Ob Fetal Monitoring Mjm

Front 1

fetal monitoring helps to prevent?

Back 1

hypoxia, cerebral palsy, fetal death

Front 2

fetal monitoring consists of monitiring?

Back 2

fetal hr and uterine contractions

Front 3

neg impact of fetal monitoring?

Back 3

mobility, physical contact with partner, time with labor nurse

Front 4

Dr. C Bravado?

Back 4

approach to determining risk
Dr: determine risk
C: contractions
Bra: baseline rate
V: variability
A: accelerations
D: decelerations
O: overall assessment

Front 5

uterine contractions are monitored with?

Back 5

ext tocodynamometer and a internal uterine pressure cath

Front 6

monitoring fetal heart sounds?

Back 6

intermittent auscultations with fetal stethacope or doppler
and continuous electronic monitoring

Front 7

int vs ext monitoring of fetal heart?

Back 7

ext electric FHR monitoring: detected thru abdminal wall with a transducer
int electronic FHR monitoring: bipolar spiral electrode attached to fetal scalp

Front 8

the increase of uterine contractions?

Back 8

1st stage: 35 - 50 mmhg, 3 > 5 cont per 10 min
2nd stage: 80 > 100 mmhg, 5 > 6 cont per 10 min

Front 9

who get continuous fetal heart monitoring?

Back 9

maternal illness (dm, htn), mult gestations, post dates, IUGR, PROM, third tri bleeding, preeclampsia, psychosocial risk, congenital mal

Front 10

fetal hr and pH show signs of?

Back 10

distress

Front 11

major effects of fetal distress?

Back 11

neurologic abnormalities (cerebral palsy, mental retardation), death

Front 12

fetal tachycardia?

Back 12

>160 bpm

Front 13

causes of fetal tachy?

Back 13

maternal fever (MC), asphyxia, infx, premature, drugs, stimulations, arrythmias, maternal anxiety, thyrotoxicosis

Front 14

fetal brady?

Back 14

<120 bpm for 10-15 min

Front 15

causes of brady?

Back 15

asphyxia, drugs, reflex, arrythmias, hypothermia, idiopathic

Front 16

Beat to beat variability?

Back 16

interaction of autonomic nervous system to adjust for changes.
important measure of fetal CNS integrity
single most important fetal characteristic of baseline FHR

Front 17

Short term variability?

Back 17

variations in amplitude seen on beat to beat basis. normally 3-8 bpm

Front 18

long term variability?

Back 18

irregular, crude wave like pattern with a cycle of 3-6 cycles per min and an amplitude of 5-15 bpm

Front 19

how is decreased variability diagnosed?

Back 19

if short term variability is absent and there is a less than 2 cycle changes/min of long term

Front 20

causes of decreased beat to beat?

Back 20

fetal asphyxia, drugs, prematurity, fetal tachy, sleep states, cardiac/cns abnormalities, arrythmias,

Front 21

what does no beat to beat variability indicate?

Back 21

acidosis: remove fetus immediately

Front 22

sinusoidal patterns?

Back 22

rate = 120 -160 bpm. but long term variability is undulating and smooth (5-10 amp) and there is shortened short term

Front 23

sinusoidal patterns are associated with?

Back 23

fetal anemia and Rh immunization

Front 24

reactivity?

Back 24

response of healthy fetus when stimulated
transient deviation from baseline 10-15 bpm

Front 25

FHR accelerations?

Back 25

increase in FHR of at least 15 bpm, usually 15-20 sec duration and assoc with intact fetus, unstressed by hypoxia or acidemia

Front 26

variations of decelerations on the fetus?

Back 26

Severe: change >60 b/m lasting at least 1 min or hr <90 b/m
Mod: falls inbetween the 2
mild: change in hr <20 b/m

Front 27

Early decelerations?

Back 27

slow hr but not below 100. proportional to contraction strength.
not cause by hypoxia
not assoc with poor fetal out come

Front 28

Late decelerations?

Back 28

usually found with acute or chronic placental vascular insufficiency
starts after peak and extends past contractions
brought on by hypoxia
may be assoc with resp/meta acidosis

Front 29

Increased incidence of late decelerations in?

Back 29

DM, HTn, preeclampsia, IUGR, abruptio placenta, hyperstimulation of uterus

Front 30

Intervention for late decel?

Back 30

change position, give o2, stop oxy, IV bolus, MgSO4, monitor BP

Front 31

Variable decelerations?

Back 31

MC. no correlation to contractions. rapid rise and fall of FHR. usually result of cord compression. Assoc with oligohydramnios.
causes short term acidosis

Front 32

prolonged decel?

Back 32

last 90 -120 sec or more. prolonged cord compression or placental insufficiency

Front 33

Iatrogenic causes of fetal distress?

Back 33

maternal position, oxytocin stimulation, peridural anesthesia,

Front 34

Fetal scalp blood sampling?

Back 34

gold standard for determining well-being of fetus
norm pH = 7.25 - 7.35, <7.20 = asphyxia
repeat test in 15-30 min if low

Front 35

Improving uterine and umbilical blood flow?

Back 35

reposition, hydrate, uterine relaxation, D/C oxy, manual elevation of fetus while preparing for C section, improve o2 sats, amnioinfusion

Front 36

post date pregnancy?

Back 36

pregnancy that cont for more than 42 weeks
50% of moms who have it once will have it again

Front 37

major concern in post dates?

Back 37

placental insufficiency and aging
asphyxia often happens

Front 38

this is very important with post dates?

Back 38

determining gestational age

Front 39

dysmaturity syndrome?

Back 39

loss of sub q fate, growth retarded, dry wrinkled cracked skin, meconium staining, long nails, unusual degree of alertness

Front 40

25 % of post terms are (dysmaturity syndrome)?

Back 40

macrosomic leading to
hypoglycemia
hyperbilirubinemia
there is maternal trauma
shoulder dystocia
clavicle fx
erbs

Front 41

Complications in postdates?

Back 41

brachial plexus injury, oligohydramnios, placental dysfunction, meconium asp (13-15% of preg)

Front 42

Biochm evaluation of post dates?

Back 42

estriol: less than 12mg/day indicates fetal jeopardy
hCS: level is proportional to weight of fetus and placenta
follow serial numbers
Amniotic fluid: Oligo?, US and amniocentesis

Front 43

Non stress test?

Back 43

continuous FHR with doppler correlates with fetal well being

Front 44

Interpretation of non stress test?

Back 44

reactive: norm variability and at least 2 accelerations in 20 min last >15 sec peak at 15 beats
non reactive: assoc with poor pernatal outcome follow up with biophyscal profile

Front 45

COntraction stress test?

Back 45

test FHR with induced uterine contractions. at least 3 in a 10 min time span
indicate measure of placental function
performed when NST is non reactive

Front 46

interpretation of CST?

Back 46

neg: 3 contraction in 10 min with no decel (usually predicts favorable outcome, 25% are false pos)
pos: severe variability or late decel in 50% of contractions
80% of repeat tests will be neg

Front 47

Biophysical profile?

Back 47

Uses US and cardio tocography to ascertain fetal well being. (for women with HTN, DM)

Front 48

components of biophysical?

Back 48

reactivity (NST within)
fetal breathing
fetal tone
fetal activity
amniotic fluid index

Front 49

amniotic fluid levels?

Back 49

34-38 weeks = 800-1000ml
after 38 is decreases
42 weeks = 500ml

Front 50

scoring BPP?

Back 50

each test is worth 0-2 points for a total of 10.
2 for normal
0 for abnormal/absent
amniotic fluid is most important
normal = 8-10
6= asphyxia should repeat test

Front 51

cervical changes are called?

Back 51

ripening

Front 52

Bishop score?

Back 52

0-3 pts for each parameter
based on:
fetal station
degree of dilation
effacement
consistency of cervix
position of cervix
bishop score of 8 is ripe

Front 53

methods for induction?

Back 53

oxytocin
prosta gel (dinoprostone, mistoprostol)
laminaria tents

Front 54

immediate newborn procedures?

Back 54

suction of mouth and nasal passage
clamp/cut umbilical cord
dry infant
APGAR

Front 55

APGAR?

Back 55

evaluates 5 signs of fetal status
HR, Resp, muscle tone, reflex, color
8-10 is good
< 8 needs assistance