Fetal distress. Ultrasound and biochemical diagnosis.MRI.Etiology and treatment. 42. Tococardiographie – normal and abnormal

Question 1

signs of reactive (normal) NST?

Answer 1

baseline fetal heart rate is 110-160bpm

2 acceleration of FHR of atleast 15bpm above baseline for more than 15 seconds in a 20 min observation

when the fetus is more than 32 weeks’ gestation

acceleration of atleast 10 beats per minute over 10 seconds when the fetus is at or below 32 weeks’ gestation

Question 2

If these accelerations do not occur, the test is said to be “nonreactive” is this bad ?

Answer 2

does not mean there is something wrong with your baby. The baby might be sleeping

Question 3

if NST is non reactive what is done next ?

Answer 3

vibroacustic stimulation - to change the sleep state and longer monitoring

Question 4

these fhr accelerationFHR accelerations describes what of the baby’s condition ?

Answer 4

absence of fetal metabolic acidemia

Question 5

what are the three basic types of deceleration?

Answer 5

early
late
variable

Question 6

when do early decelerations occur?

Answer 6

begin before the peak of the contraction.

Question 7

what causes early deceleration ?

Answer 7

it is not an alarming sign

Early decelerations can happen when the baby’s head is compressed.

This often happens during later stages of labor as the baby is descending through the birth canal. also occur during early labor if the baby is premature or in a breech position causing the uterus to squeeze the head during contractions.

Question 8

describe late deceleration ?

Answer 8

don’t begin until the peak of a contraction or after the uterine contraction is finished. They’re smooth, shallow dips in heart rate that mirror the shape of the contraction that’s causing them

Question 9

is late deceleration harmful ?

Answer 9

no cause for concern with late decelerations, as long as the baby’s heart rate also shows accelerations (this is known as variability) and quick recovery to normal heart rate range.

Question 10

late deceleration can be a sign for what ?

Answer 10

baby isn’t getting enough oxygen. Late decelerations that occur along with a fast heart rate (tachycardia) with very little variability can mean that the contractions may be harming the baby by depriving them of oxygen - uteroplacental deficiency

Question 11

what is variable decelerations ?

Answer 11

irregular, often jagged dips in the fetal heart rate that look more dramatic than late deceleration

Question 12

what causes variable decelerations ?

Answer 12

baby’s umbilical cord is temporarily compressed
This happens during most labors.
if variable decelerations happen over and over. Such a pattern can be harmful to the baby.

Question 13

what is included in biophysical profiling ?

Answer 13

4 ultrasounds assessment and NST

Question 14

what are the 4 ultrasound assessment in biophysical profiling ?

Answer 14

each including NST is given a score of two

fetal breathing
At least one episode of 30s -60
in 30 minutes = 1
>60 =2

fetal movement
three or more movements of the torso or limbs in 30 mins =2
1-3=1

Fetal muscle tone
At least one episode of active extension then flexion involving both extremities and spine =2
Either extremity or spine = 1
Extension not followed by flexion =0

amniotic fluid volume
At least one vertical pocket > 2cm in two perpendicular planes =2
2-1cm =1

A BPP of 8 or 10 is generally considered reassuring

less than that would need delivery

Question 15

how is the scoring of BPP interpreted and its management ?

Answer 15

A BPP of 8 or 10 is generally considered reassuring

6 = suspect chronic asphyxia
if more than 36 wks deliver
If less than 36 repeat 4-6hrs
See pulmonary maturity L/S is less than 2 repeat test

4 
suspect chronic asphyxia 
>36 weeks deliver 
<36 weeks repeat in 4-6 hours 
and test for 120 minutes 

if persistent score of 4 and less
deliver regardless of gestational age

Question 16

what additional ultrasound test are done to measure the fetal wellbeing

Answer 16

umbilical artery
- reduced or absent or reversed diastolic flow = failure of villous trophoblast invasion = resistance in fetoplacental circulation = IUGR and preeclampsia

middle cerebral artery
increase in diastolic velocity
s/d or pulsotray index = dilation of cerebral vessels
which is brain sparing effect in response to hypoxemia

ductus venous 
increase in doppler index 
or absent or reversed flow 
= increase in central venous pressure 
= fetal acidemia 
same if doppler index is high

Question 17

what other tests are performed to see the fetuswellbeing ?

Answer 17

Fetal movement count by the mother is an ideal first-line screening test both for high-risk and low-risk patients. A healthy fetus should have minimum 10 movements in 12-hour period. Count should be done daily beginning at 28 weeks

The principle is—there is decrease in fetal
movements when there is fetal hypoxemia.

Question 18

what are the biochemical markers we need to look out for in early pregnancy ?

Answer 18

Maternal serum alpha feto protein(MSAFP):

produced by yolk sac and fetal liver.
Highest level of AFP in fetal serum and amniotic fluid is reached around 13 weeks and thereafter it decreases. Maternal serum level reaches a peak around 32 weeks. MSAFP level is elevated in a number of conditions: (a) wrong gestational age, (b) open neural tube defects (NTDs)

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Inhibin A.
produced by corpus luteum and the placenta.Serum level of inhibin A raised in women carrying a fetus with Down’s syndrom

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PAPP-A (Pregnancy Associated Plasma Protein-A).

low PAPPA may be commonly seen in prenatal screening for Down syndrome.[5] Low levels may alternatively predict issues with the placenta, resulting in adverse complications such as intrauterine growth restriction, preeclampsia, placental abruption,

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E3 (unconjugated estriol).
evels of MSAFP and uE3 tend to be low while that of hCG is high. It is performed at 15–22 weeks
used for down syndrome

Question 19

what are the biochemichal markers needed to be looked at late pregnancy?

Answer 19

pulmonary maturation markers