Unit 3 Module 3 (Exam 2) Flashcards
Not a question
Helpful chart for later use
Slide 3
Which of the following best describes a key difference between fetal and adult circulation?
a) Fetal circulation does not require oxygen
b) Fetal circulation includes shunts and specialized vessels
c) Adult circulation uses a lower resistance system than fetal circulation
d) Fetal circulation functions in series, like adult circulation
b) Fetal circulation includes shunts and specialized vessels
Essential for providing oxygen and nutrients while the fetal lungs are still developing
Slide 4
Where does oxygen exchange occur in the fetus?
a) Lungs
b) Heart
c) Liver
d) Placenta
d) Placenta
slide 4
How does fetal circulation differ from adult circulation?
a) Fetal circulation is in series, while adult circulation is parallel
b) Both fetal and adult circulation are in parallel
c) Fetal circulation is parallel, while adult circulation is in series
d) Both fetal and adult circulation are in series
c) Fetal circulation is parallel, while adult circulation is in series
Slide 5
Which of the following structures are part of the fetal circulatory system? Select 3
a) Ductus Arteriosus
b) Pulmonary Vein
c) Foramen Ovale
d) Ductus Venosus
e) Left Atrium
f) Aortic Valve
a) Ductus Arteriosus
c) Foramen Ovale
d) Ductus Venosus
slide 5
Pulmonary vascular resistance (PVR) is ____ in the fetus due to collapsed lungs and minimal pulmonary circulation.
a) High
b) Low
c) Normal
d) Fluctuating
a) High
slide 6
Systemic vascular resistance (SVR) is ______ in the fetus because the placenta is a _______-resistance vascular bed.
a) High, low
b) Low, low
c) Low, high
d) Unchanged, high
b) Low, low
slide 6
Which of the following best describes fetal hemoglobin (HbF)?
a) It has a lower affinity for oxygen than adult hemoglobin (HbA)
b) It has the same oxygen affinity as adult hemoglobin (HbA)
c) It has a higher affinity for oxygen than adult hemoglobin (HbA)
d) It does not bind oxygen at all
c) It has a higher affinity for oxygen than adult hemoglobin (HbA)
*D/t structural differences
* Efficient oxygen extraction from the maternal blood
* Optimizes oxygen supply during fetal development
slide 6
What is the function of the umbilical vein (1)?
a) It carries oxygen-rich blood from the fetus to the placenta
b) It carries oxygen-poor blood from the fetus to the placenta
c) It brings oxygenated blood from the placenta to the fetus
d) It connects the right atrium and left atrium in fetal circulation
c) It brings oxygenated blood from the placenta to the fetus
Only 1 vein
slide 7
What is the function of the umbilical arteries?
a) They bring oxygenated blood from the placenta to the fetus
b) They carry oxygen-poor blood from the fetus back to the placenta
c) They connect the placenta directly to the fetal liver
d) They deliver oxygenated blood directly to the fetal lungs
b) They carry oxygen-poor blood from the fetus back to the placenta
2 arteries
Slide 7
Match the following processes to their correct functions:
A. Gas Exchange
B. Nutrient Exchange
C. Waste Exchange
- Essential nutrients, including glucose, are transported to the fetus for growth and development. → ____
- Metabolic by-products like carbon dioxide are transported from the fetus to the maternal circulation for elimination. → ____
- Oxygen from the mother’s blood is transferred to the fetus, and carbon dioxide is removed. → ____
A. Gas Exchange → 3. Oxygen from the mother’s blood is transferred to the fetus, and carbon dioxide produced by the fetus is carried away.
B. Nutrient Exchange → 1. Essential nutrients in maternal blood, including glucose and others, are transported to the fetus for growth and development.
C. Waste Exchange → 2. Metabolic by-products generated by the fetus, such as carbon dioxide and other wastes, are transported to the maternal circulation for elimination.
Slide 7
In adult circulation, what is the primary function of the right side of the heart?
a) To provide systemic blood flow
b) To pump oxygen-rich blood to the body
c) To receive oxygenated blood from the lungs
d) To provide pulmonary blood flow
d) To provide pulmonary blood flow
Slide 9
In fetal circulation, which statement is true?
a) Only the left side of the fetal heart provides systemic blood flow
b) The right side of the fetal heart pumps blood only to the lungs
c) Both the right and left sides of the fetal heart provide systemic blood flow
d) Fetal circulation is identical to adult circulation
c) Both the right and left sides of the fetal heart provide systemic blood flow
slide 9
The ductus venosus (DV) is a blood vessel that allows some of the oxygenated blood from the placenta to bypass the immature ______ circulation.
a) Pulmonary
b) Hepatic
c) Systemic
d) Renal
b) Hepatic (portal)
Slide 10
After passing through the ductus venosus, oxygenated blood enters the ______ before reaching the right atrium of the heart.
a) Aorta
b) Superior vena cava
c) Inferior vena cava
d) Pulmonary artery
c) Inferior vena cava
slide 10
The foramen ovale (FO) is an opening that allows oxygenated blood to flow from the ______ to the ______, bypassing the immature fetal lungs.
a) Right atrium; left atrium
b) Left atrium; right atrium
c) Right ventricle; left ventricle
d) Pulmonary artery; aorta
a) Right atrium; left atrium
slide 11
The right-to-left shunt through the foramen ovale is driven by a pressure gradient caused by ______.
a) Low fetal cardiac output
b) Low systemic vascular resistance
c) Increased left atrial pressure
d) High fetal pulmonary vascular resistance
d) High fetal pulmonary vascular resistance
Slide 11
The ductus arteriosus (DA) is a blood vessel that connects the ______ to the ______, diverting blood away from the underdeveloped fetal lungs.
a) Right atrium; left atrium
b) Pulmonary artery; descending aorta
c) Inferior vena cava; right atrium
d) Left ventricle; aorta
b) Pulmonary artery; descending aorta
Slide 11
About half of the blood entering the fetus through the umbilical vein goes to the ______, while the other half bypasses this system through the ______ and enters the inferior vena cava.
a) Liver; foramen ovale
b) Lungs; ductus arteriosus
c) Fetal portal circulation; ductus venosus
d) Right atrium; pulmonary artery
c) Fetal portal circulation; ductus venosus
slide 15
As gestational age increases, the percentage of blood directed to the ______ increases.
a) Kidneys
b) Liver
c) Heart
d) Lungs
b) Liver
slide 15
Once oxygenated blood enters the ______, it mixes with a small amount of deoxygenated blood returning from the ______.
a) Superior vena cava; fetal lower body
b) Pulmonary vein; left atrium
c) Right atrium; pulmonary artery
d) Inferior vena cava; fetal lower body
d) Inferior vena cava; fetal lower body
This is “mixed” blood
Slide 17
The mixed blood from the inferior vena cava enters the ______, where it combines with additional blood from the ______.
a) Right atrium; superior vena cava
b) Left atrium; pulmonary artery
c) Left ventricle; umbilical vein
d) Pulmonary vein; descending aorta
a) Right atrium; superior vena cava
slide 17
The majority of blood in the right atrium passes through the ______ and enters the ______, bypassing the immature lungs.
a) Ductus arteriosus; right ventricle
b) Foramen ovale; left atrium
c) Pulmonary artery; aorta
d) Superior vena cava; inferior vena cava
b) Foramen ovale; left atrium
Slide 18
Which of the following are functions of the foramen ovale in fetal circulation?
Select 3
a) Pumps blood into the pulmonary artery for gas exchange
b) Conserving energy
c) Sends deoxygenated blood to the placenta for oxygenation
d) Optimizes oxygen delivery to the fetal heart and brain
e) Bypasses the immature lungs
b) Conserving energy
d) Optimizes oxygen delivery to the fetal heart and brain
e) Bypasses the immature lungs
Slide 18
Some blood from the right atrium still enters the ______, where it will then travel through the ______ before reaching fetal circulation.
a) Right ventricle; pulmonary artery
b) Left atrium; aorta
c) Left ventricle; umbilical vein
d) Inferior vena cava; superior vena cava
a) Right ventricle; pulmonary artery
Slide 18
After passing through the foramen ovale (FO), blood enters the left atrium and then moves into the ______ before being ejected into the ascending aorta.
a) Right atrium
b) Right ventricle
c) Left ventricle
d) Pulmonary artery
c) Left ventricle
RA → FO → LA → LV → AA → Systemic Circulation
Slide 19
Which of the following are functions of the left ventricle in fetal circulation?
Select 3
a) Pumps blood into the ascending aorta
b) Directs blood toward the pulmonary circulation
c) Supplies coronary and cerebral circulation
d) Pumps deoxygenated blood to the placenta
e) Supplies blood to the upper body of the fetus
a) Pumps blood into the ascending aorta
c) Supplies coronary and cerebral circulation
e) Supplies blood to the upper body of the fetus
Slide 19
Why is pulmonary vascular resistance (PVR) high in the fetal lungs?
a) The lungs are filled with amniotic fluid
b) The fetus produces hormones
c) The placenta supplies all oxygen
d) The pulmonary arteries are enlarged
a) The lungs are filled with amniotic fluid
This causes the pressure to be higher in the RA and push blood into the LA through the FO
Slide 20
What percentage of blood from the right ventricle actually goes through the pulmonary circulation in the fetus?
a) 50%
b) 25%
c) 10%
d) 90%
c) 10%
Goes from the right atrium to the right ventricle (NOT through the FO) to the pulmonary artery to pulmonary circulation
Slide 22
Where does the majority (~90%) of blood in the pulmonary artery go in fetal circulation?
a) Through the pulmonary veins to the left atrium
b) Through the ductus arteriosus to the descending aorta
c) Directly into the right ventricle for recirculation
d) Through the umbilical artery back to the placenta
b) Through the ductus arteriosus to the descending aorta
Perfusing the lower body of the fetus
Pulmonary Vascular Resistance > Systemic Vascular Resistance
* This is why it goes through the ductus arteriosus instead of the right ventricle
Slide 22
What is the function of the umbilical arteries in fetal circulation?
a) Carry oxygenated blood from the placenta to the fetus
b) Carry deoxygenated blood from the fetus to the placenta
c) Supply oxygen-rich blood to the fetal lungs
d) Transport nutrients from the maternal blood to the fetal circulation
b) Carry deoxygenated blood from the fetus to the placenta
Slide 24
Where do the umbilical arteries transport blood for gas and nutrient exchange?
a) Fetal lungs
b) Fetal liver
c) Placental villi
d) Inferior vena cava
c) Placental villi
Gas, nutrient and waste exchange
Slide 24
Which part of the autonomic nervous system develops first and is predominant throughout fetal life?
a) Parasympathetic nervous system
b) Sympathetic nervous system
c) Somatic nervous system
d) Central nervous system
a) Parasympathetic nervous system
slide 26
Baroreceptors in the ______ and ______ sense blood pressure changes related to environmental factors.
a) Liver; kidneys
b) Brainstem; spinal cord
c) Lungs; placenta
d) Aortic arch; carotid arteries
d) Aortic arch; carotid arteries
Slide 26
Which external factor can influence fetal blood pressure regulation via baroreceptors?
Select 2
a) Amniotic fluid temperature
b) Maternal stress levels
c) Umbilical cord length
d) Maternal blood pressure
b) Maternal stress levels
d) Maternal blood pressure
Slide 26
Baroreceptors send information to the autonomic nervous system (ANS) and it regulates fetal circulation by adjusting ______ and ______ to maintain perfusion.
a) Fetal heart rate; blood vessel tone
b) Amniotic fluid volume; lung expansion
c) Placental hormone levels; glucose transport
d) Oxygen diffusion; maternal heart rate
a) Fetal heart rate; blood vessel tone
This is maintenance of perfusion
Slide 26
How quickly do the major adaptations to extrauterine life occur after birth?
a) Several hours
b) A few days
c) Within minutes
d) Over the course of weeks
c) Within minutes
Slide 27
The transition from fetus to neonate involves a complex cascade of changes that primarily affect the ______ and ______ systems.
a) Pulmonary; cardiovascular
b) Digestive; endocrine
c) Renal; skeletal
d) Muscular; integumentary
a) Pulmonary; cardiovascular
Slide 27
When do respiratory efforts typically begin after birth?
a) Immediately at the moment of delivery
b) 30–90 seconds after delivery
c) 5–10 minutes after delivery
d) Only after the umbilical cord is clamped
b) 30–90 seconds after delivery
Slide 28
When air enters the lungs after birth, intrathoracic pressure ______, leading to lung expansion.
a) Decreases
b) Increases
c) Remains unchanged
d) Fluctuates unpredictably
a) Decreases
slide 28
Which of the following occurs as a result of lung expansion after birth?
Select 2
a) PaO₂ decreases
b) PaO₂ increases
c) PaCO₂ increases
d) PaCO₂ decreases
b) PaO₂ increases
d) PaCO₂ decreases
Slide 28
What is the effect of increased alveolar oxygen tension and pH on pulmonary circulation?
a) Increased right-to-left shunting
b) Increased pulmonary vascular resistance
c) Decreased pulmonary vascular resistance
d) Closure of the aortic valve
c) Decreased pulmonary vascular resistance
Slide 28
What happens to right ventricular output during the transition to neonatal circulation?
a) It shifts to supply blood primarily to the liver
b) It increases and redirects blood flow to the lungs
c) It decreases to reduce oxygen consumption
d) It stops, allowing the left ventricle to take over circulation
b) It increases and redirects blood flow to the lungs
Slide 28
When does surfactant production typically begin in fetal development?
a) 24-28 weeks
b) 30-34 weeks
c) 38-40 weeks
d) After birth
a) 24-28 weeks
If a baby is born premature between these weeks, then it gets a special steroid shot to help produce surfactant
slide 29
The first breath after birth initiates ______, allowing for increased oxygen exchange in the neonate.
a) Pulmonary hypertension
b) Lung expansion
c) Increased right-to-left shunting
d) Decreased PaO₂
b) Lung expansion
Slide 29
Which of the following best describes the role of surfactant in neonatal lung function?
Select 2
a) Increases surface tension in the alveoli
b) Prevents alveolar collapse
c) Stimulates the first breath
d) Reduces surface tension in alveoli
e) Increases pulmonary vascular resistance
b) Prevents alveolar collapse
d) Reduces surface tension in alveoli
Slide 29
What triggers the closure of the ductus arteriosus after birth?
a) Decreased oxygen levels
b) Clamping of the umbilical cord
c) Increased pulmonary vascular resistance
d) Increased oxygen levels
d) Increased oxygen levels
Slide 30
The foramen ovale closes when ______ pressure exceeds ______ pressure, stopping the right-to-left shunt.
a) Right atrial; left atrial
b) Left atrial; right atrial
c) Pulmonary artery; aortic
d) Umbilical vein; systemic
b) Left atrial; right atrial
Slide 30
Place the following steps in the correct order of operation for the closure of the foramen ovale after birth:
A. Left atrial pressure exceeds right atrial pressure
B. Clamping of the umbilical cord increases systemic vascular resistance (SVR)
C. Decreased right-to-left shunting through the foramen ovale
D. Increased systemic vascular resistance (SVR) raises left atrial pressure
1️⃣ B → Clamping of the umbilical cord increases systemic vascular resistance (SVR)
2️⃣ D → Increased systemic vascular resistance (SVR) raises left atrial pressure
3️⃣ A → Left atrial pressure exceeds right atrial pressure
4️⃣ C → Decreased right-to-left shunting through the foramen ovale
Foramen ovale closes
Slide 30
What is the main reason for the closure of the ductus venosus?
a) Increased systemic vascular resistance
b) Decreased left atrial pressure
c) Increased IVC pressure
d) Closure of the foramen ovale
Clamping of the umbilical cord–>
c) Increased IVC pressure
Slide 30
Pulmonary hypertension of the newborn
Which of the following conditions can contribute to elevated pulmonary vascular resistance and persistent pulmonary hypertension of the newborn (PPHN)?
(Select 4)
a) Alkalosis
b) Acidosis
c) Hypovolemia
d) Hypothermia
e) Hypervolemia
f) Hypoxia
g) Hyperthermia
b) Acidosis
c) Hypovolemia
d) Hypothermia
f) Hypoxia
slide 31
What two factors can cause Pulmonary hypertention of the Newborn PPHN?
Select 2
a) Premature constriction of Ductus Arteriosis
b) Premature dilation of Ductus Arteriosis
c) L → R shunting increases acidosis and hypoxia
d) R → L shunting increases acidosis and hypoxia
a) Premature constriction of Ductus Arteriosis
d) R → L shunting increases acidosis and hypoxia
* Worsens shunt
* Downward spiral
Slide 32
Pulmonary hypertension of the newborn
Which maternal factor is associated with premature constriction of the ductus arteriosus?
a) Hypertension
b) NSAID use
c) High blood glucose levels
d) Folic acid supplementation
b) NSAID use
Slide 32
Pulmonary hypertension of the newborn
Which of the following is a risk factor for premature constriction of the ductus arteriosus?
a) Preterm births
b) Hyperglycemia
c) Increased pulmonary blood flow
d) Delayed closure of the foramen ovale
a) Preterm births
Slide 32
Pulmonary hypertension of the newborn
What is a consequence of premature ductus arteriosus constriction in a newborn?
Select 2
a) Increased pulmonary blood flow
b) Increased pulmonary artery pressure
c) Decreased pulmonary blood flow
d) Decreased right-to-left shunting
b) Increased pulmonary artery pressure
c) Decreased pulmonary blood flow
Can lead to insufficient oxygenation and strain on heart
Slide 32
Which of the following can lead to uteroplacental insufficiency and fetal hypoxemia?
a) Increased maternal blood pressure
b) Impaired oxygen transfer in the placenta
c) Increased fetal hemoglobin levels
d) Increased umbilical cord blood flow
b) Impaired oxygen transfer in the placenta
Problem with O2 transfer in uterus, or mother’s perfusion of uterus
Slide 34
What factors determine fetal oxygenation?
a) Maternal blood pressure, maternal oxygenation and umbilical cord patency
b) Fetal heart rate, lung maturity, and placental weight
c) Maternal oxygenation, maternal temperature, and fetal position
d) Fetal movements, maternal glucose levels, and umbilical cord patency
a) Maternal blood pressure, maternal oxygenation and umbilical cord patency
Slide 34
During fetal hypoxia, decreased endothelial release of ____ leads to vasoconstriction and blood flow redistribution.
a) Adenosine
b) Epinephrine
c) Nitric oxide
d) Surfactant
c) Nitric oxide
Slide 35
Adenosine accumulation in response to hypoxia causes vasodilation of ______, ensuring adequate oxygen supply to the brain.
a) Peripheral arteries
b) Umbilical vessels
c) Pulmonary arteries
d) Cerebral vessels
d) Cerebral vessels
Slide 35
Stimulation of fetal chemoreceptors in response to hypoxia results in intense ____, helping redistribute oxygen to vital organs.
a) Peripheral vasodilation
b) Peripheral vasoconstriction
c) Increased cardiac output
d) Decreased blood shunting
b) Peripheral vasoconstriction
Slide 35
Hypoxia stimulates a vagal response in the fetus, leading to ______.
a) Bradycardia
b) Tachycardia
c) Increased blood pressure
d) Increased cardiac output
a) Bradycardia
Slide 35
To compensate for hypoxia, the fetus increases blood shunting through the ____, ensuring oxygenated blood reaches the heart and brain.
a) Ductus arteriosus
b) Foramen ovale
c) Ductus venosus
d) Pulmonary veins
c) Ductus venosus
Slide 35
What is the INITIAL fetal response during labor and delivery contractions, cord compression? (select 2)
A. parasympathetic response
B. sympathetic response
C. bradycardia
D. tachycardia
A. predominant parasympathetic system
C. bradycardia d/t increased vagal activity
slide 36
Prolonged fetal hypoxia will activate the (select 2)
A. parasympathetic nervous system
B. sympathetic nervous system
C. catecholamine secretion
D. vagal response
B. sympathetic nervous system
C. catecholamine secretion
slide 37
Prolonged hypoxia will cause ______ in the fetus
A. apoptosis
B. bradycardia
C. impaired brain fucntion
D. tachycardia
D. tachycardia
slide 37
During prolonged fetal hypoxia, longer periods of hypoxia will cause
A. fetal demise
B. hypothermia
C. bradycardia
D. hyperthermia
A. fetal demise
slide 37
Chronic hypoxia occurs after how long
A. hours to days
B. weeks to months
C. 1 week
D.72 hours
B. weeks to months
slide 38
Chronic hypoxia will cause
A. fetal growth restriction
B. impaired brain and kidney function
C. apoptosis of cardiomyocytes
D. fetal demise
E. all of the above
E. all of the above
slide 38
When was electronic fetal monitoring created
A. 1980s
B.1950s
C. 1960s
D. 1970s
C. 1960s
slide 39
What are the 2 components of the electonic fetal monitoring
A. FHR interpretation
B. fetal blood pressure monitoring
C. fetal temperature monitoring
D. contraction monitor
A. FHR interpretation
D. contraction monitor
slide 39
What is fetal assessment for
A. nonsepctific reflection of fetal acidosis
B. specific reflection of fetal acidosis
C. nonspecific reflection of fetal alkolosis
D. specific reflection of fetal alkolosis
A. nonspecific reflection of fetal acidosis
slide 39
What does the elctronic fetal monitor evaluate (select 2)
A. fetal blood pressure
B. fetal well being
C. fetal distress
D. fetal temperature
B. fetal well being
C. fetal distress
allow intervention before permanent fetal injury
slide 39
How is FHR monitored (select 2)
A. surface doppler ultrasound transducer
B. fetal scalp electrode
C. fetal skin electrode
D. pulse oximeter
A. surface doppler ultrasound transducer
B. fetal scalp electrode
slide 41
true or false
Changes in FHR produce nonspecific patterns and characteristics
False: changes in FHR produce specific patterns and characteristics
it is accurate and continuous
slide 41
What does the TOCO monitor determine
A. contraction stength ONLY
B. contraction frequency and strength
C. intrauterine pressure
D. contraction frequency ONLY
D. contraction frequency only
external monitor
slide 44
IUPC monitor will measure
A. contraction stength ONLY
B. contraction frequency and strength
C. fetal heart rate
D. contraction frequency ONLY
B. contraction frequency and strength
slide 44
What does the fetus depend on during uterus contracts
A. renal reserve
B. cardiopulmonary reserve
C. placental reserve
D. hepatic reserve
C. placental reserve
slide 45
Poor reserve oxygen “intake” and impaired oxygen transfer will lead to
A. initially tachycardia
B. decompensation
C. hyperoxemia
D. optimalization
B. decompensation
slide 46
Placental or umbilical cord impairment will lead to
A. hyper perfusion
B. hypertension
C.hyperthermia
D. hypoxemia
D. hypoxemia
slide 46
Impairment in fetal oxygenation that is not likely reversible are caused by (select 4)
A. hypertension
B. increased resistance in placenta
C. placental abruption
D. placental infarction
E. increased size of placenta
F. small placenta
B. increased resistance in placenta
C. placental abruption
D. placental infarction
F. small placenta
slide 47
Uterine causes of impairment in fetal oxygenation (select 2)
A. tachysystole
B. hypoxia
C. tetanic contraction
D.hypotension
A. tachysystole
C. tetanic contraction
slide 48
Maternal causes of impairment in fetal oxygenation (select 2)
A. tachysystole
B. hypoxia
C. tetanic contraction
D.hypotension
B. hypoxia
D. hypotension
maternal stress, pitocin running too high, cocaine/ methamphetamine
slide 48
On a fetal monitor strip, how are the contractions quantified
A. over 6 min period
B. over 8 min period
C. over 10min period
D .over 15 min period
C. over 10 min period
dark line is 1 minute… little box is 10 seconds then x6 = 60 seconds
slide 50
Fetal assessments are averaged over
A. 30 minutes
B. 10 minutes
C. 15 minutes
D. 6 minutes
A. 30 minutes
slide 50
What is a normal contraction rate?
A. < 7 contractions in 5 minutes
B. </= 10 contractions in 10 minutes
C. <10 contractions in 5 minutes
D. </= 5 contractions in 10 minutes
D. </= 5 contractions in 10 minutes
slide 50
Tachysystole is defined as
A. A heart rate above 120
B. >5 contractions in 10 minute period
C.a systolic BP above 150
D. >8 contractions in 10 minutes
B. >5 contractions in 10 minute period
slide 52
How do you treat tachysystole (select 3)
A. stop pitocin
B. nitroglycerine SL or IV
C. esmolol
D. pheneylephrine
E. terbutaline
A. stop pitocin
B. nitroglycerine SL or IV
E. terbutaline (beta 2 adrenergic receptor agonist)
slide 53
What is a normal FHR
A. 60-100
B. 110-160
C. 165-190
D. 90-100
B. 110-160
slide 54
What is considered tachycardia in FHR
A. >160
B. >150
C. >125
D. >180
A. >160
slide 54
What does this fetal assessment strip represent
A. fetal bradycardia
B. bradysystole
C. fetal tachycardia
D. tachysystole
D. tachysystole
slide 52
What is considered bradycardia in FHR
A. <120
B. <130
C. <105
D. <110
D. <110
slide 54
Fetal causes of fetal tachycardia (select 5)
A. chorioamnionitis
B. hyperthyroidism
C. maternal fever
D. sepsis
E. acute fetal hypoxia
F. epinephrine/ephedrine
G. fetal heart failure
H. ritodrine/terbutaline
I. anemia
A. Choriomnionitis
D. sepsis
E. acute fetal hypoxia
G.fetal heart failure
I. anemia
slide 55
Maternal causes of fetal tachycardia (select 4)
A. Choriomnionitis
B.hyperthyroidism
C. maternal fever
D. sepsis
E. acute fetal hypoxia
F. epinephrine/ephedrine
G.maternal hypothyrodism
H. ritodrine/terbutaline
I. anemia
B. Maternal hyperthyroidism
C. maternal fever
F. epinephrine/ephedrine
H. ritodrine/terbutaline
slide 56
What is this strip showing
A. fetal tachycardia
B. tachysystole
C. Matenal tachycadia
D. bradycardia
A. fetal tachycardia
slide 58
Causes of fetal bradycardia (select 5.. so not 2)
A. hypoxemia
B. hypothermia
C. maternal hypotension
D. maternal hypoglycemia
E. hypertension
F. hyperthermia
G. congential heart block
A. hypoxemia
B. hypothermia
C. maternal hypotension
D. maternal hypoglycemia
G. congential heart block
slide 59
Fetal heart rate accelerations can be defined by (select 2)
A. increase of at least 15 bpm
B. increase of at least 20bpm
C. lasting at least 15 seoncds
D. lasting at least 20 seconds
A. increase of at least 15 BPM
C. lasting at least 15 seconds
slide 61
What does fetal heart rate accelerations represent (select 2)
A. fetal distress
B. fetal decompensation
C. sign of FHR variability
D. normal and healthy
C. sign of FHR variability
D. normal and healthy
OB provider may try to induce accelerations if they are concerned about fetal wellbeing
slide 61
true or false
Variability is fluctuations in baseline HR that are irregular in amplitude and frequency
true
slide 62
What is the strip showing
A. fetal hypotension
B. fetal tachycardia
C. tachysystole
D. fetal bradycardia
D. fetal bradycardia
slide 60
Baseline variability is the single most important indicator for?
A. fetal demise
B. oxygenation of fetus
C. CO of fetus
D. HR of fetus
B. oxygenation of fetus
slide 62
Matching
- Absent
- minimal
- moderate
- marked
A. amplitude range >25bpm
B. amplitude range 6-25bpm
C. amplitude range not detectable
D. detectable range but </=5 bpm variation
1:C Absent -amplitude range not detectable
2: D minimal - detectable range but </=5 bpm variation
3: B moderate - amplitude range 6-25bpm
D: A marked - amplitude range >25bpm
slide 63
True or false
Antenatal corticosteroids, ethanol, general anesthesia, dexamethasone, benzos, mag sulfate, systemic opioids, promethazine all cause minimal/absent variability
True
and beta adrenergic antagonists
slide 64/65
What cardiac related issues can cause decreased or absent variability (select 2)
A. fetal sleep cycles
B. arrythmias
C. fetal tachycardias
D. preexisting neurological abnomality
B. arrythmias
C. fetal tachycardias
yes they all cause this
slide 64
Which fetal abnormalities can cause decreased/absent variability (select 2)
A. prematurity
B. cogenital anomalies
C. full term
D. hyperxemia
A. prematurity
B. cogenital anomalies
severe hypoxemia
slide 64
What does “absent variability” on the fetal heart rate monitor indicate?
A) Moderate variation around baseline
B) No detectable variation around baseline
C) High variation around baseline
D) Decrease in fetal heart rate
B) No detectable variation around baseline
Slide 67
What is a possible cause of increased FHR variability during the second stage of labor?
A) Maternal hypoxia
B) Umbilical cord compression
C) Maternal relaxation
D) Fetal sleep
B) Umbilical cord compression
…in 2nd stage of labor causing Mild & transient hypoxemia
Slide 68
Which of the following is a cause of increased or marked variability in fetal heart rate (FHR)?
A) Fetal sleep
B) Fetal stimulation
C) Maternal hypoventilation
D) Decreased maternal blood pressure
B) Fetal stimulation
Slide 68
Which of the following is associated with increased variability in FHR due to maternal influence?
A) Illicit drug use or stimulants
B) Decreased maternal blood volume
C) Increased maternal relaxation
D) Decreased fetal movement
A) Illicit drug use or stimulants
Slide 68
True or False
Marked variability in fetal heart rate is defined as greater than 30 beats per minute variation.
False
Marked variability is defined as >25 bpm variation
Slide 69
How is “moderate variability” in fetal heart rate defined?
A) 5-10 bpm variation around baseline
B) 6-25 bpm variation around baseline
C) 25-30 bpm variation around baseline
D) No variation around baseline
B) 6-25 bpm variation around baseline
Slide 70
Which of the following are true about fetal heart rate decelerations? (Select 3)
A) Fetal heart rate decelerations are temporary drops in FHR.
B) The three types of fetal heart rate decelerations are Early, Late, and Variable.
C) Fetal heart rate decelerations can only be categorized as “prolonged.”
D) Maternal hypercapnia can result in fetal acidosis and myocardial depression.
A) Fetal heart rate decelerations are temporary drops in FHR
B) The three types of fetal heart rate decelerations are Early, Late, and Variable
D) Maternal hypercapnia can result in fetal acidosis and myocardial depression.
Slide 71
Which of the following are key characteristics of early decelerations in fetal heart rate (FHR)? (Select 2)
A) Symmetric abrupt decrease in FHR with return to baseline
B) The nadir (lowest point) occurs at the peak of the contraction
C) The deceleration occurs after the contraction ends
D) Abrupt drop in heart rate unrelated to contractions
E) Onset to nadir duration is 30 seconds or more
B) The nadir (lowest point) occurs at the peak of the contraction
E) Onset to nadir duration is 30 seconds or more
Slide 72
Which of the following statements describe characteristics of early decelerations in fetal heart rate (FHR)? (Select 3)
A) Symmetric gradual decrease in FHR with return to baseline
B) Abrupt decrease in FHR with a rapid return to baseline
C) FHR decreases typically < 20 bpm below baseline (not always)
D) Deceleration occurs randomly, unrelated to contractions
E) Deceleration is associated with uterine contractions
A) Symmetric gradual decrease in FHR with return to baseline
C) FHR decreases typically < 20 bpm below baseline (not always)
E) Deceleration is associated with uterine contractions
Slide 72
Which of the following are true about the cause of early decelerations in fetal heart rate? (Select 2)
A) They are caused by fetal head compression.
B) They result from a vasovagal response that decreases fetal heart rate.
C) They are due to umbilical cord compression.
D) They indicate fetal distress and require immediate intervention.
E) They occur due to increased maternal oxygen delivery.
A) They are caused by fetal head compression.
B) They result from a vasovagal response that decreases fetal heart rate.
they are BENIGN
Slide 74
Early decelerations are most commonly observed during which stage of labor?
A) Latent phase
B) Active stage of labor
C) Third stage of labor
D) Postpartum period
B) Active stage of labor
Slide 74
If early decelerations are noted in early labor, they may indicate which condition?
A) Cephalopelvic disproportion
B) Placental abruption
C) Fetal distress
D) Polyhydramnios
A) Cephalopelvic disproportion
Slide 74
Which of the following are characteristics of variable decelerations? (Select 3)
A) Abrupt decrease in fetal heart rate (FHR) and abrupt return to baseline
B) Onset, depth, and duration vary with contractions
C) Always occurring at the peak of contractions
D) Typically appear as U, V, or W shapes
E) Gradual decrease in FHR with a smooth return to baseline
A) Abrupt decrease in fetal heart rate (FHR) and abrupt return to baseline
B) Onset, depth, and duration vary with contractions
D) Typically appear as U, V, or W shapes
Slide 75
How long do variable decelerations typically last?
A) Less than 10 seconds
B) 15 seconds to less than 2 minutes
C) 2-3 minutes
D) More than 5 minutes
B) 15 seconds to less than 2 minutes
Slide 75
Which of the following factors suggest that variable decelerations are not concerning?
A) Accompanying fetal tachycardia
B) Moderate variability and accelerations in FHR are present
C) Occurrence early in labor
D) Repetitive and prolonged nature
B) Moderate variability and accelerations in FHR are present
Transient hypoxemia
Slide 76
When do variable decelerations become concerning?
A) When they are occasional and accompanied by moderate variability.
B) When they occur early in labor or frequently, indicating possible umbilical cord occlusion.
C) When they happen with fetal movement.
D) When they last less than 10 seconds.
B) When they occur early in labor or frequently, indicating possible umbilical cord occlusion.
Slide 76
Which of the following are causes of variable decelerations? (Select 3)
A) Umbilical cord compression
B) Uteroplacental insufficiency
C) Oligohydramnios (low amniotic fluid)
D) Fetal head compression during the second stage of labor
E) Maternal hypotension
A) Umbilical cord compression
C) Oligohydramnios (low amniotic fluid)
D) Fetal head compression during the second stage of labor
Slide 77
Which of the following are criteria for severe decelerations? (select 2)
A) FHR drops below 70 bpm
B) FHR decreases more than 60 bpm
C) Occurs with every fetal movement
D) Has no impact on fetal cardiac output
E) Contraction duration greater than 70 seconds
A) FHR drops below 70 bpm
B) FHR decreases more than 60 bpm from baseline
Slide 78
Severe decelerations lasting more than 60 seconds can lead to which complications? (select 2)
A) Increased fetal oxygenation
B) Decreased umbilical blood flow
C) Impaired fetal cardiac output
D) Improved placental perfusion
E) Decreased risk of fetal hypoxia
B) Decreased umbilical blood flow
C) Impaired fetal cardiac output
Slide 78
What additional factor increases concern for fetal hypoxia in the presence of severe decelerations?
A) Moderate variability
B) Accelerations in FHR
C) Minimal or absent variability
D) A single occurrence of deceleration
C) Minimal or absent variability
Slide 78
Which of the following best describes late decelerations? (select 2)
A) Symmetric gradual decrease in FHR with return to baseline
B) Begins before the peak of contraction
C) Begins after the peak of contraction or after contraction is over
D) Abrupt decrease in FHR with a quick return to baseline
A) Symmetric gradual decrease in FHR with return to baseline
C) Begins after the peak of contraction or after contraction is over
Onset of decel to nadir of FHR = / > 30 seconds
Slide 80
Late decelerations can be considered benign if ___ is present in the fetal heart rate.
A) Bradycardia
B) Variability
C) Tachycardia
D) Prolonged decelerations
B) Variability
Slide 80
Which of the following is NOT a common cause of late decelerations?
A) Hypoxemia
B) Myocardial decompensation & failure
C) Chorioamnionitis
D) Post-term gestation
E) Uterine hyperactivity
F) Maternal hypotension or hypertensive disorders
G) Maternal smoking
H) Maternal anemia
I) Placental abruption or previa
J) Umbilical cord prolapse
J) Umbilical cord prolapse
Slides 81-82
Arrange the following steps in the correct sequence for the development of late decelerations:
- Decreased oxygen tension
- Sensed by chemoreceptors
- Vagal stimulation
- Decreased fetal heart rate (FHR)
- Decreased oxygen tension→ 2. Sensed by chemoreceptors → 3. Vagal stimulation → 4. Decreased fetal heart rate (FHR)
Slide 83
Late decelerations with decreased or absent fetal heart rate (FHR) variability are considered:
A) Benign
B) Normal
C) Ominous
D) Inconsequential
C) Ominous
you get called for a c-section
Slide 83
A prolonged deceleration is defined as a decrease in FHR of ≥ __ bpm lasting at least __ minutes but less than __ minutes.
A) 10 bpm, 1 minute, 5 minutes
B) 15 bpm, 2 minutes, 10 minutes
C) 20 bpm, 3 minutes, 15 minutes
D) 25 bpm, 5 minutes, 20 minutes
B) 15 bpm, 2 minutes, 10 minutes
Slide 85
If a deceleration lasts longer than 10 minutes, it is classified as:
A) Late deceleration
B) Variable deceleration
C) Baseline change
D) Normal FHR variation
C) Baseline change
Slide 85
Which of the following is NOT a cause of prolonged decelerations in fetal heart rate?
A) Umbilical cord compression
B) Prolonged maternal hypotension/hypoxia
C) Tetanic uterine contractions
D) Prolonged head compression in the 2nd stage of labor
E) Maternal hyperglycemia
E) Maternal hyperglycemia
Slide 85
Which of the following best describes a sinusoidal fetal heart rate pattern, including its cycle frequency?
A) Irregular variability with accelerations, 6-10 cycles per minute
B) Smooth, wave-like, undulating pattern, 3-5 cycles per minute
C) Abrupt decelerations lasting less than 30 seconds, 1-2 cycles per minute
D) Gradual decrease in FHR that returns to baseline, 12-15 cycles per minute
B) Smooth, wave-like, undulating pattern, 3-5 cycles per minute
Slide 88
A sinusoidal fetal heart rate pattern typically persists for more than ___ minutes with an amplitude range of ___ bpm.
A) 10 minutes; 3-8 bpm
B) 15 minutes; 4-12 bpm
C) 20 minutes; 5-15 bpm
D) 30 minutes; 8-20 bpm
C) 20 minutes; 5-15 bpm
Slide 88
True or False
A sinusoidal fetal heart rate pattern requires obstetrical intervention.
True
Slide 88
Which of the following are associated with a sinusoidal fetal heart rate pattern? (Select 3)
A. Fetal anemia
B. Rh disease
C. Severe fetal hypoxia
D. Maternal fever
E. Uterine tachysystole
A. Fetal anemia
B. Rh disease (incompatible blood)
C. Severe fetal hypoxia
Slide 88
FHR Tracing Categories - Category 1
Category I fetal heart rate (FHR) tracing is ___ of normal fetal acid-base status.
A) Predictive
B) Indicative
C) Non-predictive
D) Suggestive
Baseline FHR ____ bpm
A) 90 - 110
B) 100 - 150
C) 110 - 160
D) 130 - 180
__ baseline variability
A) Minimal
B) Moderate
C) Marked
D) Absent
No ___ decelerations
A) Early
B) Late or variable
C) Prolonged
D) Sinusoidal
___ decelerations present/absent
A) Late
B) Variable
C) Early
D) Sinusoidal
___ present/absent
A) FHR variability
B) Decelerations
C) Accelerations
D) Baseline shifts
Category I fetal heart rate (FHR) tracing is predictive of normal fetal acid-base status.
Baseline FHR 110 - 160 bpm
Moderate baseline variability
No late or variable decelerations
Early decelerations present/absent
Accelerations present/absent
Slide 90
FHR Tracing Categories - Catergory 2
Category II: __
A) Normal
B) Intermediate
C) Indeterminate
D) Severe
Fetal ___
A) Tachycardia
B) Bradycardia
C) Hypoxia
D) Asphyxia
Absence of induced ___ after fetal stimulation
A) Decelerations
B) Contractions
C) Accelerations
D) Variability
Prolonged __ > 2 mins < 10 mins
A) Contractions
B) Bradycardia
C) Decelerations
D) Tachycardia
Recurrent late decels w/ __ variability
A) Absent
B) Moderate
C) Severe
D) Minimal
Not predictive of __ fetal acid-base status
A) Abnormal
B) Normal
C) Severe
D) Dangerous
Category II: Indeterminate
Fetal tachycardia
Absence of induced accelerations after fetal stimulation
Prolonged decelerations > 2 mins < 10 mins
Recurrent late decels w/ moderate variability
Not predictive of abnormal fetal acid-base status
Slide 91
FHR Tracing Categories - Catergory 3
Category III: ___ fetal acid-base status
A) Normal
B) Indeterminate
C) Abnormal
D) Predictive
___ FHR pattern
A) Sinusoidal
B) Early
C) Variable
D) Moderate
Absent FHR variability with recurrent ___ decels
A) Early
B) Late
C) Variable
D) Moderate
Recurrent ___ decels
A) Early
B) Variable
C) Late
D) Prolonged
Sustained ___
A) Tachycardia
B) Bradycardia
C) Normal heart rate
D) Increased variability
Category III: Abnormal fetal acid-base status
Sinusoidal FHR pattern
Absent FHR variability w/recurrent late decels
Recurrent variable decels
Sustained bradycardia
Slide 92
Which of the following are appropriate management strategies for Category III fetal heart rate (FHR) tracings? (Select 4)
A) Maternal position change
B) Discontinue labor augmentation
C) Continue oxytocin infusion
D) Treatment of tachysystole
E) Surgical delivery
A) Maternal position change
B) Discontinue labor augmentation
D) Treatment of tachysystole
E) Surgical delivery
Slide 93
True or False
The Apgar score is a subjective method for neonatal assessment to determine which neonates require resuscitation after birth.
FALSE
Goal: Reproducible, standardized & objective system to determine which neonates require resuscitation after birth.
Slide 94
At what time intervals is the Apgar score assessed?
A) 5 & 10 minutes
B) 1 & 5 minutes
C) 2 & 7 minutes
D) 3 & 9 minutes
B) 1 & 5 minutes
Slide 95
Which of the following is NOT an Apgar scoring parameter?
A) Heart rate
B) Reflex irritability
C) Blood pressure
D) Respiratory effort
E) Muscle tone
F) Color
C) Blood pressure
Slide 95
Each parameter in the Apgar score is rated on a scale of:
A) 1, 2, or 3
B) 0, 1, or 2
C) 0, 2, or 4
D) 1, 3, or 5
B) 0, 1, or 2
Slide 95
Matching
1 → B (8-10 = Normal)
2 → C (4-7 = Moderate impairment)
3 → A (0-3 = Immediate resuscitation required)
Risk for mortality inversely proportional to 1 minute score
Slide 96
How is heart rate scored in the Apgar system?
A) 0 if absent, 1 if < 100 bpm, 2 if >100 bpm
B) 0 if < 60 bpm, 1 if 60-100 bpm, 2 if >100 bpm
C) 0 if bradycardic, 1 if normocardic, 2 if tachycardic
D) 0 if < 80 bpm, 1 if 80-120 bpm, 2 if >120 bpm
A) 0 if absent, 1 if < 100 bpm, 2 if >100 bpm
Slide 97
How is respiratory effort scored in the Apgar system?
A) 0 if absent, 1 if shallow/irregular/gasping, 2 if robust/crying
B) 0 if gasping, 1 if normal breathing, 2 if crying
C) 0 if cyanotic, 1 if shallow breathing or gasping, 2 if deep breathing
D) 0 if bradypneic, 1 if tachypneic, 2 if normopneic
A) 0 if absent, 1 if shallow/irregular/gasping, 3 if robust/crying
Slide 97
How is muscle tone scored in the Apgar system?
A) 0 if absent/limp, 1 if some flexion of extremities, 2 if active movement
B) 0 if rigid, 1 if flaccid, 2 if flexed
C) 0 if normal, 1 if weak, 2 if strong
D) 0 if hypotonic, 1 if hypertonic, 2 if normal
A) 0 if absent/limp, 1 if some flexion of extremities, 2 if active movement
Slide 97
How is reflex irritability scored in the Apgar system?
A) 0 - No response, 1 - Grimace, 2 - coughing, or sneezing
B) 0 - Delayed response, 1 - Weak grimace, 2 - Forceful sneezing
C) 0 - Spontaneous movement, 1 - Mild response, 2 - Strong reaction to touch
D) 0 - Exaggerated response, 1 - Mild response, 2 - No response
A) 0 - No response, 1 - Grimace, 2 - coughing, or sneezing
Slide 97
How is the newborn’s skin color scored in the Apgar system?
A) 0 - cyanotic, 1 - Acrocyanotic , 2 - pink
B) 0 - Normal skin tone, 1 - Slightly pale, 2 - Deep red
C) 0 - Acrocyanotic, 1 - Completely pink, 2 - Pale
D) 0 - Cyanotic, 1 - Completely pink, 2 - Acrocyanotic
A) 0 - cyanotic, 1 - Acrocyanotic (pink trunk, blue extremities), 2 - pink
Slide 97
