Download Advanced Fetal Monitoring Exam Questions and Answers and more Exams Obstetrics in PDF only on Docsity!
1 /
Advanced Fetal Monitoring Exam Questions with Correctly Solved Answers
1.What category rules out fetal acidemia?: Cat 1
2.What maternal conditions greatly impact fetal oxygenation?: Severe asthma, cardiac issues, and eclamptic seizures
3.Where does the exchange of O2 and nutrients take place?: intervillous space
4.How is o2 blood transferred to the fetus?: O2 enters the intervillous space via the maternal arteries, to the villi then the
umbilical vein take the o2 blood to the fetus. The umbilical arteries take the deO2 blood from the baby through the villi and back to the mother
5.Diffusion: High to low concentration Mom to fetus for
O
Low to high concentration for CO2 so baby to mom
6.How is O2 transferred from mom to baby: Diffusion
7.Explain spiral arteries in placenta: Carry O2 into intervillous space Are maximally dilated so they can not
be increased
8.What are factors that can decrease uteroplacental blood flow?: Maternal conditions like pre-e and cardiac disease
Maternal hypotension Placental changes- abruptions, infections, edema, or smaller size Excessive uterine activity Vasoconstriction
9.What happens to the spiral arteries during pre-e?: They are constricted which decreases blood flow
10.Why does the supine position cause decreased uteroplactenal blood flow?: The aorta and vena cava get
compressed (20 weeks)
11.Why does maternal hypotension happen after regional analgesia?: Blocks the sympathetic pathway
Pooling of blood in the lower extremities decreases blood flow back to moms heart which decreases blood flow to the fetus
2 /
12.What percentage is uteroplacental blood flow decreased by during cxts?-
13.Explain the pathway for maternal- fetal exchange for fetal oxygenation (basic): Environment to lungs to heart to
vasculature to uterus to placenta to umbilical cord
14.Where is the least O2 blood in the fetus?: Limbs, kidneys, and descending aorta
15.Where is the most O2 blood in the fetus?: Umbilical vein and ductous venous
16.Connects the umbilical vein to the inferior vena cava, bypassing the liver Shunt that allows most O2 blood to fetal
heart: Ductus venosus
17. 3 important shunts in fetal circulation: ductus venosus, foramen ovale, ductus arteriosus
18.connects the two atria in the fetal heart
Allows O2 blood to flow through the heart and directly to the brain: Foramen Ovale
19.a blood vessel in a fetus that bypasses pulmonary circulation by connect- ing the pulmonary artery directly to the
ascending aorta: Ductus Arteriosus
20.What is a normal blood volume for a fetus at term?: 80-100 mL/kg
21.What happens if you stimulate the sympathetic nervous system?: In- creased heart rate
22.What does the parasympathetic nervous system do?: Regulates the sympa- thetic
23.What happens when catecholamines (sympathetic) get released?: In- creased heart rate
24.Why do pre-termers have increased heart rates?: The sympathetic develops first so there is no parasympathetic to regulate
the heart rate
25.What happens when the parasympathetic nervous system is stimulated?-
: Acetylcholine is released which decreases the intrinsic heart rate Vagus stimulation
26.What do baroreceptors do?: Protect Regulates BP
4 / This then causes metabolic acidosis (causes cellular death).
41.How one does it take for significant acidemia to take place?: 60-90 minutes
42.What is marked variability mediated by?: Adrenergic activity
43.What are things that can cause decreased variability?: Opioids, magnesium, and tobacco (medications or drugs)
Fetal sleep cycles Fetal acidemia- there will be no accels here
44.What accelerations do gestations less than 32 weeks need?: 10x
45.Describe the reasoning for early decels: Fetal head compression leads to altered cerebral blood flow which produces a
vagabond reflex and cardiac slowing
46.Describe the physiology of a late decel: Uteroplacental insufficiency results in decreased maternal/fetal O2 transfer
47.What do late decels with moderate variability mean and indicate?: It's neurogenic
Exclude clinically significant acidemia Provide interventions to increase perfusion
48.What do late decels with decreases variability mean and indicate?: Means myocardial depression
Expedited delivery
49.What are 3 causes of prolonged decels?: Interruption of uteroplacental per- fusion or exchange- tachysystole, maternal
hypotension, maternal hypoxia (seizure or cardiac arrest), placental abruption, or uterine rupture Interruption of umbilical blood flow- cord compression, cord prolapse, or ruptured vasa previa
50.Presence of fetal (not placental) blood vessels that cross the internal cervical os (marginal or velamentous cord
insertions or with succenturiate lobes). Umbilical cord crosses the internal cervial os: Vasa previa
51.What nervous system has control over bradycardia?: parasympathetic ner- vous system
5 /
52.What are some maternal conditions that can lead to fetal tachycardia?: -
Fever Dehydration Infection Medications- terbutaline, albuterol, atropine, cocaine, or caffeine Medical conditions- hyperthyroidism
53.What are some fetal conditions that can cause tachycardia?: Fetal bleeding- placental abruption
Fetal anemia Fetal sepsis Fetal hypoxia Arrhythmias
54.What are causes of sinusoidal pattens?: Severe fetal anemia- ruptured vasa previa, TTTS, Rh isoimmunization
Severe metabolic acidemia
55.How often do you chart heart tones for a low risk pt from latent phase up to the 2nd stage (until pushing)?: Every 30
mins
56.How often do you chart heart tones from the latent phase up until the second stage of labor with a high risk
patient?: Ever 15 mins
57.At what rate is exogenous oxytocin at for the mother during the first stage of labor?: 2 to 4 mu
58.At what rate is exogenous oxytocin at for the fetus during the first stage of labor?: 3 mu
59.What is the biologic half-life of oxytocin?: 10 to 15 minutes
60.How long does it take to reach a steady state of plasma concentration for Pitocin?: 30 to 60 minutes
61.When should an amnioinfusion be used?: During the first stage of labor with recurrent they are both the cells that have not
resolved with position changes
62.When should and amnioinfusion not be used?: Late decelerations, active pushing, meconium, VBAC or TOLAC
63.What is the main goal during the second stage of labor?: Maintain fetal physiologic reserve and maximize fetal
oxygenation
7 /
78.Decreased pH, increased PCO2, decreased HCO3, decreased BE: Mixed acidemia
79.What is velamentous insertion of the umbilical cord?: When the vessels are not protected by whartons jelly
80. What are some risk factors of abruptio placenta?: Prior history, hypertension, cigarette smoking, cocaine use, or
blunt abdominal trauma
81.Why is there if you tachycardic response after a prolonged decel?: It is a sympathetic response so catecholamines like
norepinephrine and epinephrine are released to recuperate
82.What do narcotics to you in regards to fetal heart rates?: Can decrease variability and accelerations
83.What can stadol and Nubian cause in fetal heart rates?: Pseudo sinusoidal patterns
84.What can cocaine cause in regards to uterine activity and fetal heart rates?: Decrease variability and increased
uterine activity
85.What can betamethasone cause in regards to fetal heart rate?: Decrease variability for 48 hours
86.What terbutaline cause?: Increased fetal heart rate baseline and increase maternal heart rate
87. How do you fetal dopplers work?: By sending and receiving US waves through the mothers abdomen
When the waves are reflected from moving objects like the fetal heart the frequency changes slightly This change is then analyzed by the electronics inside the transducer and converted into audible beeps
88.How do fetal scalp electrodes work?: Convert FECG to fetal heart rate by measuring consecutive R to R wave intervals
89.What can cause an irregular rhythm in a fetus?: Increased caffeine intake
90.What can be done to treat Fetal SVT?: Requires a risk benefit analysis Digoxin or other drugs like amiodarone
91. What can cause a complete or third-degree heart block in a fetus?: Maternal lupus
92.What ventricular rate in a fetus is associated with a complete or third-de- gree heart block?: 50 to 70 bpm
8 /
93.How can a complete heart block be treated in a neonate?: A pacemaker implantation
94. How can hypoxemia lead to a decreased AFI in a fetus?: Hypoxemia can lead to shunting which leads to decreased
renal perfusion which then causes a decrease in AFI
95.What is the most accurate test for evaluating risk of fetal death within seven days of a reassuring test?: CST
96.What is a normal fetal movement count?: 10 distinct movements in two hours
97.What is a reactive NST for greater than 32 weeks?: Accelerations peak greater than 15 bpm above the baseline and
last for greater than 15 seconds
98.What is a reactive NST for less than 32 weeks?: Accelerations with a peak of greater than 10 bpm above the baseline and
duration of longer than 10 seconds
99.How many contractions are needed for a contraction stress test?: At least three contractions and a 10 minute span each
lasting greater than 40 seconds
100. What is a negative contraction stress test?: No late or significant variable decelerations
101. What is a positive contraction stress test?: Recurrent late decelerations even if the frequency of contractions is
less than three in a 10 minute span
102. What is a suspicious contraction stress test?: Intermittent late or significant variable decelerations
103. What does a biophysical profile or BPP consist of?: An NST, fetal breathing movement, fetal movement, fetal tone,
and amniotic fluid volume
104. What is the normal value for a BPP?: 8 to 10
105. What is a concerning BPP score?: Four or less
106. What is the most concerning in regards to a BPP?: Loss of fetal tone
107. What is a normal AFI?: 5- 25
108. What does a umbilical artery Doppler velocimetry do?: Assess his vascular resistance to blood flow within the
