EFM

Question 1

Variable decel

Answer 1

• Umbilical cord compression
• Abrupt decrease (<30 sec to nadir)
• Decrease at least 15 bpm
• Lasts 15 sec <2 min

Question 2

Normal FHR

Answer 2

110-160

Question 3

Normal Contraction frequency

Answer 3

<= 5 in 10 minutes, averaged over 30 minutes

Question 4

Tachysystole

Answer 4

Abnormally frequent rate of contractions

>5 in 10 minutes averaged over 30 minutes

Question 5

Variability

Answer 5

Most significant predictor of fetal wellbeing

Question 6

Absent variability

Answer 6

0bpm/ undetectable

Question 7

Minimal variability

Answer 7

detectable, < or = 5 bpm

Question 8

Moderate variability

Answer 8

6-25 bpm

Question 9

Marked variability

Answer 9

> 25 bpm

Question 10

Late decels

Answer 10

• Utero-placental insufficiency
• Marginal placental O2 reserve
• Transient hypoxia during/after contraction
• Chemoreceptor mediated
• Gradual onset >= 30 sec
• Associated with UC
• Usually after beginning, peak and ending of UC

Question 11

Quiet sleep

Answer 11

• Stable FHR, absent to minimal variability

- Isolated accels w/o movement

Question 12

Active sleep

Answer 12

• Wider FHR baseline and frequent accels with movements

Question 13

Quiet awake

Answer 13

• Stable, wider FHR, no accels

Question 14

Active awake

Answer 14

• Unstable FHR, large long-lasting access, coalescence of accels/tachycardia

Question 15

Reactive Non-stress test (term)

Answer 15

At least 2 access of the FHR of 15x15 (15 bpm inc and 15 sec duration) observed in 20 min of monitoring

Question 16

Non-stress test (preterm)

Answer 16

• 24-48 weeks: 50% NR
• 28-32 weeks: 15% NR - reactive = 10 bpm x10 sec duration
• 32 weeks +: reactive = 15x15
• Once reactive, should stay reactive

Question 17

Fetoplacenetal circulation

Answer 17

• umbilical vein carries oxygenated blood to fetus
• umbilical arteries carry de-oxygenated blood to placenta
• Blood is shunted via the ductus venous, ductus arterioles, and foramen oval

Question 18

Hypoxemia

Answer 18

Decreased O2 concentration in blood

Question 19

Hypoxia

Answer 19

Decreased O2 concentration in tissues

Question 20

Hypercapnia

Answer 20

More than normal level of CO2 in blood

Question 21

Acidemia

Answer 21

Increased H+ ion concentration in the blood

Question 22

Acidosis

Answer 22

Increased H+ ion concentration in tissue

Question 23

Aerobic metabolism

Answer 23

Glucose –> pyruvic acid –> ATP + CO2

Question 24

Anaerobic metabolism

Answer 24

Glucse –> pyruvic acid –> ATP + Lactic Acid

Question 25

Umbilical cord occlusion --> ...

Answer 25

- Increased CO2 and RESPIRATORY acidemia - Does NOT cause base deficit - Cure: relieve umbilical cord occulsion

Question 26

Metabolic acidemia

Answer 26

- Anaerobic metabolism --> lactic acid build up, consumes the buffer base (i.e. HCO3, hemoglobin, etc.) - Cure: increase fetal oxygenation

Question 27

Complications of fetal acidemia

Answer 27

- seizure disorders - developmental delays - cerebral palsy - fetal/neonatal death

Question 28

Neonatal encephalopathy

Answer 28

Clinically defined syndrome of disturbed neurological function in term and near term infants - respiratory difficulty - depression of tone, reflexes - subnormal LOC - often seizures

Question 29

Hypoxic ischeimc encephalopathy

Answer 29

- subset of neonatal encephalopathy - result of hypoxic/anoxic episode - accumulation of lactic and carbonic acids (H+) in the blood

Question 30

Extrinsic factors regulating FHR

Answer 30

Fetal environment and uterine physiology (i.e. uterine contractions, maternal BP or HR)

Question 31

Intrinsic factors regulating FHR

Answer 31

influences specific to the fetal cardiovascular system

Question 32

Regulation of FHR

Answer 32

Interplay between - autonomic nervous system (sympathetic, parasympathetic) - chemoreceptors - baroreceptors - higher cortical functions