UW/mehl. decelerations 03-24 (2)

Question 1

Mehl. test that monitors fetal HR?

Answer 1

Non-stress test = CTG

Question 2

Mehl. What reflects accelerations?

Answer 2

well-being.

Question 3

Mehl. accelerations refers to what?

Answer 3

INCREASE in fetal HR ~ 20bpm that lasts 20 sec.

Question 4

Mehl. accelerations frequency?

Answer 4

2-3 times within a 20 minute period

Question 5

Mehl. EARLY decelerations, what pathology?

Answer 5

Fetal head compression => parasympathetic response

Question 6

Mehl. LATE decelerations, what pathology?

Answer 6

uteroplacental insufficiency or fetal hypoxia

Question 7

Mehl. EARLY decelerations. definition?

Answer 7

Drop in the fetal HR at the same time as uterine contractions

Question 8

Mehl. EARLY decelerations. Mechanism behind drop HR?

Answer 8

Due to incr. vagal outflow.
This is in part due to incr. vascular resistance as a result of the compression

Question 9

Mehl. LATE decelerations, definition?

Answer 9

fetal bradycardia that occurs just after the uterine contraction

Question 10

Mehl. LATE decelerations are ,,bad type”.

Answer 10

.

Question 11

Mehl. LATE and VARIABLE decelerations. Treatment? same for both

Answer 11

triad: stop all oxytocin
give maternal oxygen
position patient to left-lateral decubitus

IF THEY ARE NOT EFFECTIVE => C section

Question 12

Mehl. LATE decelerations. What can be done to evaluate hypoxia?

Answer 12

Fetal scalp pH can be done in theory to assess degree of fetal hypoxia if decels are prolonged. Procedure involves obtaining a fetal blood sample from the scalp.
If pH of the fetal blood < 7,2 = acidosis and hypoxia

Even though <7,35 is acidosis, the cutoff <7,2 is used as a stronger threshold to determine whether more urgent interventions are waranted.

Question 13

Mehl. VARIABLE decelerations. pathology?

Answer 13

umbilical cord compression

Question 14

Mehl. VARIABLE decelerations. Tx?

Answer 14

triad as mentioned before + AMNIOINFUSION

Question 15

Mehl. umbilical cord compression?

Answer 15

VARIABLE decelerations.

Question 16

Mehl. uteroplacental insufficiency or fetal hypoxia?

Answer 16

LATE decelerations

Question 17

Mehl. Fetal head compression?

Answer 17

EARLY decelerations

Question 18

Mehl. Fetal sleep state?

Answer 18

Normal HR (110-160)
Nonstress test - straight line within normal HR range

Brady is always pathologic. Sleep state is normal, todel brady neturi but

Question 19

Mehl. maternal fever, HR?

Answer 19

nonstress test shows a straoght line for fetal HR above upper line, ie. > 160/min. (aka fetal tachycardia)

Question 20

UW. early/late decelerations - gradual (>=30sek.)
kai yra variable - tai abrupt change (<30s)

Answer 20

.

Question 21

UW. variable causes? 3

Answer 21

Cord compression
Oligohydramnios
Cord prolapse

Question 22

UW. early deceleration explanations

Answer 22

fetal head compression - occur when the fetal head descends closer to the cervix, which contracts and causes narrowing of the fetal anterior fontanelle. The narrowed anterior fontanelle causes a transient alteration in cerebral blood flow, which stimulates a vagal response and slows the fetal heart rate. Early decelerations are a benign, physiologic finding and do not indicate fetal hypoxia; therefore, these decelerations do not require intervention and can be managed expectantly.

Question 23

UW. benign, physiologic finding ?

Answer 23

early decelerations

Question 24

UW. Mx of early decelerations?

Answer 24

expectant, no interventions

Question 25

UW. Neuraxial anesthesia (eg, epidural) -> sympathetic nerve blockade, which results in vasodilation, decreased venous return to the heart, decreased cardiac output, and resultant maternal hypotension => pathology ?????

Answer 25

decreased placental perfusion (ie, uteroplacental insufficiency) and impending fetal hypoxemia and acidemia -> late decelerations.

Question 26

UW. what need to give prior epidural?

Answer 26

INFUSION!!!! nes paskui hipotenzija buna

Question 27

UW. BP 60/40, epidural induces late decelerations Mx?

Answer 27

Infusion VASOPRESOR (phenylephrine, ephedrine) left decubital if not effective => S/C

Question 28

UW if opioids toxicity in epidural -> Mx?

Answer 28

Rarely. Can be treated with naloxone.

Question 29

UW. uterine tachysystole definition?

Answer 29

defined as >5 contractions/10 min

Question 30

UW. uterine tachysystole => decelerations? how Mx?

Answer 30

recurrent late decelerations -> give tocolytics (terbutaline)

Question 31

UW. minimal variability, definition?

Answer 31

absent or minimal variability (ie, ≤5/min), as in this patient, can indicate fetal metabolic acidosis and impending fetal compromise.

Question 32

UW. minimal variability = what drug?

Answer 32

Certain medications can cause transient absent or minimal variability unrelated to fetal acid-base status. Opioids (eg, morphine) may decrease fetal heart rate variability due to fetal CNS depression; exposed fetuses also typically have decreased frequency of accelerations. These changes are temporary and normalize as the medication effect diminishes; therefore, these patients typically require only continued monitoring. In case buvo pamineta, kad duota daznai morfino kol vaziavo su greitaja.

Question 33

UW. fetal occiput posterior position, decelerations?

Answer 33

Early, nes galva spaudzia, px kokia pozicija

Question 34

UW. congenital cardiac anomaly?

Answer 34

no effect on HR

Question 35

UW. intraamniotic infection?

Answer 35

minimal variability + tachycardia. tiesi linija ir daznis kok 180k/min

Question 36

UW. minimal variability + tachycardia. Causes?

Answer 36

INFECTION (IAI =fever ≥39 C (in the absence of another clear cause), leukocytosis (>15,000/mm3), and/or purulent amniotic fluid.) Medication adverse effects (eg, beta agonists) fetal hyperthyroidism;

Question 37

UW. table. baseline fetal HR. fetal tachy (>160). Causes? 4

Answer 37

Maternal fever Medication (beta agonists) fetal hyperthyroidism Fetal tachyarrhythmia

Question 38

UW. table. baseline fetal HR. brady <110. Causes 4?

Answer 38

Maternal hypothermia Medications effect (BAB) Fetal hypothyroidism Fetal heart block (eg antiphospholipid syndrome)

Question 39

UW. recurrent variable buvo. * Intermittent umbilical cord compression, as evidenced by variable decelerations with <50% of contractions, is typically well tolerated by the fetus (ie, no hypoxemia) and does not require intervention. * In contrast, umbilical cord compression with ≥50% of contractions (as evidenced by recurrent variable decelerations) can result in a lack of fetal-placental blood flow and cause hypoxemia and acidemia.

Answer 39

.

Question 40

UW. recurrent variable buvo. First line --> second line?

Answer 40

left decubital position --> amnioinfusion if not effective

Question 41

yra decel. faile Fetal heart rate tracing patterns. cia tos lenteles ner, bet esme, kad category I - all good Cat. II - indeterminate (not I and not III) Cat III - no variability + variable, late decel., bradycardia; arba dar gali but sinusoidail

Answer 41

.

Question 42

UW. oxytocin if decelerations?

Answer 42

stop immediately increase contraction strength and frequency, thereby increasing cord compression and impeding fetal-placental perfusion. This would exacerbate the variable decelerations.

Question 43

UW. Nuchal cords (eg, loops of umbilical cord around the fetal neck) are associated with????

Answer 43

variable decelerations, which are abrupt (≥15/min) decreases in fetal heart rate below the baseline of varying depth and duration that represent acute cord compression and interruption of fetal perfusion. Nuchal cords do not cause oligohydramnios or decreased fetal breathing movements.

Question 44

UW. placental abruption?

Answer 44

nonreassuring fetal heart rate tracing (eg, minimal variability, decelerations), and uterine tachysystole (eg, >5 contractions in a 10 minute period). zodziu buvo decelerations daznos

Question 45

UW. suspected fetal hypoxemia (eg, decreased fetal movement, late decelerations) => what test required????

Answer 45

biophysical profile (BPP) to evaluate fetal oxygenation.

Question 45

UW. biophysical profile (BPP) includes what 2 methods?

Answer 45

nonstress test and ultrasound assessment of amniotic fluid volume and fetal activity

Question 46

UW. buvo UW case su 41 week + biophysical test: no amnio volume, no respiratory, only HR and movements. Cause?

Answer 46

uteroplacental insuff. Pregnancies at ≥41 weeks gestation are at increased risk of stillbirth. In these pregnancies, placental aging leads to decreased placental function, which limits fetal perfusion during contractions and induces intermittent fetal hypoxemia