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Obs and Gynae > Fetal Monitoring > Flashcards

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
Q

Maternal factors leading to IUGR

A

Smoking, drugs, diet, high BMI, previous IUGR

26
Q

Placental factors leading to IUGR

A

Hypertension, insufficiency, renal disease, IVF

27
Q

Fetal factors leading to IUGR

A

chromosomal, genetic, viral, reduced liquor

28
Q

Doppler screening for placental disease is done at what week gestation and on what artery

A

20 weeks to the uterine artery

29
Q

Doppler of what will give the most accurate representation of fetal cardiac functioning?

A

Ductus Venosus

30
Q

Dopplers of which artery is best to choose delivery time of preterm and term babies experiencing IUGR?

A

preterm = ductus venosus, term = MCA

31
Q

Survival rate of gastroschisis?

32
Q

How does fetal hydrops present?

A

scalp oedema and ascites

33
Q

Non-immune causes of hydrops

A

Parvovirus, genetic, structural abnormalities like skeletal dysplasia

34
Q

In hydrops how will a MCA doppler appear?

A

Peak systolic flow will be elevated

35
Q

How many weeks gestation is IU transfusion given? inserted into where?

A

34 weeks, umbilical vein

36
Q

Term to describe sharing of twins to the same placenta?

A

Monochorionic

37
Q

What damage to fetus can result if you do not monitor the FHR?

A

Hypoxic ischaemic encephalopathy

38
Q

How often is FHR monitored in established labour vs pushing stage?

A

sonicaid used every 15 minutes in established and every 5 minutes in pushing

39
Q

What 2 things does continuous electrical monitoring look at in labour?

A

FHR and contractions

40
Q

What antenatal conditions would require continuous FHR monitoring in labour?

A

Previous CS, high BMI, diabetic, IUGR, twins, Preeclampsia, over term 42 weeks onwards, preterm labour, prolonged rupture of membranes

41
Q

Administration of what 2 medications in labour are cause to start continuous FHR monitoring

A

Oxytocin and epidural

42
Q

During labour, continuous FHR monitoring is required if what 2 things appear PV

A

Blood or fresh meconium stained liquor

43
Q

What does a CTG analyse?

A

Fetal HR, maternal HR, contractions

44
Q

What time reference is 1 large square on a CTG?

45
Q

baseline FHR?

46
Q

What stage does FHR become abnormal?

A

below 100 or above 180

47
Q

How long can baseline variability of FHR fluctuate and for how long before it becomes abnormal?

A

less than 5 for over 50 minutes or more than 25 for 25 minutes is abnormal

48
Q

Define an acceleration in FHR?

A

15 bpm above baseline for 15 seconds

49
Q

Define a deceleration in FHR?

A

15bmp below baseline for 15 seconds

50
Q

What happens to FHR during contractions?

A

Decreases due to fetal head pressed

51
Q

How can you tell whether there is an early or late deceleration? significance?

A

early decelerations are slowest during peak of contractions whereas late decelerations are after peak contractions and represent true hypoxia

52
Q

Dr. C Brvad in assessing features of CTG

A

DR - determine risk, C - contractions (regular, frequency, power) BR- baseline rate, V - variability, A - accelerations, D - decelerations

53
Q

What is a sinusoidal pattern on the CTG? what does it show?

A

continuous oscillations like sine wave, represents fetal anaemia, maternal haemorrhage

54
Q

Why must mothers lie in left lateral position?

A

Prevent IVC compression

55
Q

Drug given in oxytocin overdose

56
Q

How do you detect true acidaemia in the fetus

A

Fetal scalp blood sampling

57
Q

What does fetus pH need to be in order to be considered normal?

A

Above 7.25

58
Q

How do you manage fetus bradycardia and decelerations lasting over 30 minutes

A

Immediate delivery

Obs and Gynae (27 decks)

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