OB- Maternal-fetal assessment

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  1. What is the normal blood volume of infant at term delivery?
    700-800ml (10-15% of maternal)
  2. What are vascular branches of placenta that project into the intervillous space?
    Chorionic villi
  3. Fetal gas exchange is dependent on what 6 things?
    • 1. Intervillous blood flow
    • 2. Placenta surface area
    • 3. membrane permeability
    • 4. O2 tension b/w uterine & umbilical vessels
    • 5. Hgb affinity and concentration
    • 6. Umbilical cord blood flow
  4. Maternal to fetal flow rate is determined by what 2 things?
    Maternal BP & anesthesia induction
  5. What are some situations where placental area is reduced?
    • 1. Maternal issues (HTN, DM, vascular dx)
    • 2. Placenta previa, abruptio, infactions
    • 3. intrauterine infection
    • 4. circumvallage placenta
  6. What are some fetal compensation techniques for low O2 tension?
    • 1. Increase fetal CO (3-4x than adult)
    • 2. Increase O2 carrying (HbF)
    • 3. Increased affinitity for O2 (HbF)
    • 4. Anatomical fetal shunts
  7. What is the normal range for fetal heart rate.   What the average rate for prior to 30 weeks and average rate after 30 weeks?
    • Range (120-160)
    • <30wks--> 160
    • >30wks --> 140
  8. What should you be worried about if FHR <100 or >160?
    • 1. O2 status
    • 2. Infection
    • 3. Acid-base/electrolye imbalance
  9. Discuss fetal kick counts.
    • -Begin instruction ~24-28 weeks. 
    • -Tell them to establish the time of day most active (usually evening)
    • -Perform daily around same time (decide how long it takes to normally get to 10 kicks)
    • -Call if decrease movement than normal or no movement in 12 hrs
    • -If decreased fetal movement--> suggest drinking some juice (sugar) or drink something cold, move to a different side and retry kick count
  10. T or F. Intrauterine catheters can give you information on both frequency and intensity?
    True (Externol-Toco can only show frequency)
  11. What is the normal resting tone, frequency, duration, and intensity for uterine contraction?
    • tone- 5-15mm Hg
    • frequency- 3-5min
    • Duration- 30-60sec
    • Intensity- 50-75mmHg (peak contxn)
  12. What is the definition of fetal tachycardia?
    -SUSTAINED increase in HR >160 for 10min 

    (can intermittently go up to 160 and not be tachy because it can be due to fetal activity--> like if you did a couple jumping jacks, your HR would increase briefly)
  13. What are some causes of fetal tachycardia?
    Fetal: anemia, hypoxia, cardiac, arrythmia

    Maternal: fever, hyperthyroidism

    Placenta: amnionitis

    Drugs: Terb & parasympatholytic
  14. What is the definition of fetal bradycardia?
    -Baseline <120 or 30bpm drop from baseline x 10 min
  15. What are some causes of fetal bradycardia?
    • 1. Fetal hypoxia (cord compression, bradyarrhythmias)
    • 2. Maternal hypotension/hypothermia
    • 3. Drugs (beta-blockers, anesthetics
  16. What is variability of the FHR
    It's beat to beat changes in the HR. Meaning the HR is just just consistently 140--> changes beat to beat from 140- 145- 152-143-138.  Means the fetus is well-oxygenated.  If not well oxygenated--> fetus doesn't want to move to conserve oxygen and you'll have less variability
  17. What's the difference between short-term and long-term?
    Short term--> no longer really used but is exact beat-beat change

    Long term--> rhythmic flucations in FHR (3-5 cycles per min)  Easier to determine visually looking a strip.
  18. What is suggested with absent variability?
    omnious--> decreased fetal oxygenation or CNS insult or disorder
  19. What does decreased variability suggest?
    • -Hypoxia, acidosis
    • -Drugs
    • -fetal sleep
    • -congenital anomaly
    • -extreme prematurity
    • -fetal cardiac arrhythmias
  20. What are 2 causes of sinusoidal rhythm?
    • 1. Narcotics (morphine/stadol)
    • 2. Rh isoimmunized (impending death--> stat c-section)
  21. What are the 4 types of variability?
    • 1. absent
    • 2. minimal
    • 3. moderate
    • 4. marked
    • 5 sinusoidal
  22. What is the signficance of FHR acceleration?
    • Reassuring that fetus is well-oxygenated at that moment
    • -Has to be >15bpm above baseline for 15min
    • -Associated with fetal movement/contractions
  23. What is the clinical significance for variable decelerations?
    • -common, usually transient and associated with cord compression (NOT associated with poor outcomes)
    • -Mild (<30bmp below baseline)
    • -Mod (<50bpm below baseline)
    • -Severe (<70bmp, slow return to baseline)

    **Abrupt return to baseline is a reassuring sign of good oxygenation despite cord compression
  24. What is the clinical signficance of early decelerations?
    • -Benign
    • -Associated with head compression
    • -FHR is mirror image of contraction or starts decreasing just before contraction visualized
  25. What is the clinical significance of late deceleration?
    • -Ominous when persistant or uncorrectable.  Most worrisome w/ tachycardia and no variability
    • -Late decels suggest uteroplacental INSUFFICIENCY
  26. What do late decelerations suggest?
    -fetal hypoxia, metabolic acidosis
  27. What is the clinical significance of prolonged decel (>90sec)?
    • -Decreased oxygenation, poor prognosis
    • -If doesn't return to baseline in 2min--> usually expedite delivery--> forceps/vacumn or c-section
  28. What are some causes of prolonged decel?
    • -Prolonged contraction
    • -Fetal--> pelvic exam, FSE/IUPC placement, rapid descent, cord prolapse
    • -Maternal--> hypotension, valsalva, hypoxia
  29. Discuss a NST?
    • -Requires intact neuro
    • -FM triggers accel >85% of the time
    • -Healthy term fetus should have 3-4 accels with 20-25bmp accel above baseline, lasting ~40 sec
  30. What can no accelerations in an NST suggest?
    • -Sleeping fetus
    • -CNS depressants (narcotics/propranolol)
    • -Uteroplacental insufficiency (smoking, maternal dx)
  31. What is the criterion for reactive NST?
    • -must have 2 15bpm x15sec in 15mins
    • -Reassuring for 7 days
  32. What is the criterion for "negative" CST/OCT?
    • -3 moderate contxn in 10min, lasting 40-60 with reassuring FHR
    • -NO late decels
    • - Don't have to see accelerations to be neg
  33. What are some contraindications for CST/OCT?
    • 1. risk for premature labor
    • 2. premature labor
    • 3. mult gestation
    • 4. cervical incompetence
    • 5. risk for uterine rupture
  34. What is a "positive" CST/OCT?
    Fetal distress with contractions--> may see late decels with contraction
  35. What is AFI?
    Amniotic fluid index--> sum of vertical diamter of largest pocket in each abd quadrant
  36. What are normal, borderline, oligo & polyhydramnios fluid levels?
    • Normal- 8-18
    • Borderline- 5.1-8.
    • Oligo <or = 5
    • Poly > or = 25
  37. Oligohydramnios increases the risk for what 3 things?
    • 1. perinatal mortality
    • 2. lethal congenital anomaly
    • 3. IUGR
  38. What are 4 associated problems with polyhydramnios?
    • 1. NTD
    • 2. Obstruction of GI tract
    • 3. Mult gestation
    • 4. fetal hydrops
  39. What does the L/S ratio need to be to have mature lungs?
  40. What does the BPP incorporate?
    • 1. NST
    • U/S
    • 2. Fetal breathing mvmt
    • 3. fetal mvmt
    • 4. Tone
    • 5. AFI
  41. What do the BPP measures suggest?
    • 10--> normal, low risk for chronic asphyxia
    •          repeat weekly or 2x/wk for DM/>42wks
    • 8--> normal, low risk of chronic asphyxia
    •         repeat weekly unless oligo--> deliver
    • 6--> suspect chronic asphyxia
    •         >36 then deliver
    •         <36, do amnio & if <2--> repeat BPP
    •         in 4-6hrs, deliver if amnio
    • 4--> deliver >32 wks, repeat if <32wks
    • 0-2--> extend test to 120min, if persists then deliver
  42. For the BPP, what is the requirment for fetal breathing movement (FBM)?
    -1 episode (>30sec) in 30 min
  43. For BPP, what is the requirement for 2 points for fetal movement?
    -3 "discrete" body movements in 30min
  44. For BPP, what is the tone requirement to score 2?
    -1 episode of active limb/trunk extension with return to flexion (open/close hand)
  45. For BPP, what is the AFI requirement?
    At least 1 pocket = 2x1cm

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OB- Maternal-fetal assessment
2013-05-20 15:59:55

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