NCC EFM Brain Storm Revised QUIZ Test Bank MOD 004 Complete Solution 2023

Polyhydramnios correct answers single MVP 8 cm or AFI 24; 1% of pregnancies; 60% idiopathic; multiple gestation, maternal diabetes, hydrops, anomalies, TORCH; ass'd with cardiac/GI issues/renal issues Oligohydramnios correct answers single MVP 2 cm or AFI 5 at term (less than 5%ile); associated with FGR, placental abnormalities, urinary tract abnormalities, post-term pregnancies, ruptured or idiopathic membranes Doppler correct answers US transducer, depicts valve closure; uses autocorrelation Autocorrelation correct answers successive US waveforms at many points; current technology which is more accurate at detecting FHR variability; controls artifact sound waves Toco/tocotransducer correct answers detects change in contour with contractions; place at fundus or at area of maximum palpation; difficult to measure with obesity, polyhydramnios Fetal scalp electrode measures correct answers R-R waves; still has issues with artifact; risk of injury, measuring maternal HR in instance of fetal demise; rupture and dilation required IUPC correct answers solidfluid filled tips, measures mmHg and allows amnioinfusion; issue with displacement, perforation, placental abruption Intermittent auscultation correct answers goal is baseline 110-160, +/-accels, no decels; if present, put on continuous monitor min 20 minutes); cannot determine variability or types of FHR decels Active phase auscultation correct answers q15 min for high risk up to q30min Second stage auscultation correct answers q5 min if high risk up to q15min Fetal tolerance of labor correct answers auscultate after a contraction x 30-60 seconds; document rate, rhythm, accels, decels Doppler vs. fetoscope correct answers doppler uses autocorrelation and detects valve closure; fetoscope listens through opening in heart wall? Signal ambiguity correct answers confusing maternal and fetal heart rate; common with repositioning, fetal movement, during pushing (maternal tachycardia); can occur even with fetal demise due to FSE recording maternal blood flow through the placenta Suspect signal ambiguity correct answers when there is lower baseline or 50% contractions with accelerations (especially with pushing); verify and document maternal heart rate via pulse oximetry Halving/doubling correct answers Halving occurs if FHR 180-200; may double if rate 50 Extrinsic factors correct answers maternal oxygenation, uterine blood flow, placenta exchange, umbilical blood flow; intrinsic factors = fetal circulation, oxygenation of tissues, FHR regulation Primary source of oxygen for the feus correct answers the maternal respiratory system Uterine blood flow correct answers 60ml/min non-pregnant vs. 500-1000ml/min; 10-15% maternal cardiac output Normal blood flow pathway correct answers Blood from maternal vein intervillous pool of maternal blood umbilical vein (oxygenated blood) Normal placenta correct answers Placenta has 15-20 lobules on maternal surface; Decreased surface area of chorionic villi from abnormal development, infection, thrombosis, hemorrhage, inflammation (chorio increases risk of CP), degenerative changes with increasing gestational age (calcifications)/HTN/DM - can cause IUGR, hypoxia, FHR decels Acute drop in placental function correct answers fetal asphyxia Chronic drop in placental function correct answers FGR O2 and CO2 correct answers simple transport (diffusion); electrolytes, fat soluble vitamins, narcotics, anesthetic gasses, antibiotics Glucose correct answers facilitated transport, by carrier molecules Active correct answers amino acids, calcium, iron, water soluble vitamins (uses ATP) Umbilical blood flow correct answers 2 arteries (deoxygenated) and 1 vein (oxygenation) Fetal circulation correct answers when compromised, fetal blood redistributed to heart, brain, adrenals; shunting and FHR increase compensate for decreased blood flow and hypoxemia; limit mixing of oxygenated and deoxygenated blood Fetal hemoglobin correct answers AND increased O2 affinity adult; fetus has increased cardiac output and heart rate Ductus venosus correct answers (highest oxygenation) ductus arteriosus (least oxygenation); Abrupt decrease in PO2 leads to correct answers 2-3x increase to heart, brain, adrenals; decrease to gut, spleen, kidneys, limbs Severe acidemia correct answers decrease CO2, BP, and decreased blood flow to brain and heart tissue damage, fetal death Oxygenation depletion cascade correct answers aerobic metabolism hypoxemia tissue hypoxia anaerobic metabolism lactic acid metabolic acidosis