Introduction To Fetal Monitoring Flashcards
Weight gain in pregnancy varies greatly.
Most pregnant women gain between _____ and _____kg (22lb to 28lb), putting on most of the weight after week ____.
Much of the extra weight is due to _____________ , but your body will also be storing fat, ready to make breast milk after your baby is born.
10kg and 12.5
20
your baby growing
Fetal ultrasound
At the _____ week scan our sonographer can detect structural defects
20
Postterm pregnancy is defined as pregnancy that has extended to or beyond ____ weeks of gestation (294 days), or estimated date of delivery (EDD) + _____ days
42
14
___________________________, or IUGR, is when a baby in the womb (a fetus) does not grow as expected.
Intrauterine growth restriction
Intermittent auscultation is the technique of listening to and counting the fetal heartbeats for ________ of time during __________. It is usually performed using a _______________ or a _______________ device, with the uterine contractions palpated by hand.
short periods
active labour
Pinard stethoscope; hand-held Doppler
This method of measuring amniotic fluid is referred to as the ________________. If the amniotic fluid depth measures less than ___________, the pregnant woman has oligohydramnios (or polyhydramnios).
amniotic fluid index (AFI)
5 centimeters
Normal pregnancy is assessed clinically
Maternal _________
Fetal ______
Fetal __________
Fetal ________
____________
weight gain
growth
movements
heart rate; Ultrasonically
High risk pregnancies include:
________ pregnancy
___________
__________________
Diabetes mellitus
Cardiac disease
Sickle cell disease etc
Postdated; IUGR
PIH/Pre-eclampsia
High risk pregnancies Are assessed clinically by ;
__________________
Daily fetal ______________
Electronically by _______________
Ultrasonically by _____________ and by ______ ultrasound
Assessing _______________
Intermittent auscultation
Daily fetal movement counting
Electronically by cardiotocography (CTG)
Ultrasonically by biophysical profile and by doppler ultrasound
Assessing state of liquor
A _______ test result is the usual finding of antepartum tests for fetal wellbeing.
normal
Even with persistently reassuring tests, perinatal death may still occur and each patient should be informed.
T/F
T
The oldest and most widely used form of fetal assessment is ???
Daily fetal movement counting
Fetal demise is preceded by cessation of fetal activity for _________hours.
24 - 48
Fetal movement Counting
Is A good screening method from ___ to _____ weeks to select patients who require electronic monitoring.
Can detect up to ____% of fetuses destined to develop fetal distress
30 to 42
60
Intermittent Auscultation
Can be done with _______ or _________.
Every _____ minutes in first stage of labour.
Every ____ minutes in second stage of labour.
Count rates at each review.
pinard or sonicaid
15;5
Intermittent auscultation of the fetal heart is performed _______ and _________ after contractions
during and 30secs
Normal FHR = ____-______ beats/min.
FHR > ____ beats/min = tachycardia.
FHR <_____ beats per/min = bradycardia.
Record on the partograph.
120 – 160
160; 120
Intermittent auscultation is inferior to CTG monitoring
T/F
F
Has not been found to be inferior to CTG monitoring if properly conducted.
The most commonly used antenatal test of fetal wellbeing is ???
CARDIOTOCOGRAPHY
An (internal or external?) method of monitoring fetal heart rate
External
CARDIOTOCOGRAPHY
Rationale – the presence of spontaneous fetal heart rate __________ associated with ____________ ( ____________ ) is an indicator of fetal wellbeing.
accelerations
fetal movements
fetal reactivity
CHARACTERISTICS OF NORMAL FETAL HEART RATE PATTERN
Normal pattern is:
– Associated with a good outcome.
– Baseline rate between _____ and ______ beats/min.
– Variability of at least ____ beats/min.
-_______________ is associated with contractions.
– Presence of ___________.
120 and 160
5
No deceleration
accelerations
INTRAPARTUM FETAL MONITORING
Intrapartum fetal monitoring means
To ___________________________
To detect at the earliest, any evidence of fetal jeopardy and Prompt action to be taken to save the fetus from the adverse effect of anoxia
watch the fetal behaviour during labour
A normal fetus is well adapted to ____________________________ occurring during labour
intermittent hypoxia
Intrapartum fetal monitoring
The major danger to the fetus is ____________ due to prolonged periods of ____________
asphyxia
oxygen reduction
Intrapartum fetal monitoring
The risk of asphyxia is more in cases where the mother has one or more high-risk factors like _______,______,_______. etc
anaemia, PIH, DM
Oxytocin challenge Test
Popular in USA
Here oxytocin infusion is given to provoke ____________ within _________.
The response of the FHR to the contractions is interpreted as in the __________ test.
3 uterine contractions; 10mins
non-stress
Disadvantages of oxytocin challenge test
_________ and time consuming.
Risk of ______________
Invasive
hyperstimulation
Biophysical profile
The original BPP assigned a score of _____ or ______ according to the presence or absence of each of the five variables
________
___________
______________
________________
___________________
0 or 2
fetal tone
fetal breathing movement
fetal movement
amniotic fluid volume
Non stress test (done using CTG)
Interpretation of biophysical profile score
Score of _____ – normal
Score of _____ – equivocal
Score of _______ - abnormal
8 or 10
6
4 or less
Modified BPP
Consist of ______ and ______
Used widely
If either of the variable is abnormal, a _________ or ____________ is performed.
Non-stress test and Amniotic Fluid index
complete BPP or CST
The __________,__________, and ___________ have similar low false-negative mortality rates –
What is low false-negative mortalitity rates ?
modified BPP, CST and complete BPP
defined as the number of fetal deaths within one week of a normal test result.
Mention 2 pitfalls of modified BPP
No clear evidence that the 2 variables used are better predictors than the other variables omitted from the BPP.
Requires 2 modalities for fetal evaluation while normal USS findings in BPP eliminates the need for NST.
Examination of Amniotic fluid
A route of access to information about the condition of the fetus in utero.
May involve either __________ or ___________
amniocentesis or amnioscopy
Examination of Amniotic fluid
Applications:
Diagnostic
Between _____ and ______ weeks
To detect ________ abnormality eg Trisomy 21
To detect some __________ defects by measuring alpha feto protein
To detect _______ genetic disorder
To detect certain _________________
15 and 20
chromosomal; open neural tube
sex-linked
inborn errors of metabolism
Examination of Amniotic fluid
Applications:
After 20weeks
To estimate bilirubin and antibody in _______________
To estimate phospholipids as a guide to ____________
For chemical and/or cytological analysis, to estimate __________
To perform angiography or fetography
rhesus isoimmunisation
pulmonary maturity
maturity
Examination of Amniotic fluid
Applications:
Therapeutic
For the temporary relief of _________
For intra-amniotic injection to ________________
hydramnios
terminate pregnancy
Meconium staining of liquor AMNII
Said to be a sign of __________
Recent studies disregard its importance when considered in isolation
fetal distress
Meconium staining has been classified according to the stage of labour as early and late.
Early- when it is passed during the ______ stage of labour
Late- when it is passed during the _______ stage after ______________________
The colour may vary from light yellow, light green, dark green to blackish
first
second
clear fluid has been noted previously
Meconium staining of liquor AMNII
Yellow or light green in the first stage of labour : _____________________
Thick dark green meconium in early labour : ________________________
Thick meconium associated with __________ variation should alert the obstetrician
insignificant if the rest of the findings are normal as in 50% of cases
significantly increased incidence of meconium aspiration in the new born
fetal heart
Biochemical Monitoring
FETAL SCALP pH
To recognise _______ in cases of altered ______ patterns
acidosis
FHR
Biochemical monitoring
Normal fetal scalp pH _______
pH _______, 50% of the neonates are normal.
pH ______ the fetus is compromised and 30% of such infants are ________ at birth.
> 7.25
> 7.2
<7.2
depressed
Biochemical monitoring
Severe acidosis can lead to neonatal ______________ and ______________
Seizures and hypotonia
