≥ 15s but < 2 min

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25
Q

What is done after a Non-reactive NST to rule out fetal sleep cycles

A

Vibroacoustic stimulation.

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26
Q

Finding in a Non-reactive NST

A

< 2 accelerations in 40 mins

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27
Q

A Contraction stress test is a measure of uteroplacental insufficiency by detecting ____________ in response to ____________

A

Fetal HR decelerations; Uterine contractions

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28
Q

Finding of a Negative CST

A

No late or significant variable decelerations in an adequate strip (≤ 3 contractions in 10 min)

[NORMAL]

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29
Q

Finding of a Positive CST

A

Late decelerations following > 50% contractions (regardless of adequacy)

  • indicates uteroplacental insufficiency
30
Q

Finding of Equivocal-suspicious CST

A

Intermittent late or significant variable decelerations in < 50% of contractions

31
Q

Finding of an Equivocal-hyperstimulatory CST

A

Decelerations in the presence of contractions every 2 min or lasting > 90s

32
Q

Unsatisfactory

A

< 3 contractions in 10 min

33
Q

Normal amount of uterine contractions

A

≤ 5 contractions in 10 minutes, averaged over 30 min

34
Q

Finding of Tachysystole

A

> 5 contractions in 10 minutes

35
Q

Values for mild, moderate, and strong contractions (mmHg)

A

Mild: < 40 mmHg
Mod: 40-70 mmHg
Strong: > 70 mmHg

36
Q

Equation for Computing Montevideo units (to determine adequacy of uterine contractions)

A

Sum of uterine contraction amplitudes (above 20mmHg) within a 10 minute window

37
Q

What other conditions are required for CS to be indicated in the setting of prolonged labor

A
  • Adequate MVu
  • ROM
  • AOCD
  • AOFD
38
Q

Value for Normal Montevideo units (Adequate uterine contractions)

A

MVu ≥ 200mvu

39
Q

What is the course of action for inadequate uterine contractions (MVu < 200u)

A

Give Oxytocin

40
Q

CTG pattern seen in cases of fetal hypoxia from severe fetal anemia

A

Sinusoidal pattern (saw-tooth)

41
Q

Other causes of Sinusoidal “saw-tooth” CTG pattern

A
  • Severe fetal anemia
  • fetal-maternal hemorrhage
  • Twin-to-twin transfusion syndrome
  • Rh alloimmunization
  • Infection
  • Cardiac malformation
  • Hydrocephalus
  • Gastroschisis
42
Q

Immediate management of Late decelerations

A
  • Left lateral decubitus (to relieve aortocaval compression
  • Administer O2 via face mask
  • Discontinue oxytocin
  • Correct maternal hypotension
43
Q

Immediate management of Variable decelerations decelerations

A
  • Change to position of improved FHR pattern
  • Administer O2 via face mask
  • Discontinue oxytocin
  • IE to check for cord prolapse or imminent delivery
  • Consider amnioinfusion
44
Q

FIGO consensus on intrapartum fetal monitoring:

Pathologic Variability values

A

> Decreased variability for > 50 min
Increased variability for > 30 min
Sinusoidal pattern for > 30 min

45
Q

FIGO consensus on intrapartum fetal monitoring:

Pathologic Baseline values

A

FHR < 100bpm

46
Q

FIGO consensus on intrapartum fetal monitoring:

Pathologic deceleration findings

A

> Repetitive late or prolonged decelerations in 30 mins

> Repetitive late or prolonged decelerations in 20 mins, if with min. variability

> Prolonged deceleration lasting > 5 min

47
Q

Interpretation of EFM showing pathological signs (according to FIGO consensus)

A

Fetus with high probability of Hypoxia/acidosis

48
Q

Side effect of MagSul administration seen on FHR monitoring

A

Reduced variability

49
Q

This antenatal surveillance tool is used to evaluate placental blood flow in cases of intrauterine growth restriction

A

Umbilical doppler velocimetry ultrasound

50
Q

The umbilical dopper velocimetry ultrasound assesses which vessel?

A

Umbilical artery

51
Q

Umbilical artery flow velocity waveform in a normally growing fetus

A

High-velocity diastolic flow

52
Q

Umbilical artery flow velocity waveform in a fetus with IUGR

A

Diminished diastolic flow

53
Q

Umbilical artery flow velocity waveform in a fetus with extreme IUGR

A

Absent or reversed flow

54
Q

5 variables of Biophysical profile

A

1) Amniotic fluid index
2) Fetal tone
3) Fetal movement
4) Fetal breath
5) Fetal HR acceleration (Reactive NST)

55
Q

Definition of Reactive NST equivalent to a score of 2 on BPS

A

≥ 2 accelerations (≥ 15bpm for ≥ 15s) within 20 mins

56
Q

Amniotic fluid volume equivalent to a score of 2 on BPS

A

Pocket of AFV measuring ≥ 2 cm in 2 perpendicular planes (2x2cm pocket)

57
Q

Fetal tone findings equivalent to a score of 2 on BPS

A

≥ 1 episode of extremity extension with subsequent return to flexion

58
Q

Fetal breath findings equivalent to a score of 2 on BPS

A

≥ 1 episode of rhythmic breathing lasting ≥ 30 sec within 30 mins

59
Q

Fetal movement findings equivalent to a score of 2 on BPS

A

≥ 3 discrete body or limb movements within 40 mins

60
Q

Cutoffs for BPS values and interpretation

A

Score 8-10 = Normal
Score 6 = Equivocal
Score < 4 = Abnormal

61
Q

Which component of the BPS is the first to develop in the fetus and the last to go

A

Fetal tone

62
Q

Component of the BPS that is optional if the other 4 are normal

A

Reactive NST

63
Q

Component of the BPS that, if abnormal, requires further investigation even with a score of 8-10

A

Amniotic fluid volume < 2x2 cm pocket

64
Q

Interpretation and course of action for a BPS score of 8 but with low or absent AFV

A

Interpretation: Suspected chronic fetal asphyxia

Action: Deliver

65
Q

Interpretation and course of action for a BPS score of 6

A

Interpretation: Equivocal, Possible fetal asphyxia

Action:
Repeat BPS

66
Q

Interpretation and course of action for a BPS score of 6, Repeat BPS is now < 6, and with abnormal AFV

A

Interpretation: Equivocal, Possible fetal asphyxia

Action:
Deliver

67
Q

Interpretation and course of action for a BPS score of 6, Repeat BPS is the same, with normal AFV.

Patient is 35 weeks with unfavorable cervix

A

Interpretation: Equivocal, Possible fetal asphyxia

Action: Observe and repeat per protocol

68
Q

Interpretation and course of action for a BPS score of 4

A

Interpretation: Probable fetal asphyxia

Action: Repeat test.
If still ≤ 4, Deliver.

69
Q

Interpretation and course of action for a BPS score of 2

A

Interpretation: Almost certain fetal asphyxia

Action: Deliver.

70
Q
A

OB+GYN (11 decks)

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