Fetal Monitoring Flashcards

1
Q

Causes for intrinsic symmetrical IUGR

A

parental factors (ethnicity), chromosomal abnormality, TORCH infections, anatomical abnormality like cardiac disease or gastroschisis

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2
Q

Causes of extrinsic asymmetrical IUGR

A

Reduced liquor, abnormal placenta, preeclampsia, SLE, antiphospholipid syndrome, cigarettes, uterine abnormality, multiple pregnancies, later infections

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3
Q

Risk of reoccurrence with IUGR

A

40%

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4
Q

What measurements are taken on fetus USS if they are concerned about growth and development?

A

BPD, HC, AC, FL, TCD (transcerebellar diameter an early growth restricted sign)

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5
Q

What is Dolichocephaly and when is it common

A

Oval shaped head usually in breached babies

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6
Q

What measurements do you need for the estimated fetal weight?

A

BPD, FL, AC

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7
Q

How do you personalise growth charts?

A

Booking weight, height, BMI, age, ethnicity

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8
Q

Investigations performed in symmetrical IUGR?

A

Dates, mother and father weight and build, ethnicity, previous babies, TORCH scan, USS for abnormalities, drugs/alcohol, fetal ECHO, karyotype, doppler scan for flow

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9
Q

Index taken during assymetrical growth?

A

Amniotic fluid index

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10
Q

list the timeframes associated with each grade of placenta

A

0 = late first trimester early second, 1 = mid second to early third, 2 = late third trimester (30 weeks), 3 = 39 weeks

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11
Q

What does the placenta grading predominantly focus on

A

Indentations of the chorionic plate through the basilar plate and calcifications developing

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12
Q

What areas can the fetal doppler look at (2)?

A

Umbilical artery and MCA

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13
Q

2 abnormalities fetal Doppler is looking for during umbilical artery flow?

A

is there reversed EDF? is EDF present?

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14
Q

What does Doppler of the ductus venosus show?

A

If there is any cardiac decompensation present and potential urgent delivery needed

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15
Q

If a woman has abormal Doppler and movements what will you do?

A

steroids and aim to get to 37 weeks

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16
Q

How often does a woman need Dopplers to monitor asymmetrical IUGR when she is 28-37 weeks pregnant?

A

every 2 weeks if normal flow through umbilical artery but weekly if there is resistance, alternate days if there is absent EDF, deliver baby if there is reversed EDF

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17
Q

with the nuchal scan how many mm of fluid should be present behind the babies neck?

A

3mm

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18
Q

Absent nasal bone is indicative of what?

A

Downs Syndrome

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19
Q

How many weeks is the quadruple test performed?

A

15-20 weeks

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20
Q

When is the combined test performed?

A

first trimester 11-13+6

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21
Q

What test for Downs Syndrome can be performed in the late stages of pregnancy?

A

NIPT

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22
Q

What can you give to reduce chances of IUGR in future pregnancies?

A

Aspirin

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23
Q

3 phases of normal growth in utero including timings and predominant growth type

A

phase 1 is 0-16 weeks (cellular hyperplasia), phase 2 is 16-32 weeks (cellular hyperplasia and hypertrophy), phase 3 is 32 weeks to term (hypertrophy)

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24
Q

What morbidity in later life are IUGR babies predisposed to?

A

Glucose intolerance, insulin resistance, T2DM

25
Maternal factors leading to IUGR
Smoking, drugs, diet, high BMI, previous IUGR
26
Placental factors leading to IUGR
Hypertension, insufficiency, renal disease, IVF
27
Fetal factors leading to IUGR
chromosomal, genetic, viral, reduced liquor
28
Doppler screening for placental disease is done at what week gestation and on what artery
20 weeks to the uterine artery
29
Doppler of what will give the most accurate representation of fetal cardiac functioning?
Ductus Venosus
30
Dopplers of which artery is best to choose delivery time of preterm and term babies experiencing IUGR?
preterm = ductus venosus, term = MCA
31
Survival rate of gastroschisis?
90%
32
How does fetal hydrops present?
scalp oedema and ascites
33
Non-immune causes of hydrops
Parvovirus, genetic, structural abnormalities like skeletal dysplasia
34
In hydrops how will a MCA doppler appear?
Peak systolic flow will be elevated
35
How many weeks gestation is IU transfusion given? inserted into where?
34 weeks, umbilical vein
36
Term to describe sharing of twins to the same placenta?
Monochorionic
37
What damage to fetus can result if you do not monitor the FHR?
Hypoxic ischaemic encephalopathy
38
How often is FHR monitored in established labour vs pushing stage?
sonicaid used every 15 minutes in established and every 5 minutes in pushing
39
What 2 things does continuous electrical monitoring look at in labour?
FHR and contractions
40
What antenatal conditions would require continuous FHR monitoring in labour?
Previous CS, high BMI, diabetic, IUGR, twins, Preeclampsia, over term 42 weeks onwards, preterm labour, prolonged rupture of membranes
41
Administration of what 2 medications in labour are cause to start continuous FHR monitoring
Oxytocin and epidural
42
During labour, continuous FHR monitoring is required if what 2 things appear PV
Blood or fresh meconium stained liquor
43
What does a CTG analyse?
Fetal HR, maternal HR, contractions
44
What time reference is 1 large square on a CTG?
1 minute
45
baseline FHR?
110-160
46
What stage does FHR become abnormal?
below 100 or above 180
47
How long can baseline variability of FHR fluctuate and for how long before it becomes abnormal?
less than 5 for over 50 minutes or more than 25 for 25 minutes is abnormal
48
Define an acceleration in FHR?
15 bpm above baseline for 15 seconds
49
Define a deceleration in FHR?
15bmp below baseline for 15 seconds
50
What happens to FHR during contractions?
Decreases due to fetal head pressed
51
How can you tell whether there is an early or late deceleration? significance?
early decelerations are slowest during peak of contractions whereas late decelerations are after peak contractions and represent true hypoxia
52
Dr. C Brvad in assessing features of CTG
DR - determine risk, C - contractions (regular, frequency, power) BR- baseline rate, V - variability, A - accelerations, D - decelerations
53
What is a sinusoidal pattern on the CTG? what does it show?
continuous oscillations like sine wave, represents fetal anaemia, maternal haemorrhage
54
Why must mothers lie in left lateral position?
Prevent IVC compression
55
Drug given in oxytocin overdose
Tocolysis
56
How do you detect true acidaemia in the fetus
Fetal scalp blood sampling
57
What does fetus pH need to be in order to be considered normal?
Above 7.25
58
How do you manage fetus bradycardia and decelerations lasting over 30 minutes
Immediate delivery