Unit 3 Module 3 (Exam 2) Flashcards by Kimberly Diane Hill

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Helpful chart for later use

Slide 3

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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

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Where does oxygen exchange occur in the fetus?
a) Lungs
b) Heart
c) Liver
d) Placenta

d) Placenta

slide 4

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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As gestational age increases, the percentage of blood directed to the ______ increases.
a) Kidneys
b) Liver
c) Heart
d) Lungs

b) Liver

slide 15

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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

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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

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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

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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

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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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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** ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote Slide 30

# Pulmonary hypertention 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 ## Footnote 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 ## Footnote Slide 32

# Pulmonary hypertention 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 ## Footnote Slide 32

# Pulmonary hypertention 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 ## Footnote Slide 32

# Pulmonary hypertention 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** ## Footnote Slide 32

Which of the following can lead to uteroplacental insufficiency and fetal hypoxemia? a) Increased maternal blood pressure b) Increased umbilical cord blood flow c) Increased fetal hemoglobin levels d) Impaired oxygen transfer in the placenta

d) Impaired oxygen transfer in the placenta ## Footnote 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 ## Footnote Slide 34

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** ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote slide 37

Prolonged hypoxia will cause ______ in the fetus A. apoptosis B. bradycardia C. impaired brain fucntion D. tachycardia

D. tachycardia ## Footnote slide 37

During prolonged fetal hypoxia, longer periods of hypoxia will cause A. fetal demise B. hypothermia C. bradycardia D. hyperthermia

A. fetal demise ## Footnote 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 ## Footnote slide 38

Chronic hypoxia will cause A. fetal growth restirction B. impaired brain and kidney function C. apoptosis of cardiomyocytes D. fetal demise E. all of the above

E. all of the above ## Footnote slide 38

When was electronic fetal monitoring created A. 1980s B.1950s C. 1960s D. 1970s

C. 1960s ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote slide 45

Poor reserve oxygen "intake" and impaired oxygen transfer will lead to A. initially tachycardia B. decompensation C. hyperoxemia D. optimalization

B. decompensation ## Footnote slide 46

Placental or umbilical cord impairment will lead to A. hyper perfusion B. hypertension C.hyperthermia D. hypoxemia

D. hypoxemia ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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.

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 ## Footnote 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) ## Footnote slide 53

What is a normal FHR A. 60-100 B. 110-160 C. 165-190 D. 90-100

B. 110-160 ## Footnote slide 54

What is considered tachycardia in FHR A. >160 B. >150 C. >125 D. >180

A. >160 ## Footnote slide 54

What does this fetal assessment strip represent A. fetal bradycardia B. bradysystole C. fetal tachycardia D. tachysystole

D. tachysystole ## Footnote slide 52

What is considered bradycardia in FHR A. <120 B. <130 C. <105 D. <110

D. <110 ## Footnote 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 ## Footnote 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 ## Footnote slide 56

What is this strip showing A. fetal tachycardia B. tachysystole C. Matenal tachycadia D. bradycardia

A. fetal tachycardia ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote slide 61

# true or false Variability is fluctuations in baseline HR that are irregular in amplitude and frequency

true ## Footnote slide 62

What is the strip showing A. fetal hypotension B. fetal tachycardia C. tachysystole D. fetal bradycardia

D. fetal bradycardia ## Footnote 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 ## Footnote slide 62

# Matching 1. Absent 2. minimal 3. moderate 4. marked A. amplitude range >25bpm B. amplitude range 6-25bpm C. amplitude range not detectable D. detectable range but

1:C Absent -amplitude range not detectable 2: D minimal - detectable range but 25bpm ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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. ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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* ## Footnote 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. ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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* ## Footnote 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 ## Footnote 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 ## Footnote Slides 81-82

Arrange the following steps in the correct sequence for the development of late decelerations: 1. Decreased oxygen tension 2. Sensed by chemoreceptors 3. Vagal stimulation 4. Decreased fetal heart rate (FHR)

1. Decreased oxygen tension→ 2. Sensed by chemoreceptors → 3. Vagal stimulation → 4. Decreased fetal heart rate (FHR) ## Footnote 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* ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote Slide 88

# True or False A sinusoidal fetal heart rate pattern requires obstetrical intervention.

True ## Footnote 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 ## Footnote 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 ## Footnote 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** ## Footnote 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 ## Footnote 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. ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote Slide 96

# Slide 97 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 ## Footnote Slide 97

How is respiratory effort scored in the Apgar system? A) 0 if absent, 1 if irregular/slow, 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

C) 0 if cyanotic, 1 if shallow breathing or gasping, 2 if deep breathing ## Footnote 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 ## Footnote Slide 97

How is reflex irritability scored in the Apgar system? A) 0 - No response, 1 - Grimace, 2 - Crying, 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 - Crying, coughing, or sneezing ## Footnote Slide 97

How is the newborn’s skin color scored in the Apgar system? A) 0 - Pale or cyanotic, 1 - Acrocyanotic , 2 - Completely 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 - Pale or cyanotic, 1 - Acrocyanotic (pink trunk, blue extremities), 2 - Completely pink ## Footnote Slide 97

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