Prenatal Assessment Of Fetal Well Being

Question 1

False positive test

Answer 1

Abnormal test that prompts untimely delivery but not associated with evidence of fetal compromise

Question 2

False negative test

Answer 2

Fetal death occurs within a week of a normal antepartum test

Question 3

Antepartum fetal monitoring

Answer 3

1- screening tests

2- specific tests

Question 4

Screening tests

Answer 4

1- fetal movements

2- symphysiofundal height

Question 5

Fetal movements are felt by mother in which trimester

Answer 5

Second trimester

Question 6

What is quickening

Answer 6

It is the first movement perceived by the mother

Question 7

Frequency of normal fetal movements

Answer 7

Greater than 10 times per hour. No of times the mother perceives it in one day are from 10-1000

Question 8

Which week is the fetal activity greatest

Answer 8

28- 32 weeks

Question 9

Hours at which activity is greatest

Answer 9

9 pm to 2 am

Question 10

Cardiff count to ten kick chart

Answer 10

Start counting at 9 am and count atleast 10 kicks by 9 pm otherwise consult doctor

Question 11

Other methods of fetal movements assessment

Answer 11

Daily counting at the same time for the 1 hour. If 10 are counted all is fine. If not count for another 1 hour. Less than 10 kicks in 2 hours go to doctor

Question 12

Another method (2)

Answer 12

Fewer than 4 kicks in 30 minutes, go to doctor

Question 13

Non stress CTG

Answer 13

Ctg performed in the antenatal period without any stress

Question 14

Requirements of CtG

Answer 14

Abdominal probe and pressure gauge

Question 15

Components of cTG

Answer 15

Tocogram and cardiogram

Question 16

CTG variables

Answer 16

1- baseline fetal heart rate
2 - fetal heart rate variability
3- accelerations
4- decelerations

Question 17

Effect on CTG by fetal nervous system maturation (28-32 weeks)

Answer 17

Before nervous system maturation there is high baseline fetal heart rate and low variability

2- fetus develops periods of quiet sleep

Question 18

Quiet sleep phase of fetus

Answer 18

Lasts for 20-30 minutes and has absence of fetal movements, absence of accelerations and low fetal heart rate variability

Question 19

Fetal heart rate in prolonged pregnancy

Answer 19

Less than 110 beats per min

Question 20

Normal fetal heart rate

Answer 20

135 beats per minute
Range of 110 to 150 beats per min
Less than 110 is bradycardia
Greater than 150 is tachycardia

Question 21

Effects of acute hypoxia on fetal heart rate

Answer 21

Bradycardia due to vagal stimulation.

May get normal due to sympathetic stimulation. It also causes peripheral vasoconstriction

Question 22

Chronic hypoxia on fetal heart rate

Answer 22

Remains normal

Question 23

Non hypoxic bradycardia

Answer 23

Prolonged pregnancy. 
Fetal heart block. 
Maternal hypothyroidism. 
Maternal hypoglycaemia. 
CMV. 
Beta blockers. 
Local anesthetic drugs injected into blood vessels

Question 24

Non tachycardic hypoxia

Answer 24

Fetal prematurity.
Anemia. 
Maternal anxiety. 
Hyperthyroidism. 
Pyrexia.
Beta sympathomimetics. 
Para sympatholytics.

Question 25

Fetal heart rate variability

Answer 25

Normally 5-25 beats per min

Question 26

Reduced heart rate variability

Answer 26

Less than 5 beats per minute in fetal hypoxia.

Also occurs during quiet sleep phase. Maternal drugs like diazepam and local anesthetics, earlier gestation

Question 27

Sinusoidal pattern

Answer 27

Heart rate variability greater than 25 beats per min.
Periodicity of 2-5 cycles per min.
Loss of short term beat to beat variability.
Seen in fetal anemia

Question 28

Acceleration

Answer 28

Greater than 15 beats per min for more than 15 seconds

Question 29

Decelerations

Answer 29

Of greater than 15 beats per min for 10 seconds

Question 30

What is the first sign of fetal hypoxia on CtG

Answer 30

Loss of accelerations

Question 31

Reactive CTG

Answer 31

Baseline FHR of 110 to 150
FHR variability of 5 to 25
Atleast 2 accelerations over 15 to 20 minute period
No decelerations

Question 32

Sequence of CtG variables in hypoxia

Answer 32

1- loss of accelerations
2- loss of variability
3- appearance of decelerations

Question 33

CTG scoring system

Answer 33

6 point scoring system. 
Baseline FHR. 
FHR in response to fetal movements. 
FHR in response to braxton hicks contractions. 
2 points to each normal response.

Question 34

Stress Test CTG

Answer 34

1- oxytocin stress test
2 - nipple stimulation test
3- vibroacoustic stress test

Question 35

Fetal ultrasound growth parameters

Answer 35

1- abdominal circumference
2- biparietal diameter
3- femur length

Question 36

Min time b/w 2 ultrasounds

Answer 36

2 weeks

Question 37

Biophysical profile

Answer 37

1- CtG 
Ultrasound 
2- fetal body movements 
3- fetal breathing movements 
4- fetal tone 
5- liquor volume

Question 38

Manning scoring for BPP

Answer 38

2 for normal. 0 for abnormal.
Total score is 10.
Score of 6. Repeat.
Score of 4. Delivery

Question 39

Drawback of bpP

Answer 39

High false positive rate

Question 40

Modifications of BPP

Answer 40

1- If ultrasound is normal: ctg is minused
2- In USD. Fetal body movements can be cut out.
3- we can use only CTG, fetal breathing movements and liquor volume
4- we can use only CTG and liquor volume

Question 41

Doppler ultrasound

Answer 41

Flow velocity waveform 
Systolic flow is S
Diastolic flow is D
Low S/D ratio is good 
High S/D ratio is bad 
Absent end diastolic flow. 
Reversed end diastolic flow.