Modern Obstetrics
36 important questions on Modern Obstetrics
What are the 4 components of cardiotocographs (CTG)’s
Baseline variability
Accelerations
Decelerations
Baseline heart rate is assessed in the absence of movement, accelerations, decelerations and contractions (stillness). What is the range for a healthy baseline HR and what are the 2 types of baseline abnormalities?
Baseline bradycardia
Baseline tachycardia
What is the cause of baseline tachycardia and bradycardia and what are they classified as?
hypoxia, reduced or absent baseline variability and decelerations
Brachycardia = FHR <110bpm
Hypoxia
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State the possible 5 reasons for hypoxia in a baby that has baseline bradycardia
foetal conduction defect
placental abruption
prolonged cord compression
uterine hyperstimulation
What is baseline variability, what is a normal baseline variability and the 3 types of baseline variability abnormalities
Normal is 5-25 bpm
Reduced is 3-5bpm fluctuations around baseline
Increased is >25bpm fluctuations around baseline
Absent <3bpm
What are the causes of abnormal baseline variabilities; reduced, increased and absent?
Causes of increased baseline variability most likely acute hypoxia. This is a result of o activation of carotid chemoreflex & sympathetic stimulation, hemorrhage, uterine stimulation
What is acceleration and deceleration? What are the 4 classifications fo decelerations?
temporary/brief decrease in FHR
Early, variable, prolonged, late
What is the reason for extremely premature babies to have BL HR ≥160bpm?
What does foetal growth assessment assess and what 3 things is it used to determine
Head circumference
Abdominal circumference
Femur length
What is the purpose of vascular doppler studies and what are the 3 arteries and single venosus this tests for?
Ductus venosus
Middle cerebral artery
Umbilical artery
Uterine artery (maternal)
Where is the ductus venous located? Where does ductus venosus redirect the blood and how much?
Redirects the 50% of the blood from the placenta to the heart away from the semifunctional liver
In a ductus venous vascular doppler study what does the “A” wave indicate in general. What does an abnormal and normal “A” wave look like?
Abnormal= reduced "A" wave, disappeared "A" wave or inverse "A" wave
Which artery of the vascular doppler study arteries provides information about the acute O2 foetal status to the brain?
What is the normal anatomy of the Middle cerebral artery in terms of resistance?
the baby's brain is well nourished, so the blood vessels don't need to be wide open to capture every bit of flow = low diameter = high resistance
What anatomical change occurs in the middle cerebral artery to reverse a state of hypoxia?
What is the purpose of the umbilical artery and what is the purpose of umbilical artery vascular doppler studies?
flow in this artery assesses degree of placental vascular resistance downstream
Umbilical artery assesses vascular resistance in the placenta. What is the cause of placenta vascular resistance and its effect on gas and nutrient exchange?
Reduces gas & nutrient exchange
What's the purpose of the uterine artery (maternal) and uterine artery vascular doppler studies?
Uterine artery Doppler studies are used to evaluate this blood flow
Maladaptation is the collective name for what 2 conditions that arise from failure of a mother's blood vessels to physically alter and widen during early pregnancy as it should during normal pregnancy. What is Maladaptation?
Preeclampsia
Where does amniotic fluid come from to be able to conduct amniotic fluid volume ultrasounds and what do AFV ultrasounds tell us?
AFV shows how well the kidney is functioning and developing through amount of urine (amniotic fluid) produced
What is the 2 step process involved in conducting AFV ultrasounds?
- divide the uterus into four imaginary quadrants using the umbilicus as the center
- measure the largest pocket in each quadrant and combine all quadrants together → create Amniotic Fluid Index (AFI).
Amniotic Fluid Index (AFI) has 3 categories divided by the centimeters of all the pockets added together. State the 3 categories and their cut offs
Oligohydramnios (≤5 cm)
Polyhydramnios (≥24 cm)
Why is Oligohydramnios, a reading of (≤5 cm) , particularly dangerous?
What is biophysical profile an indicator of and what are the short term, long term and additional indicators?
short term indicators = Fetal Breathing Movements, Gross Body Movements and fetal tone
Long term indicators = Amniotic Fluid Index (AFI)
Additional indicators = The CTG
Of the 3 short term biophysical profile indicators, what is an indication of a healthy Fetal Breathing Movement?
Of the 3 short term biophysical profile indicators, what is an indication of healthy Gross Body Movements?
Of the 3 short term biophysical profile indicators, what is an indication of a healthy and unhealthy fetal tone?
Unhealthy = a slow extension without a full return to flexion + a baby whose hand remains partially open
Is Amniotic Fluid Index (AFI) a long term indicator of placental support to a baby?
Is The CTG an additional indicator of short and long term viability of pregnancy?
What does fetal blood sampling measure and what other ultrasound FHM technique does FBS complement and why?
FBS complements an abnormal CTG trace because an CTG trace can give off a false reading. Reduces "false positive" diagnoses of foetal unwellness by CTG
When is the best time to use fetal blood sampling?
Does fetal blood sampling involve taking a small sample of blood from the baby's scalp?
What is the physiological knowledge around blood, oxygen and h+ ions required to interpret the results of fetal blood sampling?
What is the lactate mmol and pH for pre acidotic foetal blood sampling results and what should be done when they are abnormal?
We repeat the test within 30 minutes to see if there is a trend, or we may decide to deliver if the baby's condition seems to be deteriorating quickly
What is the lactate mmol and pH for normal foetal blood sampling results?
What is the lactate mmol and pH for acidotic foetal blood sampling results and what 2 things should be done as a result?
indicates the baby is no longer coping and is at high risk
baby must be immediately
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