In the Name of God

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In the Name of God

  • BY:
  • Mitra Ahmad Soltani
  • References:
  • 1-Williams Obstetrics / 22nd Edition/ MC. Graw Hill/ 2005 2-Novak’s Gynecology/ 13 th Edition/ Williams and Wilkins/ 2002 3-Clinical Gynecology Endocrinology and Infertility/ 7 th Edition / Williams & Wilkins / 2005 4-TE Linde’s (Operative Gynecology) 9 th Edition / Williams and Wilkins / 2003
  • 5-Iranian Council for Graduate Medical. Education. Promotion and board Exam questions.(2000-2007)

Fetal Monitoring

1- For a patient who has labor pain, an abnormal NST mandates an int monitoring of FHR. Supraventricular arrhythmia is detected. The fetus looks healthy by ultrasonography. AF is clear. What step should be taken?

2-In the second stage of labor ,you notice a persistent fetal heart rate bradycardia of 110 bpm. What is your management?

  • A- left lateral position, nasal oxygen, 1000 cc serum, fetal monitoring
  • B- detecting fetal blood PH
  • C-after 40 min intervention is needed
  • D- It is a normal event in this stage . No further step is needed.
  • Ans:D

3-BPP of a 34-week pregnancy is 4. What step should be taken?

  • A-L/S should be determined . If it is below 2, the BPP should be repeated
  • B-immediate pregnancy termination
  • C-BPP should be repeated if it is below 6 , pregnancy termination
  • D- BPP should be repeated 48 hours later and management is designed according to that score
  • Ans:C

Points to remember

  • NST:
  • Favorable: Increase15 bpm for 15 seconds within 20 min of beginning the test (before 32 wks of GA we consider 10bpm lasting 10 seconds)
  • BPP:
  • Pregnancy termination for:
  • reduced AF
  • Gestational age over 36 weeks
  • Score of 2
  • Repeating the BPP test for:
  • Score below 6 + less than 36 weeks gestation/ low Bishop/ L/S>2

+OCT: late decelerations following 50% or more of contractions

  • 3 or more contractions
  • Lasting at least 40 seconds
  • In a 10-min period
  • By either spontaneous contractions or:
      • 0.5 mU/min oxytocin
      • Doubled every 20 minutes
  • Hyperstimulation: frequency more than every 2 min or lasting longer than 90 seconds

normal fetal movement

  • 10 movements in up to 2 hours

4- What is the fetal heart rate pattern in a fetus with placental insufficiency?

  • A-late deceleration and loss of variability occurring concomitantly
  • B-first late deceleration and then loss of variability
  • C- first loss of variability and then late deceleration
  • D-first accentuated variability and then late deceleration
  • Ans:B

5- Which statement is wrong about MCA Doppler?

  • A- compared to FHR monitoring , MCA Doppler is more sensitive to fetal hypoxia
  • B- in an IUGR case, hypoxia causes reduction in Pulsatility Index (PI)
  • C- in an anemic fetus because of Rh incompatibility velocity is reduced in MCA
  • D- with pregnancy advancing there will be a normal increase in MCA velocity
  • Ans:c

Doppler systolic-diastolic waveform indices of blood flow velocity

6- After epidural procedure for a pregnant woman the fetal heart rate shows 12-14 waves of sinusoidal waves with acceleration. With regard to the following data, what is your management?: age:26 yrs/ GA:36 wks/ dil:3 cm/ eff=50%

  • A-pregnancy termination for hypoxia
  • B-this is pseudo sinusoidal pattern normal after epidural procedure. No step is needed.
  • C-change of position and oxygen to relieve pressure on the umbilical cord
  • D-pregnancy termination for fetal hemorrhage
  • Ans:B

7- Amnioinfusion has been proposed to cure variable deceleration due to oligohydramnios. What has the least probability to occur during amnio infusion?

  • A-abruption
  • B-uterine rupture
  • C-uterine hypertonia
  • D-cord prolaps
  • Ans:A

8- Silent oscillatory pattern refers to:

  • A- baseline variability of FHR of less than 5 bpm
  • B- two or more acceleration of 15 bpm
  • C-one acceleration of 15 bpm
  • D-baseline FHR variability of more than 5 bpm
  • Ans:A

9-Which is wrong about late deceleration:

  • A-it occurs after the peak and nadir of uterine contraction
  • B-lag phase represents fetal PO2 level not fetal blood PH
  • C-the less the fetal PO2 before uterine contraction, the more is the lag phase before deceleration
  • D-reduced fetal PO2 level below critical level activates chemoreceptors and decelerations
  • Ans:C

Points to remember

  • Positive OCT: 50% or more of uterine contractions accompany FHR decelerations
  • Variable deceleration: occurs >= three times in a 20 min interval with FHR drop to 70 bpm
  • Persistent deceleration: more than 30 bpm reduction in a 2-10 min interval
  • Bradycardia: more than 30 bpm reduction of FHR in more than 10 min

9- NST of a G2 / GA=37 wks/ cephalic presentation/ with a history of 2 IUFDs shows a 2-min deceleration. What is the best management?

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