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55 Cards in this Set
- Front
- Back
fetal monitoring helps to prevent?
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hypoxia, cerebral palsy, fetal death
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fetal monitoring consists of monitiring?
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fetal hr and uterine contractions
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neg impact of fetal monitoring?
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mobility, physical contact with partner, time with labor nurse
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Dr. C Bravado?
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approach to determining risk
Dr: determine risk C: contractions Bra: baseline rate V: variability A: accelerations D: decelerations O: overall assessment |
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uterine contractions are monitored with?
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ext tocodynamometer and a internal uterine pressure cath
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monitoring fetal heart sounds?
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intermittent auscultations with fetal stethacope or doppler
and continuous electronic monitoring |
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int vs ext monitoring of fetal heart?
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ext electric FHR monitoring: detected thru abdminal wall with a transducer
int electronic FHR monitoring: bipolar spiral electrode attached to fetal scalp |
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the increase of uterine contractions?
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1st stage: 35 - 50 mmhg, 3 > 5 cont per 10 min
2nd stage: 80 > 100 mmhg, 5 > 6 cont per 10 min |
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who get continuous fetal heart monitoring?
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maternal illness (dm, htn), mult gestations, post dates, IUGR, PROM, third tri bleeding, preeclampsia, psychosocial risk, congenital mal
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fetal hr and pH show signs of?
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distress
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major effects of fetal distress?
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neurologic abnormalities (cerebral palsy, mental retardation), death
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fetal tachycardia?
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>160 bpm
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causes of fetal tachy?
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maternal fever (MC), asphyxia, infx, premature, drugs, stimulations, arrythmias, maternal anxiety, thyrotoxicosis
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fetal brady?
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<120 bpm for 10-15 min
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causes of brady?
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asphyxia, drugs, reflex, arrythmias, hypothermia, idiopathic
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Beat to beat variability?
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interaction of autonomic nervous system to adjust for changes.
important measure of fetal CNS integrity single most important fetal characteristic of baseline FHR |
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Short term variability?
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variations in amplitude seen on beat to beat basis. normally 3-8 bpm
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long term variability?
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irregular, crude wave like pattern with a cycle of 3-6 cycles per min and an amplitude of 5-15 bpm
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how is decreased variability diagnosed?
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if short term variability is absent and there is a less than 2 cycle changes/min of long term
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causes of decreased beat to beat?
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fetal asphyxia, drugs, prematurity, fetal tachy, sleep states, cardiac/cns abnormalities, arrythmias,
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what does no beat to beat variability indicate?
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acidosis: remove fetus immediately
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sinusoidal patterns?
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rate = 120 -160 bpm. but long term variability is undulating and smooth (5-10 amp) and there is shortened short term
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sinusoidal patterns are associated with?
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fetal anemia and Rh immunization
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reactivity?
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response of healthy fetus when stimulated
transient deviation from baseline 10-15 bpm |
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FHR accelerations?
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increase in FHR of at least 15 bpm, usually 15-20 sec duration and assoc with intact fetus, unstressed by hypoxia or acidemia
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variations of decelerations on the fetus?
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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 |
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Early decelerations?
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slow hr but not below 100. proportional to contraction strength.
not cause by hypoxia not assoc with poor fetal out come |
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Late decelerations?
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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 |
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Increased incidence of late decelerations in?
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DM, HTn, preeclampsia, IUGR, abruptio placenta, hyperstimulation of uterus
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Intervention for late decel?
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change position, give o2, stop oxy, IV bolus, MgSO4, monitor BP
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Variable decelerations?
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MC. no correlation to contractions. rapid rise and fall of FHR. usually result of cord compression. Assoc with oligohydramnios.
causes short term acidosis |
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prolonged decel?
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last 90 -120 sec or more. prolonged cord compression or placental insufficiency
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Iatrogenic causes of fetal distress?
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maternal position, oxytocin stimulation, peridural anesthesia,
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Fetal scalp blood sampling?
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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 |
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Improving uterine and umbilical blood flow?
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reposition, hydrate, uterine relaxation, D/C oxy, manual elevation of fetus while preparing for C section, improve o2 sats, amnioinfusion
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post date pregnancy?
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pregnancy that cont for more than 42 weeks
50% of moms who have it once will have it again |
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major concern in post dates?
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placental insufficiency and aging
asphyxia often happens |
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this is very important with post dates?
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determining gestational age
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dysmaturity syndrome?
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loss of sub q fate, growth retarded, dry wrinkled cracked skin, meconium staining, long nails, unusual degree of alertness
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25 % of post terms are (dysmaturity syndrome)?
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macrosomic leading to
hypoglycemia hyperbilirubinemia there is maternal trauma shoulder dystocia clavicle fx erbs |
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Complications in postdates?
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brachial plexus injury, oligohydramnios, placental dysfunction, meconium asp (13-15% of preg)
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Biochm evaluation of post dates?
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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 |
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Non stress test?
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continuous FHR with doppler correlates with fetal well being
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Interpretation of non stress test?
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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 |
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COntraction stress test?
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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 |
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interpretation of CST?
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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 |
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Biophysical profile?
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Uses US and cardio tocography to ascertain fetal well being. (for women with HTN, DM)
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components of biophysical?
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reactivity (NST within)
fetal breathing fetal tone fetal activity amniotic fluid index |
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amniotic fluid levels?
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34-38 weeks = 800-1000ml
after 38 is decreases 42 weeks = 500ml |
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scoring BPP?
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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 |
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cervical changes are called?
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ripening
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Bishop score?
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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 |
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methods for induction?
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oxytocin
prosta gel (dinoprostone, mistoprostol) laminaria tents |
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immediate newborn procedures?
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suction of mouth and nasal passage
clamp/cut umbilical cord dry infant APGAR |
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APGAR?
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evaluates 5 signs of fetal status
HR, Resp, muscle tone, reflex, color 8-10 is good < 8 needs assistance |