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97 Cards in this Set
- Front
- Back
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Normal baseline FHR
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110-160
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Normal baseline variability
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5 or greater bpm
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Non-reassuring baseline variability
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<5 bpm but less than 30 min
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Abnormal baseline variability
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<5 bpm for 90 min or more
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Which autonomic NS affects short-term variability?
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PS
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Which autonomic NS affects long-term variability?
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S
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What is the effect of high gestation on variability?
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Increases
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Definition of NRCTGs
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Reduced or less than 5 bpm for 40 - 89 mins
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What is B-B or Short Term V?
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Varying intervals between successive heart beats
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What's Long Term V?
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Irregular waves ont he CTG 3-5 bpm
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What is an EFM acceleration?
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Transient increase in FHR of 15 bpm or more lasting for 15 sec
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What kind of outcome is associated with the presence of FHR accelerations?
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Good
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What's an EFM deceleration?
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Transient slowing of FHR 15 bpm or more below baseline for at least 15 sec
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Cause of early decelerations?
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Head compression
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When does an early deceleration begin?
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Onset of contraction
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When does an early deceleration return to baseline?
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AS the contraction ends
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When are early decelerations important?
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Early in labor or antenatal
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What's a late deceleration?
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Uniform periodic slowing of FHR with the onset of contractions
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Which sequelae are associated with repetitive late decels?
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Umbilical artery acidosis, Apgar <7 @ 5, & CP
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Pathogenesis of late decelerations?
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Due to acute and chronic feto-placental vascular insufficiency
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When do late decelerations start?
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After the peak of uterine contraction
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When do late decelerations end?
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After uterine contraction
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What precipitates late decelerations?
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Hypoxemia
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Which acid-base abnormalities are associated with late decelerations?
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Respiratory & metabolic acidosis
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Which conditions are associated with late decelerations?
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PIH, DM, IUGR, placental insufficiency
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Which types of decelerations are associated with CP?
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Late & variable
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What are the characteristics of variable decelerations?
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Rapid onset recovery & isolation
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Atypical variable decelerations are associated with which sequelae?
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Umbilical artery acidosis & Apgar < 7 @ 5 min
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Which type of deceleration can be biphasic?
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Variable
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What is the mechanism of variable deceleration?
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Vagal activity
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What is the rule of 60?
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Decrease of 60 bpm, or rate of 60 bpm for > 60 sec
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What is a mechanical cause of variable decelerations?
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Cord compression
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Besides umbilical artery acisosis & low APGAR score, what are some sother equelae associated with variable deceleration?
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Oligohydramnios +/- ROM, RDS
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What's a prolonged deceleration?
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A drop in FHR of 30 bpm or more for at least 2 min
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When is a prolonged deceleration pathological?
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When it crosses 2 contractions
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What is the immediate consequence of a prolonged deceleration?
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Reduction in O2 transfer to placenta.
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What are three causes of prolonged decelerations?
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Cord prolapse, maternal HTN, uterine hypertonia
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What follows a prolonged deceleration?
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VE or ARM or SROM w/ high PP.
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Besides maternal position, IVF, & assessing BP, what else is included in the management of prolonged deceleration?
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VE to exclude cord prolapse & FBS if cervix dilated & well applied PP
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What are five factors that can increase fetal vagal tone?
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Postdates, drugs, arrythmias, hypothermia, cord compression
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What's abnormal bradycardia?
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< 100
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What are 3 maternal conditions that can lead to baseline tachycardia?
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Fever, thyrotoxicosis, & anxiety
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What are 3 non-maternal conditions that can lead to baseline tachycardia?
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Asphyxia, drugs, prematurity
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What is the B-b variability in a sinusoidal pattern?
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Zero
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What is the frequency of a sinusoidal pattern?
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3-5 / min
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What is the amplitude of a sinusoidal pattern?
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5-15 bpm & above baseline
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Why should sinusoidal patterns be viewed with suspicion?
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Assoc w/ feto-maternal hemorrhage
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What What are four "As" that can cause a sinusoidal pattern?
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Ascites, analgesics, anemia, abruption
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Besides the four As, what are some other causes of a sinusoidal pattern?
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Cord compression & hypovolemia
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When is the saltatory pattern seen?
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During fetal thumb sucking
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What was the endpoint of the FOREMOST trial?
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Reduce operative deliveries for the Nr CTG
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What was a secondary endpoint of the FOREMOST trial?
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Investigate incidence of dystocia
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When is an abnormal CTG an indication for FBS?
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When it persists after reversible factors have been corrected
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When are persistent late decels an indication for FBS?
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When there are 2 other abnormal features, such as b-tach or reduced B-B variability
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What are some prerequisites for FBS?
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Rom, PP accessible & weell applied
Dilated > 3 cm Left alteral maternal position |
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What's the normal range for FBS-arterial pH?
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7.25-7.35
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What are four fetal contraindications to FBS?
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Premature, active Herpes, known HIV/HepB/HepC status, thrombocytopenia.
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What are five maternal contraindications to FBS?
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Unfavorable cervix, mobile PP, malpresentation, pl praevia or APH, sepsis
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When should FBS bbe performed in relation to FHR?
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Between decelerations
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What is a consequence of excess pressure on the PP?
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Reduces perfusion
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On which structure should FBS sampling not be done?
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Caput
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What are the three classifications of CTGs?
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Normal, suspicious (one nonreassuring), pathologic (2 or more)
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At birth, when should cord PH be done?
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If CTG suspicious, preterm labor
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What if FBS-arterial is acidotic?
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Deliver immediately
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What are four cardiovascular changes in the pregnant patient?
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Increased HR, decreased TPR, changes in BP, dilutional anemia
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Why might pregnant women develop pulmonary edema?
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Decreased oncotic pressure
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What physiologic change is associated with uterine enlargement?
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Displacement of the diaphragm
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How does pregnancy affect the respiratory system?
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Increased tidal volume, increased O2 consumption.
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Which hormones increase during pregnancy?
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Progesterone, estrogen, hPL, hCG
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In pregnancy, what happens to the insulin response, gycogen stores, and ketone production?
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Increase, decrease, occurs during fasting
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What's the goal of multifetal pregnancy reduction?
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Decrease # of fetuses & risk of preterm delivery
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Prenatal diagnosis of DS?
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NT & maternal age
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What is the effect of MFPR on AFP3?
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Makes it unreliable.
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What is the effect of MFPR on MsAFP?
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Increases
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What is the effect of in vitro gestation on HCG?
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Increases
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A medication used to prevent PTB?
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Corticosteroids
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What are four causes of IUGR?
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Excess demand, abnormal placentation, velementous cord insertion, congenital anomalies
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What are three etiologies for discordant growth?
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Uteroplacental insufficiency, discordant anomaly, & TTTS
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When does Twin to Twin Transfusion Syndrome occur?
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Between weeks 15 & 26
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What are three types of placental anastomoses?
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A-A, V-V (bidirectional), A-V shunt (unidirectional)
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What are the sequelae for the recipient in TTTS?
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Macrosomia, polycythemia, hypervolemia, (polyuria, polyhydramnios, CHF), hydrops
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What are the sequelae for the donor in TTTS?
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Anemia, hypovolemia, IUGR, oliguria, oligohydramnios, hydrops
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What unique sonographic findings are associated w/ the donor in TTTS?
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Small umbilical cord, abnormal dopplers, increased mobility
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Which unique sonographic findings are associated w/ the recipient in TTTS?
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Enlarged umbilical cord, abnl dopplers, decr mobility
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What is the goal of amnioreduction?
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To normalize amniotic fluid volume
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What is the goal of amnioreduction regarding: PTL? PPROM? Uteroplacental perfusion?
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Reduce, reduce, increase
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What are the numerical endpoints for amnioreduction?
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AFI > 40, GVP > 12
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What are the complications of amnioreduction?
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PPROM, chorio, abruption
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What's the goal of septostomy
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To allow normalization of AF in both sacs
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What's an advantage of septostomy over amnioreduction?
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Decreased need for repeat procedures
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What are two complications of septostomy?
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PTL, PPROM
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What are the targets in selective laser ablation?
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AVAs involved n transfusion
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What are the complications of selective laser ablation?
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IUFD, PPROM, PTD
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What are the goals of selective feticide?
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Cessation of transfusion & improving the chance of survival of one fetus
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What are the consequences of inadequate protein intake in multiple gestation situation?
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IUGR, altered placental function, altered fxn
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What's a consequene of iron deficiency in the multiple gestation situation?
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PTD
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What is the effect of calcium supplementation on nutrition in the multiple gestation situation?
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Reduce PTD
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