Module 5 Unit C&D Practice Questions Flashcards
A pregnant individual at term has had an uncomplicated pregnancy. Today the fundal height that is 2 cm less than the number of gestational weeks. What is the most likely cause for that finding?
The fetus has descended into the maternal pelvis.
[Although a fetal growth abnormality and a decrease in amniotic fluid levels are possible causes the most likely cause at term is that the fetus dropped into the pelvis in the last weeks of pregnancy, a process known as lightening, and that can cause the fundal height to decrease even as the fetus continues to grow normally. In a patient who has regular prenatal care, it is very unlikely that incorrect dating is the cause of this change in fundal height.]
The clinician is auscultating fetal heart tones with a patient who is 39 weeks’ gestation. The fetal heart rate is 112 bpm. Which of the following are appropriate clinical decisions at this point? [select all that apply]
a) This FHR is bradycardic and the patient should be transported emergently to Labor and Delivery.
b) The fetus could be sleeping.
c) The clinician should palpate the maternal pulse to ensure that they are not inadvertently auscultating the mother’s heart rate.
d) The patient must have a nonstress test today.
b) The fetus could be sleeping.
c) The clinician should palpate the maternal pulse to ensure that they are not inadvertently auscultating the mother’s heart rate.
[Recall that in the third trimester, a normal fetal heart rate is approximately 110-160 bpm. A fetuses nearing term have a more developed parasympathetic nervous system and, therefore, a generally lower baseline heart rate compared with earlier-gestation fetuses. Like adults, fetuses have a lower heart rate when sleeping than when awake.
It is always a good practice, particularly with a fetal heart rate in the lower range of normal, to simultaneously listen to the fetal heart rate with the Doppler and palpate the maternal radial pulse to ensure that they are different heart rates.]
A 32-year-old G2P1001 at 35 weeks gestation calls the CNM/WHNP to report that she did not get 10 fetal movements today with her regular counting. She was asked to come in for an NST and has been on the fetal monitor for 15 minutes. There are no contractions, heart rate accelerations, or fetal movements. What action would be most appropriate?
Perform vibroaccoustic stimulation (VAS)
[For NSTs that do not meet criteria for reactivity in 20 minutes, clinicians can consider extending the NST up to a total of 40 minutes or using a vibroacoustic stimulator (a handheld machine that delivers a vibrating “buzz” to the maternal abdomen) to encourage the fetus to wake up/move. If the fetus remains non-reactive, the next step would be a BPP.
At this point in time you are not concerned with whether or not the fetus will tolerate labor, you want to first ensure fetal well-being. Therefore a contraction stress test is not the appropriate next step.]
After performing Leopold’s Maneuvers on a patient who is 37 weeks’ gestation, the clinician determines that the fetus is in a cephalic presentation with the fetal back on the mother’s left. Where should the clinician initially attempt to auscultate fetal heart tones?
Left lower quadrant of the maternal abdomen
[Because the fetus is in a cephalic presentation, the FHTs will usually be below the maternal umbilicus. The FHTs are also auscultated most clearly where the back is palpated.]
True or false? Evidence supports teaching all patients to determine daily how long it takes for the baby to kick 10 times.
False
[Formal fetal movement counting is not associated with any difference in perinatal mortality. At every visit, discuss with pregnant patients the range of fetal movement patterns that are considered normal and potentially abnormal.]
A patient has just finished a 40-minute nonstress test and the clinician told her that the test was nonreactive. The patient is scared and anxious about her baby. What is an appropriate clinician response?
Many nonstress tests are nonreactive just because the baby is sleeping. We will do a biophysical profile now to make sure your baby is doing well.
[For NSTs that do not meet criteria for reactivity in 20 minutes, clinicians can consider extending the NST up to a total of 40 minutes or using a vibroacoustic stimulator to encourage the fetus to move. A common practice in some settings is to give the patient a sweet drink like orange juice to “wake the baby up,” either after a period of monitoring shows non-reactivity or even proactively at the beginning of the NST. However, several fairly recent studies indicate that maternal ingestion of glucose does NOT increase fetal movements or promote reactive non-stress tests. Also, although this may be difficult, avoid providing empty reassurance. As you can see, the correct answer provides clear information, and refrains from providing reassurance when it is not yet clear if the baby is “fine.”]
True or false? Evidence is clear that ultrasound is, by far, the most accurate method to estimate fetal weight.
False
[Of the three methods of estimating fetal weight (ultrasound, clinicians’ exams, and maternal perception) research has not shown that any of the methods are far superior to the others.]
A 39-week patient had a BPP and everything was normal except the amniotic fluid measurement was a 1.8 cm pocket. How should the clinician assess this result?
This patient needs further follow up now.
[Recall that a normal amniotic fluid volume assessment includes:
-Single deepest pocket vertical depth of 2.1-8 cm
Amniotic fluid index of 5-25 cm
-In this case the single pocket was less than 2.
The BPP scores that require additional/collaborative management are:
-Any BPP in which the amniotic fluid is abnormal
-6/10 with normal fluid (score of 2 for amniotic fluid but 2 other elements are inadequate). This is commonly seen when the NST is non-reactive and the fetus does not fully meet the gross movement or tone requirements.
-4/10 or less]
The clinician wants to perform formal Leopold’s Maneuvers. How should the clinician position their body and hands for the first maneuver?
Facing the maternal head, fingers of both hands curved around the fundus
[For the first maneuver the clinician is trying to determine which fetal part is in the fundus. Therefore, the clinician is facing the maternal head with fingers of both hands curved around the fundus.]
Which of the following are appropriate statements to include in teaching a pregnant patient in the third trimester about fetal movement awareness? [select all that apply]
a) It’s normal for your baby to move less as you get closer to your due date.
b) Babies often move differently with more small movements near their due date but they should still move the same number of times.
c) We don’t want you to get anxious about fetal movement so just try to not worry about it too much.
d) Call us anytime you feel any concern about your baby’s movements.
b) Babies often move differently with more small movements near their due date but they should still move the same number of times.
d) Call us anytime you feel any concern about your baby’s movements.
[It is NOT normal for fetuses to move less near term but it IS common for the character of the movements to change. Encourage patients to promptly report any change, and have a very low threshold for further investigation of any possible decrease in fetal movement.]
The clinician is certain that a 27-week fetus is in a breech presentation. How should the clinician proceed?
Plan to recheck at future prenatal visits because nothing needs to be done now.
[Recall that this patient is only 27 weeks, and it is not unusual for fetuses in the early part of the third trimester to move around and be in non-cephalic presentations. Around 32 weeks most fetuses settle into a cephalic presentation and tend to stay there. it is important for prenatal care providers to be alert to and appropriately respond to patients in non-cephalic presentations near term.]
A nonreactive non-stress test (NST) should be subsequently evaluated with which of the following:
Biophysical profile (BPP)
What is the physiologic connection between amniotic fluid volume and fetal well-being?
Fetuses who are well-oxygenated perfuse their kidneys well and produce ample urine, which contributes to a healthy amount of amniotic fluid.
[Hypoxic fetuses shunt blood away from their kidneys (to more vital organs). That decreased perfusion to the fetal kidneys can then result in decreased fetal urine output. Amniotic fluid is, in large part, composed of fetal urine so the volume of amniotic fluid can give us insights into fetal well-being.]
What is the normal range for amniotic fluid volume measurements (AFI and single deepest vertical pocket)?
Single deepest pocket vertical depth of 2.1-8 cm
Amniotic fluid index of 5-25 cm
What does a positive contraction stress test mean?
An abnormal, potentially worrisome test
