Easy Points: Phys OB - Intrapartum Assessment

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orcl777
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252794
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Easy Points: Phys OB - Intrapartum Assessment
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2013-12-12 09:59:04
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Fetal Intrapartum phys ob olfu2016
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Phys,OB
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Phys OB: Fetal Intrapartum
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  1. most commonly used intrapartum assessment
    Non - Stress Test
  2. With most complication and infection among intrapartum assessment
    Internal Electronic Fetal Monitoring
  3. Requirements to achieve Internal electronic Fetal Monitoring
    • 1. Patient should be in labor
    • 2. Bag of water should be ruptured
    • 3. significant cervical dilatation
  4. Components of cardiometer
    P wave, T wave, ORS complex
  5. Fitfall of Internal Electronic Fetal Monitoring
    Scalp electrode can pick up maternal R waves
  6. what are the two probes used in External Electronic Fetal Monitoring
    • 1. Fetal Heart Tone
    • 2. Uterine Contractions
  7. Where is the fetal heart tone best heard
    Fetal back
  8. If fetal heart tone is heard in lower portion, lower quadrant what presentation?
    Cephalic Presentation
  9. If fetal heart tone is heard in lower portion, upper quadrant what presentation?
    Breach presentation
  10. placement of the uterine probe to assess uterine contraction in External Electronic Fetal Monitoring
    Fundal Portion
  11. Normal Fetal Heart Rate 
    16 weeks?
    40 weeks?
    • 16 weeks AOG - 160 bpm
    • 40 weeks AOG - 150 bpm
  12. what is the cut off for normal fetal heart rate?
    110-160 bpm
  13. Enumerate Fetal Heart Rate pattern
    • 1. Bradycardia
    • 2. Tachycardia
    • 3. Beat to Beat variability
    • 4. Cardiac Arrythmia
    • 5. Sinosoidal
  14. Define fetal bradycardia
    mild, moderate and severe
    • bradycardia < 110 bpm
    • mild - 100-119 bpm
    • moderate - 80-100 bpm
    • severe - < 80 bpm
  15. The most prevalent obstetrical procedure in the United States
    Continuous graph-paper portrayal of the fetal HR
    Potentially diagnostic in assessing pathophysiological events affecting
    Continuous electronic fetal monitoring (EFM)
  16. Types of EFM
    • Internal Electronic Monitoring
    • External Electronic Monitoring
    • Fetal HR Patterns
  17. Which method measures fetal HR by attaching a bipolar spiral or coiled electrode directly to the fetus
    Internal Electronic Monitoring
  18. Which fetal monitoring?
    -Wire electrode penetrates fetal scalp
    ruptured amniotic membranes
    -Vaginal body fluids create a saline electrical bridge that completes the circuit & permits measurement of the voltage differences b/w 2 poles
    -2 wires of the bipolar electrode attached to a reference electrode on the maternal thigh to eliminate electrical interference
    -Electrical fetal cardiac signal (P wave, QRS complex, T wave) is amplified & fed into a cardiotachometer for fetal heart rate calculation
    Internal electronic monitoring
  19. Calculates fetal heart rate
    Cardiotachometer
  20. Portion of the fetal electrocardiogram most reliably detected
    Peak R-wave voltage
  21. Phenomenon of continuous R-to-R wave FHR computation
    Beat-to-beat variability
  22. Maternal ECG is __ times stronger than fetal ECG
    5
  23. ECG findings if carrying a live fetus
    Low maternal ECG signal is detected but masked by the fetal ECG
  24. ECG findings if carrying a dead fetus
    • Weaker maternal signal will be amplified & displayed as the ―fetal‖ HR
    • Hence, when the fetus is dead, the maternal R waves are still detected by the scalp electrode as the next best signal and are counted by the cardiotachometer
  25. Advantage of External (Indirect) Electronic Monitoring
    Membrane rupture & uterine invasion is avoided
  26. Disadvantage of External (Indirect) Electronic Monitoring
    Does NOT provide the precision of fetal HR measurement or the quantification of uterine pressure
  27. What does Ultrasound Doppler principle detect?
    Fetal HR detected through maternal abdominal wall
  28. Which method?
    US waves undergo a shift in frequency as they are reflected from moving fetal heart valves & from pulsatile blood ejected during systole
    Transducer applied on maternal abdomen at site where fetal heart action is best detected
    Ultrasound doppler
  29. Probe that monitors fetal activity
    Doppler
  30. Probe that monitors uterine activity
    Toco
  31. Descriptive characteristics of baseline fetal heart activity
    • Rate
    • Beat-to-Beat variability
    • Fetal arrhythmia
    • Distinct Patterns of FHR (Sinusoidal, Saltatory)
  32. What happens to FHR as AOG increases?
    Decreases
  33. Normal postnatal HR
    • 90 bpm
    • ↓ 24 bpm b/w 16 weeks & term or ~1 bpm/wk
  34. Normal gradual slowing of the FHR corresponds to maturation of what?
    PARASYMPATHETIC (vagal) heart control
  35. Minimum interpretable baseline duration must be at least __ minutes in any __ minute segment
    2; 10
  36. The result of tonic balance b/w accelerator & decelerator influences on pacemaker cells
    Average FHR
  37. Accelerator influence of HR
    Sympathetic system
  38. Decelerator factor of HR
    Parasympathetic system
  39. Modulates HR via hypoxia and hypercapnia
    Arterial chemoreceptors
  40. Attributed to head compression from occiput posterior or transverse positions, particularly during second-stage labor
    Bradycardia
  41. Reassuring or nonreassuring?:
    80 to 120 beats/min with good variability
    Reassuring
  42. Reassuring or nonreassuring?:
    < 80 bpm
    Nonreassuring
  43. Parameters of bradycardia:
    Mild: ?
    Moderate:?
    Severe: ?
    • Mild: 100-119 bpm
    • Moderate: 80 –100 bpm for at least 3 minutes
    • Severe: < 80 bpm
  44. Condition that is caused by the following:
    -Congenital heart block
    -Serious fetal compromise
    -Maternal hypothermia under general anesthesia d/t repair of a cerebral aneurysm or during maternal cardiopulmonary bypass for open-heart surgery
    -Severe pyelonephritis
    Fetal bradycardia
  45. Parameters of tachycardia:
    Mild: ?
    Severe: ?
    • Mild: 161-180 bpm
    • Severe > 180 bpm
  46. Condition caused by the following:
    Maternal Infection
    Maternal fever
    Amnionitis
    Fetal compromise
    Cardiac arrhythmias
    Drugs
    Tachycardia
  47. __ bpm increase in FHR for __ degree C increase in maternal fever
    10; 1
  48. Most common cause of fetal tachycardia
    maternal fever from chorioamnionitis
  49. Can induce fetal tachycardia before onset of maternal fever.
    Amnionitis
  50. Key feature to distinguish fetal compromise in association with tachycardia
    concomitant heart rate decelerations
  51. Drugs that cause fetal tachycardia
    • Atropine
    • Terbutaline
  52. Wandering baseline is unsteady and "wanders" between __ and __ bpm
    120; 160
  53. Suggestive of neurologically abnormal fetus
    May occur as a preterminal event
    Wandering baseline
  54. Reflects the function of ANS
    Most important parameters of the fetal HR
    Important index of cardiovascular function regulated by ANS
    beat-to-beat variability
  55. Which grade of beat-to-beat variability?
    Amplitude: UNDETECTABLE
    straight line of cardiac rate where there is no acceleration or deceleration
    Grade 1: Absent
  56. Management of absent beat-to-beat variability
    Deliver baby ASAP via CS as this is a dying fetus
  57. Which grade of beat-to-beat variability?
    Amplitude: < 5 bpm
    Grade 2: Minimal
  58. Management of minimal beat-to-beat variability
    • dissociate and put the mother in the left lateral position to decompress the abdominal aorta
    • give oxygen as well.
    • If after resuscitation, there is no change: DELIVER THE BABY ASAP
  59. Which grade of beat-to-beat variability?
    Amplitude: 6 – 25 bpm
    NORMAL
    Grade 3: Moderate
  60. Which grade of beat-to-beat variability?
    Amplitude: > 25 bpm
    Grade 4: Marked
  61. instantaneous change in FHR from one beat (R wave) to the next
    Measure the time interval b/w cardiac systoles
    Not seen by the naked eye
    Normally present only when electrocardiac cycles are measured directly w/ scalp electrode
    Microscopic portion of variability
    Short term variability
  62. oscillatory changes that occur in one minute and results in the waviness of the baseline
    NORMAL frequency: 3-5 cpm
    Long-term variability

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