Quad screen and FHR Flashcards
office visits
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
quad screen
test maternal blood for: AFP hCG Estriol Inhibin-A
AFP
produced by fetus
hCG
produced by placenta
estriol
produced by both fetus and placenta
inhibin A
produced by placenta and ovaries
trisomy 21
nuchal translucency
decreased AFP and estriol
increased hCG and inhibin A
trisomy 18
aka edwards syndrome
decreased AFP, hCG, estriol
normal inhibin A
live for 5-15days
trisomy 13
aka pataus syndrome
nuchal translucency
quad screening usually normal, sometimes hCG increased
median survival 2.5 days
who should be screened with quad screen
everyone, but particularly: family hx of birth defects 35+ harmful meds during prego DM viral infection radiation exposure
high AFP suggests
neural tube defects
spina bifida, anencephaly
most common cause of elevated AFP is inaccurate dating of prego
low levels of AFP and abnormal hCG and estriol
chromosomal defects
early gestation fetal heart
predominately under control of sympathetics and arterial chemoreceptors
late gestation fetal heart
under vagal control
baseline FHR
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
bradycardia
FHR <110
110-119 in absence of other concerning patterns is not usually a sign of compromise
etiologies of bradycardia
heart block
occiput posterior or transverse
serious fetal compormise
tachycardia
FHR>160
in presense of good variability tachy is not a sign of fetal distress
etiologies of tachy
meternal fever fetal hypoxia fetal anemia amnionitis fetal tachyarrythmia SVT heart failure drugs rebound
baseline change
decrease of increase in rate for >10min
baseline variability
fluctuations in FHR of more then 2 cycles/min
no distinction is made between short term and long term variability
grades of fluctuation
based on amplitude range
minimal variability
<5BPM
moderate variability
6-25BPM
marked variability
> 25BPM
sinusoidal pattern
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
most significant intrapartum sign of fetal compromise
persistently minimal or absent FHR variability
etiologies of decreased variabiliyt
metabolic acidosis CNS depressants fetal sleep cycles congenital anomalies prematurity tachy preexisting neuro abnormality betamethasone
accelerations
abrupt increase in FHR above baseline with onset to peak <2min duration
adequate accelerations
10bmp above baseline for >10sec
>32wks >15bpm above baseline for >15sec
prolonged accelerations
increase in HR 2-10min
reactivity
increase of 15bpm for 15 seconds twice 20min period
premature fetuses often do not have reactivity
used in antenatal testing
episodic deceleration patterns
not associated with uterine contractions
periodic deceleration patterns
those associated with uterine contractions
early and late decelerations
variables can also be periodic
gradual decelerations
decrease to nadir >30secs
abrupt deceleration
decrease in FHR >15bpm <30 sec
early deceleration
gradual deceleration with the nadir at peak of contraction
late deceleration
gradual deceleration, but begins after onset of contraction and nadir occurs after peak of contraction
variable deceleration
abrupt deceleration lasting >15sec but <2min
usually indicated cord compression
not concerning unless continues to happen
recurrent decelerations
variable, early, or late
occur with >50% of contractions in 20min segment
prolonged deceleration
decrease of FHR >15bpm measured from most recently determined baseline rate
deceleration lasts >2min, but <10min
etiologies of prolonged and recurrent decelerations
maternal hypotension uterine hyperactivity cord prolapse cord compression abruption artifact maternal seizure
late decelerations associated with preservation of beat-beat variability
appear to be mediated by aa chemo receptors in mild hypoxia
decreased O2 -> vasoconstriction -> HTN -> decreased HR
etiologies of late decelerations
excessive uterine contractions
maternal hypotension
maternal hypoxemia
reduced placental exchange (HTN, DM, IUGR, abruption)
management of late decelerations
place pt on left side discontinue oxytocin correct hypotension IV hydration Rx Tx tachyssystole O2 mask
if late decelerations persist for >30 min
must do scalp pH
scalp pH
> 7.25 good
7.2-7.25 repeat in 30 min
<7.2 delivery
recurrent late decelerations with minimal or absent variability
expeditious delivery
variable deceleration
vagally mediated via chemo and baroreceptors
accelerations before and after variable deceleration thoght to be partial cord occulsions
management of variables
change positions to where FHR pattern most improved
discontinue oxytocin
check for cord prolapse or imminent delivery by vag exam
consider aminoinfusion
O2 administration
uterine contractions
quantified as number of contraction in 10 min averaged over 30min
normal uterine contractions
5 or less contractions in 10 min averaged over 30min
tachysystole
> 5 contractions in 10min averaged over 30 min
category I
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
category II
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
category III
FHR shows either of the following:
sinusoidal pattern or
absent variability with recurrent late decelerations, recurrent variable decelerations, or
brady
