MF assessment

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Author:
rhondak
ID:
221032
Filename:
MF assessment
Updated:
2013-05-25 20:16:32
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MFA
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Description:
Maternal-Fetal Assessment
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  1. Indications for Fetal monitoring
    • DM
    • HTN
    • IUGR
    • ↓ fetal movement
    • previous stillbirth
    • Routine surveillance
    • Rh disease
  2. What can be measured with external monitoring (Tocotransducer)?
    Frequency of uterine contractions only. Not intensity
  3. What needs to happen for the placement of an internal fetal heart monitor (Spiral electrode)?
    Dilation and rupture of membranes
  4. What uterine measurements are seen in active labor?
    • Resting tone 5-15 mm Hg
    • Frequency 3-5 mins
    • Duration 30-60 secs
    • INTeNSITY 50-75 mm Hg
  5. Define and give causes for fetal tachycardia
    • Sustained FHR >160 for >10 minutes
    • Loss of PSM activity

    • Causes:
    • Fetal anemia or hypoxia
    • Maternal Fever
    • Hyperthyroidism
    • Amnionitis
  6. When is fetal tachycardia an ominous sign
    • Late Decels
    • Severe variables
    • No variability
  7. Define and give causes for fetal bradycardia -
    Decreased from baseline X10 minutes (<120 or 30 drop from baseline)

    • Causes:
    • Fetal hypoxia from cord compression
    • Maternal hypotension or hypothermia
    • B-Blockers
    • Anesthetic agents
  8. What is variability indicative of?
    • Normal neurological control of HR
    • Fetal reserve

    (Balance between SYM and PSM systems balance)
  9. Begins prior to contraction peak
    Recovers with contraction

    Causes:
    Uterine contractions
    Vag exam or fundal pressure
    IUPC placement
    Early Decel
  10. Begins late - at or after peak
    recovers after contraction ends

    Indicates hypoxic stress, metabolic acidosis

    Seen c strong contraction
    Late Deceleration
  11. Causes of Late Decels
    • Uteroplacental insufficiency
    • Maternal DM
    • supine hypotension
    • postmaturity
    • amnionitis
    • PIH
    • previa
    • Abruptio placenta
  12. How long is a prolonged decel
    >90 seconds - fetal survival poor if not managed
  13. What is the criteria for a reactive NST

    (Best time is late in evening: baby more active)
    2 - 15bpm accelerations

    x15 seconds

    within 15 minutes
  14. Oxytocin Challenge Test or
    Contraction Stress Test criterion
    3 moderate contractions in 10 minutes, lasting 40-60 seconds

    Oxytocin IV or nipple stim until contractions begin
  15. When is CST ordered and what constitutes healthy/compromised?
    CST is ordered when there is a non-reactive NST

    Healthy CST is with a stable FHR and No late decels

    Compromised with late decels
  16. What are the indications for fetal Ultrasound?
    • Fetal:
    • gestational age
    • growth/Well-being
    • well being
    • amniotic fluid level
    • confirm demise/presentation
  17. What are indications for Ultrasound for mom?
    • evaluate vaginal bleeding
    • R/O molar pregnancy
    • evaluate mass
    • cervical length
  18. What are AFI measurements for:

    NL, Oligo, and Poly
    • NL - 8-18
    • Oligo - < 5cm

    Poly - > 25cm
  19. What problems are associated with Polyhydramnios?
    • NTD
    • GI tract obstruction
    • Multiple gestation
    • Fetal hydrops
  20. What are consequences of oligohydramnios?
    • Restricted fetal movement
    •    Impaired lung development, compression 
    •    orthopedic abnormalities

    Cord compression (inadequate circulation)
  21. What is late amniocentesis used to detect?
    • Fetal Lung Maturity
    • (inadequate surfactant = RDS)
  22. What is scoring for the L/S ratio?
    2 or > = mature lungs

    at 1.5 = 50% incidence of RDS

    <1.5 = 73% incidence of RDS
  23. When does fetal breathing become regular and what does it demonstrate?
    Fetal breathing becomes regular at 20-21 wks and this demonstrate intact neurologic control
  24. BIOPHYSICAL PROFILE  (to test CNS functioning) is composed of what
    • NST
    • FBM
    • Fetal tone
    • Fetal movement
    • AFI

    Scoring is 2 or 0 for each category. Max 10
  25. What must happen for a score of 2 in each category of BPP?
    • FBM: 1 episode (>30sec) in 30 min
    • Movement: 3 discrete body/limb movement in 30 mins
    • Tone: 1 episode limb or trunk extension and back to flexion
    • NST: Reactive
    • AFI: at least 1 pocket = 2x1 cm
  26. BPP Scoring management
    8 or 10: 10 NL low risk. 8 NL. Deliver if Oligo

    6: Suspect chronic asphyxia >36 wks - deliver. < 36wks repeat

    4: Suspect chronic asphyxia >32 wks deliver, <32 wks repeat

    0-2: Strongly suspect chronic asphyxia - Extend test to 120 minutes. If persistently <4, deliver

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