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DMST 244 OBGYN 1 > Module 7 2nd and 3rd trimester fetal well being > Flashcards

Module 7 2nd and 3rd trimester fetal well being Flashcards

1
Q

What is a biophysical profile?

A

A non-invasive, in-utero observation of fetal well-being parameters to evaluate its state of health

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2
Q

Because BPP is initiated and regulated by fetal central nervous system (CNS), these parameters are indicators of what?

A

Indicators of functional fetal central nervous system and absence of hypoxia or acidosis

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3
Q

A normal BPP is considered what in terms of gestation?

A

Highly reassuring, with low false positive and false negative rates of antepartum fetal surveillance

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4
Q

Interpretation of the BPP Informs what?

A

Diagnosis and management plans concerning the ongoing pregnancy and timely delivery

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5
Q

What would be indications for antepartum testing? 9

A

Pregnancy related or maternal conditions related to
1. Decreased fetal movement
2. Gestational HTN
3. Diabetes (pregestational or gestational)
4. Hypertension/ preeclampsia
5. Fetal growth restrictions
6. Oligohydraminos
7. Late term or post term pregnancy
8. Multiple pregnancy
9. Maternal cyanotic heart disease

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6
Q

What is observed during ultrasound for BPP? 3

A
  1. Gross fetal movement
  2. Fetal breathing
  3. Fetal tone
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7
Q

What is a measured element of BPP during Ultrasound?

A

Amniotic fluid pocket

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8
Q

Is a non stress test something that ultrasound conducts? What is a non stress test?

A
  1. Not performed by ultrasound
  2. Fetal monitor heart beat test performed in labor and delivery of MFM departments
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9
Q

BPP scores were fashioned after what?

A

Apgar scores of the newborn

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10
Q

What was measured on the Apgar scores? 5

A
  1. HR
  2. Resp
  3. Muscle tone
  4. Reflex irritability
  5. Color
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11
Q

So what tests are performed on a BPP and what are their scores? 5

A

Ultrasound
1. Gross fetal movement (2)
2. Fetal breathing (2)
3. Fetal tone (2)
4. Amniotic fluid pocket (2)
not ultrasound
1. Fetal monitor heart beat test (2)

Total marks 10

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12
Q

Why is a BPP performed? 3

A
  1. To assess for fetal hypoxia
  2. Asphyxia
  3. Low oxygen levels in the fetus
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13
Q

For each criteria of the BPP the fetus is given a score what is it? 2

A
  1. 2 for doing the required exercise
  2. 0 if the element is not adequately performed
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14
Q

How long does the fetus have to perform the BPP test?

A

30 minutes

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15
Q

The u/s elements of the BPP exam is out of what?

A

8 marks

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16
Q

What are some fetal biophysical activities that can be identified on ultrasound? 4

A
  1. Gross body movements
  2. Breathing
  3. Fetal tone
  4. Amniotic fluid not an activity
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17
Q

What are some gross body movements?

A

Rolling of the fetal trunk or turning of the fetal head

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18
Q

What is the breathing aspect of the BPP

A

Just practice breathing motion, hiccups

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19
Q

What is the fetal tone of the BPP?

A

Flexion and extension of a limb, fingers etc.

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20
Q

What are some additional assessments included with BPP? 5

A
  1. Biometry (BPD/HC, AC, FL)
  2. Doppler flow of the umbilical artery
  3. Amniotic fluid volume (AFI can be used here as well)
  4. Placenta grade and position
  5. Cord position
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21
Q

What are some factors that affect BPP score? 2

A
  1. Asphyxia
  2. Drugs
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22
Q

How does asphyxia affect the BPP score? 3

A

Low oxygen in the fetus
1. Extent or severity will result in a low BPP score
2. Duration or length of time fetus has low oxygen
3. frequency of the insult

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23
Q

What are some drugs that affect the BPP score? 3

A
  1. Sedatives (barbiturates- opium)
  2. Analgesics (morphine)
  3. Anesthetics (halothane)
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24
Q

Activity centers in the fetal brain that mature first are last to be affected by what?

A

Low oxygenation

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25
Q

The area in the fetal brain that controls fetal tone develops when?

A

First and is the last activity to disappear with worsening asphyxia

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26
Q

The fetal heart rate reactivity centers matures when?

A

About 28 weeks and is one of the first to be affected by asphyxia (this is monitored by the NST)

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27
Q

What should be assessed first for BPP

A

Fetal lie

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28
Q

If fetus isn’t practicing breathing what should we do?

A

Continue on with biometry. Keep checking for breathing between biometry

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29
Q

What is fetal breathing movements? How essential are these movements? What does it increase with?

A
  1. Spontaneous movements of the diaphragm in a cephalad- caudad direction
  2. Considered essential for fetal lung growth and preparation for extrauterine breathing
  3. Incidence increases with gestational age
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30
Q

How would we score a 2 on the fetal breathing movements?

A

30 seconds of continuous breathing is required

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31
Q

A score of zero on the fetal breathing movements is not a reliable indicator of what?

A

Poor wellness, as the fetus may have long episodes of apnea and still be normal

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32
Q

What is the most frequent element that we do not see the fetus perform during the BPP?

A

The fetal breathing movements

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33
Q

If we see fetal breathing as soon as the BPP exam starts what should we do?

A

Measure it as this tends to be when the fetus will be most active

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34
Q

What are some obvious signs of fetal breathing?

A

Abdomen heaving in and out

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35
Q

What is the Pitfall of the Fetal breathing movement portion of the BPP exam?

A

Mom’s breathing causes movement- make sure its the baby breathing

36
Q

How many gross body movements must be seen in 30 minutes to give a score of 2?

A

3 or more

37
Q

A gross body movement is what? 2

A
  1. When either the head or trunk moves (rolls)
  2. Large limb movements, face/hand movements swallowing also count
38
Q

How will a fetus score a 2/2 on the fetus tone test? 6

A

One movement of
1. Arm
2. Leg
3. Spine
4. Finger/ Hand
5. Toe/ Foot
6. A yawn

39
Q

What is an amniotic fluid pocket normally?

A

> 2x2 cm is normal and would get a 2/2 score

40
Q

What should we not include in the amniotic fluid pocket assessment?

A

Umbilical cord

41
Q

When would a patient under go a NST?

A

If the BPP score was <8

42
Q

NST are performed where?

A

In labor and delivery departments in the hospital on maternal fetal medicine clinics

43
Q

A 6/8 because of absent fetal breathing is not as concerning why? 2

A
  1. A NST would be recommended
  2. Some sites would not recommend NST if the biometry (growth of the fetus) is normal
44
Q

A 6/8 because of absent amniotic fluid or 0/2 for amniotic fluid is concerning why? 2

A
  1. Pregnancy is term or post dates delivery is recommended
  2. If pregnancy is preterm, bedrest is recommended and follow up BPP in a few days to see if the amniotic fluid level is improving
45
Q

What is Amniotic fluid index?

A

Method of assessing the amount of amniotic fluid in the amniotic sac around the fetus

46
Q

AFI is also performed when?

A

BPP scan

47
Q

Does AFI scores affect BPP scores?

A

No

48
Q

The amniotic fluid levels help in the assessment of what?

A

Placental function

49
Q

Amniotic fluid levels can also be affected by what? 2

A
  1. Maternal factors: Diabetes or high blood pressure
  2. Fetal: Renal abnormalities or swallowing difficulties
50
Q

If AFI is <5cm them it is termed what?

A

Olgiohydraminos

51
Q

If AFI >20 to 25cm then it is termed what?

A

polyhydraminos

52
Q

Amniotic fluid volume increases until when?

A

34 weeks then slowly diminishes

53
Q

When looking for AFI, we should measure how?

A

Vertical depth perpendicular to the floor

54
Q

Does the sequence of the quadrants matter when looking for AFI?

A

No

55
Q

Some machines will indicate the location of the fluid how?

A

RLQ, LLQ, RUQ, LUQ

56
Q

What is a NST (non-stress test)?

A

A tracing of the fetal heart is taken via electrodes placed on the maternal abdomen over the area of the fetal heart

57
Q

Is the NST a U/S test?

A

No

58
Q

Who performs the NST?

A

Obstetrician or a fetal assessment nurse

59
Q

What is a good indication during a NST?

A

An increased heart rate with fetal motion, with a quick return to base line once activity stops is a good indication of fetal well being

60
Q

For a NST what is carefully assessed?

A

The time the heart takes to return to normal

61
Q

Signs of fetal distress during NST are what? 3

A
  1. Slow response of the fetal heart to return to normal
  2. No change in fetal heart rate with activity
  3. Heart rate decelerations
62
Q

When assessing the NST what do we wait for?

A

At least 2 episodes of acceleration of >15 b/m and at least 15 seconds duration associated with fetal movement in a 30 minute period

63
Q

If the NST criteria is met what is the score? what if its not met?

A

2 if met and 0 if not met

64
Q

Which BPP results are considered normal?

A

8/10 or 10/10

65
Q

Which BPP scans would warrant us to repeat scan?

A

6/10 would warrant us to scan in 24 hours

66
Q

What are two high risk maternal factors or diseases?

A
  1. High blood pressure
  2. Type 1 Diabetes
67
Q

What happens if the BPP is 4/10, 2/10, or 0/10?

A

consideration for delivery

68
Q

BPP is not performed prior to how many weeks? why?

A

28 weeks, the score alone is not the indicator of fetal wellbeing

69
Q

What re some factors that might affect amniotic fluid? 2

A
  1. Premature rupture of membranes (PROM)
  2. Placental insufficiency
70
Q

What results in Placental insufficiency?

A
  1. Placental function is impaired from poor vascularization or impaired blood fetal growth resulting in a poor outcome
71
Q

The presence of normal biophysical activity indicates what?

A

That the CNS area that controls that activity is functioning well

72
Q

What is another tool we use normally for BPP?

A

Fetal doppler

73
Q

Fetal Doppler access the feto-placental circulation how?

A

In a non invasive manner

74
Q

Poor doppler results can help detect what? 3

A
  1. IUGR
  2. Twin to Twin transfusion
  3. Fetal growth compromise due to maternal hypertension/ IDDM
75
Q

What is the most common vessel to doppler?

A

Umbilical artery

76
Q

Low or absent diastolic flow indicates what?

A

Difficulty for fetus to return blood to placenta or a high resistance bed

77
Q

What are some reasons for Absent diastolic flow? 2

A

Placenta insufficiency or high vascular resistance

78
Q

What can reversed diastolic flow indicate? What does it mean?

A
  1. Very worrisome
  2. Can indicate immediate delivery depending on gestational age
79
Q

What are some factors affecting doppler waveform? 3

A
  1. Fetal respirations
  2. Heart rate
  3. Blood viscosity (hematocrit) in severely anemic fetuses
80
Q

Umbilical Artery flow becomes less resistive as what happens?

A

Pregnancy advances in normal states
as the vessels get larger as the pregnancy progresses the blood flow in these vessels are less resistive

81
Q

Although not a criteria for BPP, the placenta should be assessed for what?

A

Abruption and grade

82
Q

A grade 3 placenta is associated with what?

A

Abnormal fetal heart rates and increased risk of abruption

83
Q

A grade 3 placenta is a normal what?

A

Aging placenta in the late 3rd trimester. Seeing a grade 3 earlier in pregnancy is concerning.

84
Q

When do we normally see grade 3 placentas? (What habits cause it)

A

mothers who smoke

85
Q

What is this an example of?

A

Grade 3 placenta

86
Q

What is this an example of?

A

Grade 1 Placenta

DMST 244 OBGYN 1 (22 decks)

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