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Y4R2 - Obstetrics I 🤰 > L2: Fetal Evaluation > Flashcards

L2: Fetal Evaluation Flashcards

1
Q

Another Name of Fetal Evaluation

A

Fetal Survaillence

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2
Q

Methods of Fetal Evaluation

A

A) Determination of fetal age.
B) Determination of fetal maturity.
C) Evaluation of fetal wellbeing.
D) Prenatal diagnosis of congenital anomalies.

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3
Q

Duration of Normal Pregnancy

A
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4
Q
A
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5
Q

Determination of GA

  • Methods
A
  • Hx
  • Ex
  • INVx
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6
Q

Determination of GA

  • By Hx
A
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7
Q

Determination of GA by Hx

  • Menstruation-delivery interval (Naegele’s rule)
A
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8
Q

Menstruation-delivery interval (Naegele’s rule)

  • Method
A

Commonest Method

  • EDD date of 1st day of LNMP+7 days +9 months.
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9
Q

Menstruation-delivery interval (Naegele’s rule)

  • Characters of LMNP
A

a) Should be of normal characters.

b) Should be preceded by 3 consecutive normal cycles.

c) Shouldn’t be preceded by use of hormonal contraception.

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10
Q

Menstruation-delivery interval (Naegele’s rule)

  • Causes of Falacies
A

a) Maternal forgetting Recent use of COCs.

b) Bleeding in early pregnancy.

c) Irregular menstruation or prepregnancy amenorrhea.

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11
Q

Determination of GA by Hx

  • Ovulation-delivery interval
A

EDD = date of ovulation day - 7 days + 9 months.

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12
Q

Determination of GA by Hx

  • Coital-delivery interval (date of single coitus)
A

EDD = date of single coitus (as in rape) 7 days + 9 months.

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13
Q

Determination of GA by Hx

  • Date of embryo transfer (ET)
A

EDD = date of ET (in ARTs) 7 days + 9 months.

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14
Q

Determination of GA by Hx

  • Date of quickening
A

18-20 weeks in primigravida & 16-18 weeks in multipara.

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15
Q

Determination of GA by Hx

  • Date of 1st +ve pregnancy test
A

Most kits allow urine diagnosis of pregnancy at 4th or 5th weeks after LMP.

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16
Q

Determination of GA by Ex

A
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17
Q

Determination of GA by Ex

  • Fundal Level
A
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18
Q

Determination of GA by Ex

  • Symphysis-fundus height (gravidogram)
A
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19
Q

Determination of GA by Ex

  • McDonald’s formula
A
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20
Q

Determination of GA by Ex

  • Fetal weight (Johnson formula)
A
  • Fetal weight (in gm) = [fundal height (in cm) - n] x 155.

▪ n = 12 if head isn’t engaged & 11 if head is engaged

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21
Q

Determination of GA by Ex

  • Measurement of abdominal girth
A

Using certain tables.

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22
Q

Determination of GA by Ex

  • Ballotment
A

Internal ballottement at 16 weeks & external ballottement at 20 weeks.

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23
Q

Determination of GA by Ex

  • Auscultation of FHS
A
  • By Doptone at 10 weeks
  • By Pinard’s stethoscope at 20 weeks.
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24
Q

Determination of GA by INVx

A
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25
Q

Determination of GA by US

  • Intro
A
  • Fetal body measurements (fetal biometry) reflect GA & there are curves corresponding to development of each of these measurements throughout pregnancy (fetal growth curves).
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26
Q

Determination of GA by US

  • Common Measurments
A
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27
Q

Determination of GA by US

  • GS
A

At 4 weeks by TVS & 6 weeks by TAS

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28
Q

Determination of GA by US

  • CRL
A

At 5 weeks by TVS & 7 weeks by TAS

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29
Q

Determination of GA by US

  • BPD
A
  • At 13 weeks
  • it ↑↑from 2.4 cm at 13 weeks to 9.5 cm at term

is more accurate at 20-30 weeks

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30
Q

Determination of GA by US

  • FL
A
  • At 14 weeks
  • it ↑↑ from 1.5 cm at 14 weeks to 7.8 cm at term
  • is more accurate than BPD after 30 weeks
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31
Q

Determination of GA by US

  • AC
A
  • More accurate than BPD after 30 weeks
  • it is the single most important measurement to
    make in late pregnancy
  • (it reflects fetal size & weight rather than age)
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32
Q

Determination of GA by US

  • HC
A

…

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33
Q

Determination of GA by US

  • EFW
A
  • Using > 2 parameters in published formulas.
  • True weight is 15-20% above estimated weight.
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34
Q

Measurements used in early pregnancy (up to 12-13 w)

A

GS diameter & CRL

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35
Q

Measurements used during 2nd & 3d trimesters

A

BPD, FL, AC, HC & EFW

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36
Q

Accurate GA è uncertain LNMP can be obtained from

A

a) 1 CRL measurement early in 1st trimester.
b) 2 measurements () 16 & 24 weeks showing linear growth.

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37
Q

Accuracy of ultrasound dating of pregnancy is as follows

A

a) In 1st trimester: CRL is accurate èin 3-5 days from menstrual dating.

b) In 2d trimester: Measurements are èin 2 weeks from menstrual dating.

c) In 3rd trimester: Measurements are èin 3 weeks from menstrual dating.

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38
Q

Causes of Oversized Uterus

A
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39
Q

Causes of Causes of Undersized Uterus

A
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40
Q

Determination of Fetal Maturity

  • Importance
A

A) Before elective TOP to determine fetal prognosis.

B) For performing & standardization of all fetal wellbeing tests.

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41
Q

Determination of Fetal Maturity

  • Methods
A
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42
Q

Determination of Fetal Maturity by Hx & Ex

A

For determination of fetal age (see above).

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43
Q

Determination of Fetal Maturity by INVx

A
  • US
  • X-Ray
  • Amniotic Fluid
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44
Q

Determination of Fetal Maturity by INVx

  • US
A

BPD, FL, AC & EFW.

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45
Q

Determination of Fetal Maturity by INVx

  • X-Ray
A

Appearance of ossific centers.

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46
Q

Determination of Fetal Maturity by INVx

  • AF
A
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47
Q

Determination of Fetal Maturity by AF

A
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48
Q

Determination of Fetal Maturity by AF

  • Fetal Lung Maturity
49
Q

Determination of Fetal Maturity by AF

  • Fetal Kidney Maturity
A

AF creatinine level (levels ≥ 2 mg/dl indicate maturity)

50
Q

Determination of Fetal Maturity by AF

  • Fetal Liver Maturity
A

AF bilirubin level.

51
Q

Determination of Fetal Maturity by AF

  • Fetal Skin Maturity
A

Detection of fat cells after staining by Nile blue sulfate.

52
Q

Types of Evaluation of Fetal Wellbeing (Fetal Wellbeing Tests)

  • According to time
A
  • Antepartum
  • Intrapartum
53
Q

Def of Antepartum Evaluation of Fteal Wellbeing

A

Assessment of in utero fetal condition during pregnancy.

54
Q

Time of Antepartum Evaluation of Fteal Wellbeing

A

Started usually at 30 weeks.

55
Q

Methods of Antepartum Evaluation of Fetal Wellbeing

56
Q

Methods of Antepartum Evaluation of Fetal Wellbeing

  • ClinicalMethods of Antepartum Evaluation of Fetal Wellbeing
  • Biophysical
57
Q

Methods of Antepartum Evaluation of Fetal Wellbeing

  • Biochemical
58
Q

Methods of Antepartum Evaluation of Fetal Wellbeing

  • Clinical (Detailed)
59
Q

Methods of Antepartum Evaluation of Fetal Wellbeing

  • Daily fetal movement count (DFMC):
60
Q

Methods of Antepartum Evaluation of Fetal Wellbeing

  • Antepartum FHR monitoring
A

By using external Doppler machine applied on mother’s abdomen.

61
Q

Features of FHR tracing

A
  • Baseline Rate
  • Variability
  • Periodic Changes
62
Q

Normal Baseline rate of FHR

A

120-160 bpm

63
Q

Abnormal Baseline rate of FHR

64
Q

Abnormal Baseline rate of FHR

  • tachycardia
65
Q

Abnormal Baseline rate of FHR

  • Bradycardia
66
Q

Importance of Variability of FHR

A

Most clinically significant indicator of fetal status & it is regulated by fetal autonomic nervous system.

67
Q

Types of Variability of FHR

A
  • Short term variability (beat to beat variability)
  • Long term variability (baseline variability)
68
Q

Types of Variability of FHR

  • Short term variability Long term variability (beat to beat variability)
A

Instantaneous change (of 2-3 beats) in FHR from one beat to next beat

69
Q

Types of Variability of FHR

  • Long term variability (baseline variability)
A

Oscillation of baseline tracing è amplitude of 5-25 bpm & frequency of 3-5 oscillations/min

70
Q

Types of Variability of FHR

  • Causes of decreased or lost variability
71
Q

Periodic Changes of FHR

A
  • Acceleration
  • Decceleration
72
Q

Periodic Changes of FHR

  • Def of Acceleration
A
  • Transient episodes of ↑↑ FHR è amplitude of ≥ 15 bpm & duration of ≥ 15 seconds.
73
Q

Periodic Changes of FHR

  • Causes of Acceleration
A

Fetal movement, uterine contractions or partial cord compression.

74
Q

Periodic Changes of FHR

  • Def of Deceleration
A
  • Transient episodes of↓↓ FHR è amplitude of ≥ 15 bpm & duration of ≥ 15 seconds.
75
Q

Periodic Changes of FHR

  • Types of Deceleration
76
Q

Types & Causes of Deceleration

  • Early Deceleration
77
Q

Types & Causes of Deceleration

  • Late Deceleration
78
Q

Types & Causes of Deceleration

  • variable deceleration
79
Q

Types & Causes of Deceleration

  • Prolonged Deceleration
80
Q

Antepartum Fetal Evaluation

  • Doppler US
81
Q

Antepartum Fetal Evaluation by Doppler US

  • Method
A

abdominally or transvaginally

82
Q

Antepartum Fetal Evaluation by Doppler US

  • Importance
A
  • It demonstrates direction & characteristics of blood flow:

▪ So, it helps in assessment of placental blood flow through measuring Doppler indices in umbilical or uterine arteries.

83
Q

Antepartum Fetal Evaluation by Doppler US

  • Most Important Index
A

Most important Doppler index is:
▪ S/D ratio (systolic/ diastolic velocity ratio).

84
Q

Antepartum Fetal Evaluation by Doppler US

  • First Abnormality to appear
A

Umbilical artery Doppler abnormalities are 1st to appear:

▪ So, it is logic to use Doppler as the main screening tool

85
Q

Antepartum Fetal Evaluation by Doppler US

  • Results in defective placental flow (as in PIH)
A

In defective placental flow (as in PIH):

▪ There is ↑↑umbilical artery S/D ratio (normally = 3 at 30 weeks) & in severe cases, there is absent or reversed diastolic flow

86
Q

Antepartum Fetal Evaluation

  • Amnioscopy
A

Visualization of amniotic cavity through intact membranes when cervix is sufficiently dilated to diagnose meconium stained liquor.

87
Q

Antepartum Fetal Evaluation

  • NST & CST
88
Q

Most commonly used test for fetal wellbeing

89
Q

Another name of CST

A

Named also oxytocin challenge test (OCT)

90
Q

Def of NST & CST

91
Q

Principle of NST & CST

92
Q

Indications of NST & CST

93
Q

Time of NST & CST

94
Q

Technique of NST & CST

95
Q

Interpretation of NST & CST

96
Q

Frequency of NST & CST

97
Q

Advantages of NST & CST

98
Q

Disadvantages of NST & CST

99
Q

Vibroacoustic stimulation test (VAST)

A

By using about 80 db sound probe as an
alternative to fetal movements in NST (at this
db, it isn’t a stress test).

100
Q

CI of CST

A

→ Previous uterine scar (as previous CS).
→ Placenta previa.
→ PROM.
→ Multifetal pregnancy
→ Threatened preterm labor
→ history of preterm labor.

101
Q

Antepartum fetal Evaluation

  • Biophysical profile (BPP)
102
Q

Antepartum fetal Evaluation by BPP

103
Q

Antepartum fetal Evaluation by BPP

  • Def
A
  • Scoring system for certain fetal biophysical activities that help in assessment of in utero fetal condition.
104
Q

Antepartum fetal Evaluation by BPP

  • Time
A

Usually started at 32-34 weeks.

105
Q

Antepartum fetal Evaluation by BPP

  • Technique
106
Q

Antepartum fetal Evaluation by BPP

  • Interpretation
107
Q

Antepartum fetal Evaluation by BPP

  • Advantages
A

a) Non invasive
b) safe
c) easy to perform.
d) Can be used for assessment of wellbeing of twins.
e) Low false -ve results.

108
Q

Antepartum fetal Evaluation by BPP

  • Disadvantages
109
Q

Antepartum fetal Evaluation by BPP

  • Modified Additions
110
Q

Antepartum fetal Evaluation

  • Biochemical Assessment
111
Q

Def of Intrapartum Evaluation of Fetal Wellbeing

A

Assessment of in utero fetal condition during labor.

112
Q

Time of Intrapartum Evaluation of Fetal Wellbeing

A

Started whenever labor starts.

113
Q

Methods of Intrapartum Evaluation of Fetal Wellbeing

A
  • Clinical
  • Biophysical
  • Biochemical
114
Q

Methods of Intrapartum Evaluation of Fetal Wellbeing

  • Clinical
A

1) Partogram.
2) Examination of AF.

115
Q

Methods of Intrapartum Evaluation of Fetal Wellbeing

  • Biophysical
116
Q

Intrapartum Evaluation of Fetal Wellbeing by Biophysical Tests

  • Intermittent FHR monitoring
117
Q

Intrapartum Evaluation of Fetal Wellbeing by Biophysical Tests

  • Continuous electronic FHR monitoring
118
Q

Intrapartum Evaluation of Fetal Wellbeing

  • Biochemical Tests

Y4R2 - Obstetrics I 🤰 (59 decks)

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