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97 Cards in this Set

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