UW/mehl. decelerations 03-24 (2) Flashcards
Mehl. test that monitors fetal HR?
Non-stress test = CTG
Mehl. What reflects accelerations?
well-being.
Mehl. accelerations refers to what?
INCREASE in fetal HR ~ 20bpm that lasts 20 sec.
Mehl. accelerations frequency?
2-3 times within a 20 minute period
Mehl. EARLY decelerations, what pathology?
Fetal head compression => parasympathetic response
Mehl. LATE decelerations, what pathology?
uteroplacental insufficiency or fetal hypoxia
Mehl. EARLY decelerations. definition?
Drop in the fetal HR at the same time as uterine contractions
Mehl. EARLY decelerations. Mechanism behind drop HR?
Due to incr. vagal outflow.
This is in part due to incr. vascular resistance as a result of the compression
Mehl. LATE decelerations, definition?
fetal bradycardia that occurs just after the uterine contraction
Mehl. LATE decelerations are ,,bad type”.
.
Mehl. LATE and VARIABLE decelerations. Treatment? same for both
triad: stop all oxytocin
give maternal oxygen
position patient to left-lateral decubitus
IF THEY ARE NOT EFFECTIVE => C section
Mehl. LATE decelerations. What can be done to evaluate hypoxia?
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.
Mehl. VARIABLE decelerations. pathology?
umbilical cord compression
Mehl. VARIABLE decelerations. Tx?
triad as mentioned before + AMNIOINFUSION
Mehl. umbilical cord compression?
VARIABLE decelerations.
Mehl. uteroplacental insufficiency or fetal hypoxia?
LATE decelerations
Mehl. Fetal head compression?
EARLY decelerations
Mehl. Fetal sleep state?
Normal HR (110-160)
Nonstress test - straight line within normal HR range
Brady is always pathologic. Sleep state is normal, todel brady neturi but
Mehl. maternal fever, HR?
nonstress test shows a straoght line for fetal HR above upper line, ie. > 160/min. (aka fetal tachycardia)
UW. early/late decelerations - gradual (>=30sek.)
kai yra variable - tai abrupt change (<30s)
.
UW. variable causes? 3
Cord compression
Oligohydramnios
Cord prolapse
UW. early deceleration explanations
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.
UW. benign, physiologic finding ?
early decelerations
UW. Mx of early decelerations?
expectant, no interventions
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 ?????
decreased placental perfusion (ie, uteroplacental insufficiency) and impending fetal hypoxemia and acidemia -> late decelerations.
UW. what need to give prior epidural?
INFUSION!!!! nes paskui hipotenzija buna
UW. BP 60/40, epidural induces late decelerations Mx?
Infusion
VASOPRESOR (phenylephrine, ephedrine)
left decubital
if not effective => S/C
UW if opioids toxicity in epidural -> Mx?
Rarely. Can be treated with naloxone.
UW. uterine tachysystole definition?
defined as >5 contractions/10 min
UW. uterine tachysystole => decelerations? how Mx?
recurrent late decelerations -> give tocolytics (terbutaline)
UW. minimal variability, definition?
absent or minimal variability (ie, ≤5/min), as in this patient, can indicate fetal metabolic acidosis and impending fetal compromise.
UW. minimal variability = what drug?
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.
UW. fetal occiput posterior position, decelerations?
Early, nes galva spaudzia, px kokia pozicija
UW. congenital cardiac anomaly?
no effect on HR
UW. intraamniotic infection?
minimal variability + tachycardia.
tiesi linija ir daznis kok 180k/min
UW. minimal variability + tachycardia. Causes?
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;
UW. table. baseline fetal HR. fetal tachy (>160). Causes? 4
Maternal fever
Medication (beta agonists)
fetal hyperthyroidism
Fetal tachyarrhythmia
UW. table. baseline fetal HR. brady <110. Causes 4?
Maternal hypothermia
Medications effect (BAB)
Fetal hypothyroidism
Fetal heart block (eg antiphospholipid syndrome)
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.
.
UW. recurrent variable buvo. First line –> second line?
left decubital position –> amnioinfusion if not effective
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
.
UW. oxytocin if decelerations?
stop immediately
increase contraction strength and frequency, thereby increasing cord compression and impeding fetal-placental perfusion. This would exacerbate the variable decelerations.
UW. Nuchal cords (eg, loops of umbilical cord around the fetal neck) are associated with????
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.
UW. placental abruption?
nonreassuring fetal heart rate tracing (eg, minimal variability, decelerations), and uterine tachysystole (eg, >5 contractions in a 10 minute period).
zodziu buvo decelerations daznos
UW. suspected fetal hypoxemia (eg, decreased fetal movement, late decelerations) => what test required????
biophysical profile (BPP) to evaluate fetal oxygenation.
UW. biophysical profile (BPP) includes what 2 methods?
nonstress test and ultrasound assessment of amniotic fluid volume and fetal activity
UW. buvo UW case su 41 week + biophysical test: no amnio volume, no respiratory, only HR and movements. Cause?
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
