monitoring of the fetal heart

Question 1

how does acute placental insufficiency happen ?

Answer 1

suddenly occurs with an otherwise normal fetus leading to acute fetal distress such as in cord accidents and placental separation

Question 2

what is the end result or consequence of chronic placental insufficiency ?

Answer 2

small for gestational age

Question 3

what are the placental function tests ?

Answer 3

daily fetal movement count 
non stress test 
fetal biophysical profile 
doppler color flow studies 
oxytocin challenge test

Question 4

what blood vessels are checked using the doppler ?

Answer 4

ductus venosus
umbilical artery
middle cerebral artery

Question 5

what does the fetal biophysical profile include ?

Answer 5

breathing movement 
total body movement 
tone 
AFI 
CTG

Question 6

what does the modified BPP include ?

Answer 6

AFI plus NST

Question 7

what does high resistance in the doppler suggest ?

Answer 7

placental insufficiency

Question 8

what does low resistance in doppler indicate ?

Answer 8

hypoxia due to brain sparing phenomenon

Question 9

what does absent or reversed end-diastolic flow in the umbilical artery indicate ?

Answer 9

severely compromised fetus

Question 10

what does a positive OCT test indicate ?

Answer 10

FHR decreases with oxytocinn administration

Question 11

what does a negative OCT test indicate ?

Answer 11

No FHR changes in response to contractions which indicates good fetal well being

Question 12

what are the maternal risk factors that could cause fetal hypoxia ?

Answer 12

previous CS 
pre-eclampsia 
post term pregnancy 
prolonged membranes rupture 
induced labour 
diabetes 
antepartum hge

Question 13

what are the fetal risk factors for hypoxia ?

Answer 13

small for gestational age 
prematurity 
oligohydraminous 
abnormal doppler 
multiple pregnancies 
meconium

Question 14

how can meconium cause fetal distress ?

Answer 14

through aspiration pneumonia

Question 15

what are the intra-partum risk factors ?

Answer 15

oxytocin augmentation 
hypertonic uterus 
epidural analgesia 
vaginal bleeding 
maternal pyrexia 
fresh meconium 
Abnormal FHR

Question 16

in active labour how can fetal heart monitoring be performed in low risk and high risk patients ?

Answer 16

low risk - pinard and sonicaid

High risk - CTG and FBS if needed

Question 17

how often should FHR be assessed in the first stage of labour and in the second stage ?

Answer 17

first stage every 15 mins

second stage every 5 mins

Question 18

what is the normal baseline fetal heart rate ?

Answer 18

110-160 bpm

Question 19

at what FHR do we diagnose bradycardia and tachycardia ?

Answer 19

bradycardia : <110 bpm

tachycardia : > 160 bpm

Question 20

at what FHR do we consider the tachycardia and bradycardia to be pathological ?

Answer 20

pathological tachy : more than 180 bpm

pathological brady: less than 100 bpm

Question 21

what are the values for :
normal beat to beat variability
non-reassuring
pathological ?

Answer 21

normal: 5-25 bpm
non-reassuring: less than 5 for 30 to 50 minutes
or
more than 25 bpm for 15-25 minutes
pathological: less than 5 bpm for more than 50 minutes
or more than 25 for more than 25 minutes

Question 22

what is acceleration ?

Answer 22

increase in FHR by 15 bpm for longer than 15 seconds

Question 23

what is deceleration ?

Answer 23

a transient decrease in FHR by at least 15 bpm for more than 15 seconds

Question 24

what are the types of deceleration ?

Answer 24

variable and non variable

Question 25

what are the different types of non variable deceleration ?

Answer 25

non variable declaration : early and late

Question 26

what is early deceleration ?

Answer 26

uterine contractions and the decelerations occur at the same time on the CTG strio

Question 27

what is early deceleration a sign of ?

Answer 27

head compression, which means the mother is in labour and is a good sign

Question 28

what is late deceleration ?

Answer 28

the declaration happens after the uterine contraction , this is usually not a good sign

Question 29

what is late deceleration an indication of ?

Answer 29

uteroplacental insufficiency

Question 30

what is variable deceleration ?

Answer 30

uterine contractions and decelerations are not related to each other

Question 31

what is variable deceleration a sign of ?

Answer 31

cord compression

Question 32

what are efficient uterine contractions defined as ?

Answer 32

3 contractions in 10 minutes and each contraction should last more than 40 seconds each

Question 33

what is the RCOG classifications of CTG ?

Answer 33

normal = all 4 features are reassuring 
suspicious = one non reassuring feature 
pathological = one abnormal pattern or 2 non reassuring features

Question 34

when would there be a need for urgent intervention ?

Answer 34

if there is an acute onset of bradycardia or 1 single prolonged deceleration lasting more than 3 minutes

Question 35

what is sinusoidal rhythm an indication off ?

Answer 35

severe fetal anemia ( must be lasting at least 10 minutes)