OBN: Fetal Assessment

Question 1

___ is caused by head compression since the vagal nerve is activated

Answer 1

Early deceleration

Question 2

Cite 4 possible causes of uteroplacental insufficiency

Answer 2

1. Maternal hypotension
2. Excessive uterine activity
3. Placental dysfunction
4. Maternal diseases

Question 3

Abrupt decrease in FHR is defined as decrease from onset to FHR nadir is <30seconds. This suggests ____

Answer 3

Cord compression

Question 4

Normal baseline variability ranges from ___ beats per minute

Answer 4

6-25 bpm

Question 5

Late deceleration is due to ____

Answer 5

uteroplacental insufficiency

Question 6

Severe fatal anemia can lead to this type of pattern

Answer 6

Sinusoidal

Question 7

The cut-off of value for normal uterine contraction

Answer 7

less than 5 contractions in 10 minutes

Question 8

Determine the category.

110-160bpm, moderate variability, no decelerations, no acceleration

Answer 8

Category 1

Question 9

Determine the category.

Absent baseline variability, with bradycardia, recurrent late decelerations, and sinusoidal pattern

Answer 9

category 3

Question 10

A reactive NST means there are ____ accelerations within 20-40 minutes.

Answer 10

Reactive.

Note that NST: There should be no contraction present!

Question 11

What is the normal fetal movement per hour?

Answer 11

10 FM up to 2 hours

Question 12

[Fetal breathing]

What happens to the chest wall and abdomen of the fetus during inspiration?

Answer 12

1. Chest wall collapses

2. Abdomen protrudes

Question 13

[Fetal breathing]

What happens to the chest wall and abdomen of the fetus during expiration?

Answer 13

1. Chest wall expands

Question 14

Contraction stress test is a test of ____

Answer 14

uteroplacental function

Question 15

What are the criteria for a satisfactory contraction stress test?

Answer 15

1. 3 or more contractions
2. 40 seconds or more
3. 10 minute period

Question 16

A positive contraction stress test means that there is ___ of the fetal heart

Answer 16

1. Late deceleration following 50% or more of contraction
2. late deceleration even if the contraction is fewer than 3 in 10 mins

due to uteroplacental insufficiency

this is abnormal

Question 17

___ is a test of fetal condition

Answer 17

Non-stress test

Question 18

What are the methods in conducting CST?

Answer 18

1. Oxytocin infusion

2. Nipple stimulation

Question 19

What are the components of BPP?

Answer 19

Remember: NST MATaBa 3 2 1 1

SCORE 2 if

1. NST >/2 accel of >/15 bpm for >/15 sec
2. Movement = >/3 in 30 min
3. Amniotic fluid at least 2cm in 2 pockets
4. Tone >/ 1 episode of extremity extension and subsequent flexion
5. Breathing >/1 lasting >/ 30sec

Question 20

[BPP score Recommended management]

8/10

Answer 20

Deliver

Question 21

[BPP score Recommended management]

BPP of 6/10
Abnormal fluid volume

Answer 21

Deliver

Question 22

[BPP score Recommended management]

BPP of 6/10
Normal fluid, favorable cervix
>36 weeks AOG

Answer 22

deliver

Question 23

[BPP score Recommended management]

repeat testing BPP of 6/10

Answer 23

deliver

Question 24

[BPP score Recommended management]

BPP of 7/10

Answer 24

repeat

Question 25

[BPP score Recommended management] BPP of 4/10

Answer 25

repeat testing same day

Question 26

[BPP score Recommended management] initial BPP of 4/10; repeated same day becoming 6/10

Answer 26

deliver

Question 27

[Neural control of BPS activity] fetal tone

Answer 27

cortex-subcortical area last affected by asphyxia

Question 28

[Neural control of BPS activity] what is the first affected BPS parameter in fetal hypoxia?

Answer 28

HR

Question 29

[Neural control of BPS activity] fetal movement

Answer 29

cortex-nuclei

Question 30

[Neural control of BPS activity] fetal breathign

Answer 30

ventral surface of 4th ventricle

Question 31

[Neural control of BPS activity] fetal heart reactivity

Answer 31

Medulla and posterior thalamus

Question 32

[Fetal heart rate patterns] What is the normal HR of a fetus?

Answer 32

110-160; minimum 2 minutes in a 10 minute strip

Question 33

[Fetal heart rate patterns] A moderate variability of FHR mean that the amplitude is between

Answer 33

6-25 bpm (NORMA:)

Question 34

[Fetal heart rate patterns: Acceleration] Normal for >/32 weeks

Answer 34

>15bpm from baseline lasting 15 seconds less than 2 minutes

Question 35

[Fetal heart rate patterns: Acceleration] < 32 weeks

Answer 35

>/ 10 bpm from baseline lasting 10 seconds less than 2 mins

Question 36

[Fetal heart rate patterns: Acceleration] prolonged acceleration means ___

Answer 36

acceleration >2mins but <10 mins

Question 37

[Fetal heart rate patterns: Acceleration] a baseline change can be implied if the acceleration lasts

Answer 37

>/ 10mins

Question 38

[FHR abnormalities] oncet, nadir, and recovery are coincident with the beginning and ending of contraction

Answer 38

Early deceleration

Question 39

[FHR abnormalities] what are the causes of early deceleration?

Answer 39

1. Fetal head compression --> Increase ICP leading to decreased HR

Question 40

[FHR abnormalities] onset, nadir, and recovery of deceleration occur after the beginning, peak, and ending of a contraction

Answer 40

Late deceleration

Question 41

[FHR abnormalities] what are the causes of late deceleration?

Answer 41

1. Uteroplacental insufficiency; stimulation of chemoreceptor leading to stimulation of vagal nerve decreasing the HR

Question 42

what is the most common deceleration pattern?

Answer 42

variable deceleration

Question 43

Variable deceleration is due to ___

Answer 43

umbilical cord occlusion

Question 44

[Intervention] Recurrent late deceleration, prolonged deceleration, or bradycardia

Answer 44

1. Lateral decubitus positioning 2. Administer maternal oxygen 3. Administer IV fluid bolus 4. Reduce uterine contraction frequency

Question 45

[Intervention] Tachysystole with Cat II or Cat III tracing

Answer 45

1. Discontinue oxytocin or prostaglandin | 2. Give tocolytics (terbutaline, magnesium sulfate)

Question 46

[Intervention] Recurrent variable decelerations

Answer 46

Repositioning of the mother

Question 47

[Intervention] Prolonged deceleration or bradycardia from umbilical cord compression

Answer 47

1. Amnioinfusion

Question 48

[Intervention] recurrent variable decelerations, prolonged decelerations, bradycardia with prolapsed cord

Answer 48

elevate the presenting part, prepare for delivery