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Repro II > Quad screen and FHR > Flashcards

Quad screen and FHR Flashcards

1
Q

office visits

A 
first visit 8-10 wks (earlier if at risk for ectopic)
every 4 wks for first 2 wks
every 2-3 weeks until 36wks
every wk after 36
postpartum 21 and 56 days
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2
Q

quad screen

A 
test maternal blood for:
AFP 
hCG
Estriol
Inhibin-A
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3
Q

AFP

A

produced by fetus

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4
Q

hCG

A

produced by placenta

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5
Q

estriol

A

produced by both fetus and placenta

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6
Q

inhibin A

A

produced by placenta and ovaries

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7
Q

trisomy 21

A

nuchal translucency
decreased AFP and estriol
increased hCG and inhibin A

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8
Q

trisomy 18

A

aka edwards syndrome
decreased AFP, hCG, estriol
normal inhibin A
live for 5-15days

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9
Q

trisomy 13

A

aka pataus syndrome
nuchal translucency
quad screening usually normal, sometimes hCG increased
median survival 2.5 days

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10
Q

who should be screened with quad screen

A 
everyone, but particularly:
family hx of birth defects
35+
harmful meds during prego
DM
viral infection
radiation exposure
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11
Q

high AFP suggests

A

neural tube defects
spina bifida, anencephaly
most common cause of elevated AFP is inaccurate dating of prego

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12
Q

low levels of AFP and abnormal hCG and estriol

A

chromosomal defects

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13
Q

early gestation fetal heart

A

predominately under control of sympathetics and arterial chemoreceptors

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14
Q

late gestation fetal heart

A

under vagal control

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15
Q

baseline FHR

A

heart rate during a ten min (minimum of 2 min)segment rounded to nearest 5 beat/min increment excluding segments that differ by more then 25beats/min

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16
Q

bradycardia

A

FHR <110

110-119 in absence of other concerning patterns is not usually a sign of compromise

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17
Q

etiologies of bradycardia

A

heart block
occiput posterior or transverse
serious fetal compormise

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18
Q

tachycardia

A

FHR>160

in presense of good variability tachy is not a sign of fetal distress

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19
Q

etiologies of tachy

A 
meternal fever
fetal hypoxia
fetal anemia
amnionitis
fetal tachyarrythmia 
SVT
heart failure
drugs
rebound
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20
Q

baseline change

A

decrease of increase in rate for >10min

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21
Q

baseline variability

A

fluctuations in FHR of more then 2 cycles/min

no distinction is made between short term and long term variability

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22
Q

grades of fluctuation

A

based on amplitude range

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23
Q

minimal variability

A

<5BPM

24
Q

moderate variability

A

6-25BPM

25
Q

marked variability

A

> 25BPM

26
Q

sinusoidal pattern

A

regular amplitude and frequency and is exluded in the definition of varability
lasts 10min with fixed period of 3-5 cycles/min and an amplitude 5-15bpm

27
Q

most significant intrapartum sign of fetal compromise

A

persistently minimal or absent FHR variability

28
Q

etiologies of decreased variabiliyt

A 
metabolic acidosis
CNS depressants
fetal sleep cycles
congenital anomalies
prematurity
tachy
preexisting neuro abnormality
betamethasone
29
Q

accelerations

A

abrupt increase in FHR above baseline with onset to peak <2min duration

30
Q

adequate accelerations

A

10bmp above baseline for >10sec

>32wks >15bpm above baseline for >15sec

31
Q

prolonged accelerations

A

increase in HR 2-10min

32
Q

reactivity

A

increase of 15bpm for 15 seconds twice 20min period
premature fetuses often do not have reactivity
used in antenatal testing

33
Q

episodic deceleration patterns

A

not associated with uterine contractions

34
Q

periodic deceleration patterns

A

those associated with uterine contractions
early and late decelerations
variables can also be periodic

35
Q

gradual decelerations

A

decrease to nadir >30secs

36
Q

abrupt deceleration

A

decrease in FHR >15bpm <30 sec

37
Q

early deceleration

A

gradual deceleration with the nadir at peak of contraction

38
Q

late deceleration

A

gradual deceleration, but begins after onset of contraction and nadir occurs after peak of contraction

39
Q

variable deceleration

A

abrupt deceleration lasting >15sec but <2min
usually indicated cord compression
not concerning unless continues to happen

40
Q

recurrent decelerations

A

variable, early, or late

occur with >50% of contractions in 20min segment

41
Q

prolonged deceleration

A

decrease of FHR >15bpm measured from most recently determined baseline rate
deceleration lasts >2min, but <10min

42
Q

etiologies of prolonged and recurrent decelerations

A 
maternal hypotension
uterine hyperactivity
cord prolapse
cord compression
abruption
artifact
maternal seizure
43
Q

late decelerations associated with preservation of beat-beat variability

A

appear to be mediated by aa chemo receptors in mild hypoxia

decreased O2 -> vasoconstriction -> HTN -> decreased HR

44
Q

etiologies of late decelerations

A

excessive uterine contractions
maternal hypotension
maternal hypoxemia
reduced placental exchange (HTN, DM, IUGR, abruption)

45
Q

management of late decelerations

A 
place pt on left side
discontinue oxytocin
correct hypotension
IV hydration
Rx Tx tachyssystole
O2 mask
46
Q

if late decelerations persist for >30 min

A

must do scalp pH

47
Q

scalp pH

A

> 7.25 good
7.2-7.25 repeat in 30 min
<7.2 delivery

48
Q

recurrent late decelerations with minimal or absent variability

A

expeditious delivery

49
Q

variable deceleration

A

vagally mediated via chemo and baroreceptors

accelerations before and after variable deceleration thoght to be partial cord occulsions

50
Q

management of variables

A

change positions to where FHR pattern most improved
discontinue oxytocin
check for cord prolapse or imminent delivery by vag exam
consider aminoinfusion
O2 administration

51
Q

uterine contractions

A

quantified as number of contraction in 10 min averaged over 30min

52
Q

normal uterine contractions

A

5 or less contractions in 10 min averaged over 30min

53
Q

tachysystole

A

> 5 contractions in 10min averaged over 30 min

54
Q

category I

A 
normal
FHR shows ALL of the following:
baseline 110-160
moderate FHR variability
accelerations present or absent
no late or variable decelerations
may have early decelerations
55
Q

category II

A

indeterminate
FHR shows ANY of the following
tachy
brady w/o absent variability
absent variability w/o recurrent decelerations
marked variability
absence of accelerations after stimulation
prolonged deceleration >2min, but <10min
recurrent late decelerations with moderate variability
variable decelerations with slow return to baseline and/or overshoot

56
Q

category III

A

FHR shows either of the following:
sinusoidal pattern or
absent variability with recurrent late decelerations, recurrent variable decelerations, or
brady

Repro II (20 decks)

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