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OB Exam 1 > Module 2: Part 2 > Flashcards

Module 2: Part 2 Flashcards

1
Q

Modified Biophysical Profile (BPP)

A

Focused on the components of the BPP that are most predictive of outcome

-NST (indicator of acid-base balance)
-Amniotic fluid volume (index of uteroplacental function

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2
Q

considered a normal BPP in 90% of exams

A

Reactive NST + max vertical pocket of amniotic fluid > 2 cm

as reliable as the full BPP for prediction of fetal well being!

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3
Q

We usually perform a BPP after _____

A

a non stress test

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4
Q

T/F
Modified Biophysical Profile (BPP) looks more at the non-stress test.

A

True
b/c its an indicator of acid base balance

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5
Q

Modified BPP is abnormal. Now what?

A

do a full BPP

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6
Q

Contraction Stress Test (CST)
what does it do?

A

“Oxytocin Challenge Test (OCT)”

-uteroplacental function (FETAL OXYGENATION)
-response of FHR to uterine contractions (oxytocin or nipple stimulation)
-3+ contractions for at least 40 seconds in a 10 minute period

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7
Q

NST vs Contraction Stress Test (CST)/(OCT)

A

NST: indicator of fetal acid-base balance

CST/OST: uteroplacental function/fetal oxygenation

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8
Q

Contraction Stress Test (CST)/(OCT)
results and what they mean

A

Negative: no decels with contractions 🙂👍🏼

Positive: repetitive late/severe variable decels with contractions (not good)

Unsatisfactory: positive CST & absence of FHR variability (BAD)

Equivocal: not positive or negative (repeated in 24 -72 hours)

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9
Q

Umbilical Artery Doppler Velocimetry

A

-direction & characteristics of blood flow
-maternal, uteroplacental or fetal circulation
-provides an indirect measure of fetal status

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10
Q

Amniocentesis

A

-amniotic fluid sample
-needle into uterus thru abdomen using US

assesses:
-fetal lung maturity
-chromosomal abnormalities
-many other reasons

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11
Q

Amniotic Fluid
fxn

A

-Critical for baby’s movement & growth
-Cushion fetus and umbilical cord

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12
Q

Amniotic Fluid
-production
-clearance

A

2nd half of pregnancy: main from fetal urination (700 ml/day) & lung secretions (350 ml/day)

clearance: mainly baby swallowing & passing it back into mom’s blood stream and direct flow across the amnion (placental membrane) into placental blood vessels

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13
Q

Amniotic fluid volume can be used to assess …

A

long-term uteroplacental function

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14
Q

Techniques to Measure Amniotic Fluid

A

Amniotic Fluid Index (AFI)
add together: depth in cm of 4 different pockets of fluid not containing cord or fetal extremities in 4 abdominal quadrants

use umbilicus as a reference point (perpendicular to the floor)

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15
Q

Amniotic Fluid (AFI)
-Normal
-Polyhydramnios
-Oligohydramnios

A

Normal: 8-18 cm
Polyhydramnios: AFI > 25 cm
Oligohydramnios: AFI < 5cm

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16
Q

Oligohydramnios

A

(AFI < 5cm)
↓ amniotic fluid for gestational age
diagnosed using US

Qualitatively (normal or reduced)
or
Quantitatively (Amniotic Fluid Index ≤5)

IUGR fetus may redistribute blood away from kidneys, decreasing fetal urine..Oligo

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17
Q

Oligohydramnios increases risk of …

A

cord compression and death

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18
Q

Polyhydramnios
can be caused by (3)

A

Causes: gestational diabetes, fetal anomalies, fetal infections

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19
Q

Polyhydramnios
associated with… (2)

A

(AFI > 25 cm)
Excessive amniotic fluid

Associated with:
-perinatal morbidity and mortality
-fetal macrosomia

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20
Q

Polyhydramnios
S/S (6)

A

-maternal dyspnea
-preterm labor
-PROM (water breaks too early)
-abnormal fetal presentation
-cord prolapse
-postpartum hemorrhage

21
Q

Polyhydramnios treatment

A

Amnioreduction

22
Q

Most common fetal malformation a/w polyhydroamnios

A
23
Q

What can happen at delivery if mom has polyhydyroamnios?

A

cord prolapse (cord comes before head)
emergency!
labor RN will reach in vagina to lift baby’s head off the cord

STAT C-section

24
Q

Post-Term Pregnancy (2)

A

Pregnancy beyond 42 weeks or 14 days beyond best estimate of Estimated date of delivery (EDD)

25
Q

Post-Term Pregnancy risks

A

Increased use of antenatal fetal surveillance

↑ fetal compromise & oligohydramnios

26
Q

Intrauterine Fetal Demise (IUFD)

A

(stillbirth)
Demise of fetus after 20 weeks & prior to delivery

Maternal, uteroplacental and fetal causes

27
Q

Delivery in the case of Intrauterine Fetal Demise (IUFD)

A

A) 90% go into spontaneous labor within 2 weeks

B) Induce using prostaglandins or oxytocin

28
Q

Intrauterine Fetal Demise (IUFD)
retained past 3 weeks

A

DIC in 20-25% with singleton fetus

Consumption of clotting factors

29
Q

T/F
Intrauterine Fetal Demise (IUFD) is still considered a full stomach

A

True

30
Q

Kleihaurer-Betke (acid elution) test

A

MVA, trauma or abuse

-estimates fetal blood in maternal circulation
-must be drawn w/in 6-8H of event

31
Q

fetal blood in maternal circulation should be ___ ml

A

ZERO

32
Q

gold standard for confirming IUFD by documenting the absence of fetal cardiac activity

A

Ultrasonography

33
Q

Causes of Intrauterine Fetal Demise

“Review table 6.13”

A

Isoimmunization: mom and baby Rh incompatible

34
Q

Death of one fetus in a twin gestation

A

risks depend placentation

monochorionic: surviving twin @ significant risk (IUFD, neuro injury, preterm birth)

Dichorionic: may have little impact on the surviving twin.

35
Q

In Monochorionic IUFD, the surviving twin is at risk for neuro injury. Why?

A

shared circulation in almost all cases

(profound hypoTN &/or transfer of thromboplastic proteins from the dead fetus to the live fetus)

36
Q

What happens to the demised twin in Dichorionic pregnancy?

A

may be resorbed completely or may become compressed and incorporated into the membranes (fetus papyraceus)

DIC is rare

37
Q

3 Risk Factors for the Fetus during Labor

A

Uterine contractions
Fetal cord accident
Fetal head compression

38
Q

Physiologic Stress of Contractions

A

-Transient ↓uteroplacental blood flow
-Stasis in intervillous spaces
-Fetus relies on reserves
-Impact if the fetus has decreased placental function

39
Q

⭐️
ONE OF THE MOST IMPORTANT DETERMINANTS OF PLACENTAL FUNCTION IS

A

UTERINE BLOOD FLOW

40
Q

The stress of contractions will be impactful to the fetus if…

A

the fetus has decreased placental function

(normal placental fxn can compensate)

41
Q

Factors for regulation of FHR

A

Neuronal and Humoral factors affect the intrinsic FHR

SNS, PNS, baroreceptors, chemoreceptors

42
Q

Parasympathetic & Sympathetic
effect on FHR

A

Parasympathetic outflow via vagus nerve decreases FHR

Sympathetic activity increases FHR and CO

43
Q

Baroreceptors & Chemoreceptors
What do they respond to?

A

Baroreceptors: respond to ↑BP

Chemoreceptors: respond to ↓PaO2 & PaCO2 through the ANS

44
Q

Maternal and Fetal Physical Assessment (6)

A

Maternal VS & physical
Fetal presentation
Fetal movement
Fetal heart assessment
Uterine activity
Labor progress

45
Q

What are we assessing during labor? (6)

A

Uterine contractions
Baseline fetal heart rate
Baseline variability
Presence of accelerations
Periods of decelerations
Patterns

46
Q

FHR Monitoring
Electronic fetal monitoring (EFM)

A

FHR baseline rate & patterns + relationship with uterine contractions

47
Q

FHR External monitoring

A

uses an ultrasound transducer & tocotransducer to measure contractions

placed on the mom’s belly

48
Q

FHR Internal monitoring

A

wire or electrode containing a needle inserted through the vagina and placed on the baby’s scalp

(mother has to be at least 2 cm and ruptured)

49
Q

Before you use FHR Internal monitoring, mom must meet which requirements?

A

at least 2 cm dilated and ruptured (water broke)

OB Exam 1 (13 decks)

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