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Year2 Repro exam II > Quad Screen and fetal heart rate > Flashcards

Quad Screen and fetal heart rate Flashcards

1
Q

Describe the office visit plan for pregnant women

A

every 4 weeks for first 28 weeks
every 2-3 weeks until 36 weeks
every week after 36 weeks

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2
Q

what is the quad screen

A

maternal blood screening that looks for 4 specific substances
AFP, hCG, Estriol and Inhibin A

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3
Q

what produces AFP

A

fetus

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4
Q

what produces hCG

A

placenta

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5
Q

what produces estriol

A

fetus and placenta

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6
Q

what produces Inhibin A

A

placenta and ovaries

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7
Q

how will downs present on quad screen

A

decreased AFP, estriol

Increased hCG and inhibin A

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8
Q

US of downs may show what

A

nuchal translucency

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9
Q

how will edwards trisomy 18 present on quad screen

A

decreased: AFP hCG and estriol

normal inhibin A

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10
Q

signs of trisomy 18

A

severe mental retardation, rocker bottom feet, micrognathia, low set ears, clenched hands, prominent occiput

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11
Q

lifespan of neonates with trisomy 18

A

50% die within first week

only 8% live beyond year 1

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12
Q

What is trisomy 13

A

pataus

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13
Q

patau on US

A

nuchal translucency

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14
Q

trisomy 13 on quad screen

A

sometimes hCG dec

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15
Q

survival baby with patau

A

2.5 days

5% make it a year

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16
Q

quad screen recommended especially for women who

A 
\+FMH birth defects
35+ y.o
use of harmful medications or drugs during pregnancy
DM and use insulin
viral infection during pregnancy
exposed to high levels radiation
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17
Q

the quad screen is combined with what factors

A

mothers age and ethnicity

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18
Q

high AFP suggests what

A

spina bifida or elevated ARP levels from inaccurate dating of pregnancy

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19
Q

low levels AFP

abnormal hCG and estriol suggest what

A

baby has Trisomy 21 and 18

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20
Q

what causes the decrease in fetal heart rate as it develops

A

response to parasympathetics

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21
Q

what are the components of the fetal heart rate tracing

A
  • baseline rate
  • baseline fetal heart rate variability
  • presence of accelerations
  • periodic of episodic decelerations
  • changes of trends of FHR patterns over time
  • Frequency and intensity of uterine contractions
22
Q

what is the baseline fetal heart rate

A

during 10 minute segment rounded to nearest 5 beat per min

23
Q

minimum amount of time for baseline fetal heart rate

A

2 minutes

24
Q

what is bradycardia in fetus

A

mean FHR <110 BPM

in absence of other non-reassuring patterns is not usually a sign of compromise

25
Q

etiologies of bradycardia in fetus

A

heart block, occiput posterior or transverse position, serious fetal compromise

26
Q

what is tachycardia in fetus

A

mean FHR >160BPM

27
Q

etiologies of tachycardia in fetus

A

maternal fever, fetal hypoxia, fetal anemia, amnionitis, fetal tachyarrhythmia(no variability), fetal heart failure, drugs, rebound

28
Q

what constitutes a baseline change in fetal heart rate

A

decrease or increase in HR that lasts longer than 10 minutes

29
Q

what is baseline variability

A

fluctuations of fetal heart rate more than 2 cycles per minute

30
Q

grades of HR variability depend on what

A

amplitude range

31
Q

what is minimal HR variability?
moderate?
marked?

A

25 BPM

32
Q

what is a sinusoidal pattern of fetal heart tracing

A

smooth, undulatin pattern

lasting at least 10 minutes with a fixed period of 3-5 cycles per minute with amplitude of 5-15 bpm

33
Q

what is the most significant intrapartum sign of fetal compromise

A

persistently minimal or absent FHR variability

34
Q

what can cause decreased variability in fetal heart rate

A

metabolic acidosis, CNS depressants, fetal sleep cycles, congenital anomalies, prematurity, fetal tachy, preexisting neurologic abnormality, betamethasone

35
Q

what is an acceleration in fetal heart racing

A

onset peak of acceleration <30 sec and less than 2 minutes in duration

36
Q

what is adequate acceleration for <32 weeks old fetus

A

> 10 BPM above baseline for >10 seconds

37
Q

what is adequate acceleration for >32 weeks old fetus

A

> 15 BPM above baseline for >15 seconds

38
Q

what is a prolonged acceleration in HR

A

2-10 minutes

39
Q

absence of acclerations in HR more more than how long correlates with increased neonatal morbidity

A

80 minutes

40
Q

what can be used to induce accelerations in fetal heart rate

A

fetal scalp stimulation

41
Q

what is “reactivity” in fetal heart rate

A

increase 15 BPM above baseline for 15 sec duration

42
Q

what are episodic patterns in fetal heart rate

A

not assoc with uterine contractions

43
Q

what are periodic patterns in fetal heart rate

A

associated with uterine contractions

44
Q

what are the types of deceleration patterns

A

gradual- decrease and return to baseline with time from onset of deceleration to nadir >30 sec
abrubt- decrease in FHR >15 bpm with onset deceleration to nadir <30 sec

45
Q

what is nadir when talking about decelerations

A

low point of FHR

46
Q

early deceleration

A

gradual decrease in FHR with onset duration to nadir >30 sec

47
Q

late deceleration

A

gradual decrease in FHR with onset deceleration to nadir >30 sex
onset deceleration occurs after begining of the contraction
nadir of contraction occurs after peak

48
Q

decelerations occur with what

A

> 50% of uterine contractions

49
Q

what is a prolonged deceleration

A

decrease in FHR >15 bpm measure from most recent baseline rate

50
Q

etiologies of prolonged deceleration in fetal heart patterns

A

maternal hypotension, uterine hyperactivity, cord prolapse, cord compression, abruption, artifact, maternal seizure

51
Q

common cause of prolonged deceleration

A

umbilical cord compression

Year2 Repro exam II (19 decks)

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