EFM Exam Questions and Answers Latest Updated 2022 Graded A+

EFM Exam Questions and Answers Latest Updated 2022 Graded A+ Hypoxemia ✔✔Decreased oxygen in blood Hypoxia ✔✔Not enough oxygen to supply organs Normal fetal PO2 ✔✔15-25 mmhm What factors can change the maternal HR? ...

EFM Exam Questions and Answers Latest Updated 2022 Graded A+ Hypoxemia ✔✔Decreased oxygen in blood Hypoxia ✔✔Not enough oxygen to supply organs Normal fetal PO2 ✔✔15-25 mmhm What factors can change the maternal HR? ✔✔Intrinsic pacemakers (SA & AV node) Cardiac conduction system Autonomic regulation... Sympathetic, parasympathetic Humoral factors (catecholamines) Extrinsic factors (medications) Local factors (Ca, K) What are the 3 most common causes of decrease cardiac output in the OB patient? ✔✔Reduced preload (HypoTN) from -hypovolemia -compression of inferior vena cava -anesthesia In what area of the placenta does exchange of gases, nutrients, waste, hormones, antibodies & medications occur? ✔✔Maternal blood in the intervillous space and fetal blood in the villous capillaries These are separated by the blood-blood barrier Oxygen, CO2, NaCl, lipids, vitamins and some drugs are exchanged by... ✔✔Simple diffusion Glucose & carbohydrates are exchanged by... ✔✔Facilitated diffusion Amino acids, water-soluble vitamins & large ions are transported by... ✔✔Active transport What conditions decrease the volume of the blood in the intervillous space? ✔✔Abruption Infarction Thrombosis Infection ...These can also decrease the surface area of the chorionic villous thus decreasing O2 absorption (less surface area = less absorption) Diffusion across the blood-blood barrier is inversely proportional to _ ✔✔Distance. Greater distance = less diffusion Villous hemorrhage, thrombosis, infarction, deems, fibrosis...can increase distance What could result from trauma that causes damages chorionic vessels? ✔✔Maternal-fetal hemorrhage! Ruptured vasa previa ✔✔Vasa previa is a placental vessels that crosses the chorionic membrane and is close to the cervical os. It can be damaged from just a cervical exam or cervical check! What 3 shunts/mechanisms direct oxygenated blood to vital organs in the fetus? ✔✔Ductus venous, foramen ovale, ductus arteriosus When fetus is born, what changes are responsible for the fetus's transition to neonate life? ✔✔Umbilical-placental circulation is eliminated Clamping of umbilical cord eliminates umbilica.-placental circulation and raises the BP in neonate's aorta Flow across ductus arteriosus is reversed Catecholamines release increases BP & HR Expansion of neonate's lungs occurs The fetal circulation is designed to send oxygenated blood primarily to what 3 organs in the fetus? ✔✔brain, heart, adrenal gland Which ventricle is dominant in the fetal heart? ✔✔Right ventricle Because fetal circulation works in parallel rather than in series like adult circulation Umbilical vein - type of blood it carries & where? ✔✔Carries oxygenated blood from placenta to fetus Compression of umbilical vein ✔✔Can cause acceleration, sometimes before a variable or prolonged accelerations Umbilical artery ✔✔Carries deoxygenated blood from fetus to placenta Compression of umbilical artery ✔✔Variable Oxygen depletion cascade ✔✔aerobic metabolism >hypoxemia >tissue hypoxia >anaerobic metabolism >lactic acid build up >metabolic acidosis CO = HR x SV for a fetus ✔✔Cardiac output for a fetus is only related to their heart rate, not their stroke volume. a fetus cannot regulate their stroke volume, only their heart rate Aerobic metabolism ✔✔O2 > ATP > by products are CO2 & H2O Hypoxia can lead to what time of metabolism? ✔✔Anaerobic metabolism... by product = lactic acid Sustained hypoxia > sustained anaerobic metabolism with by product of lactic acid leads to _ ✔✔Metabolic acidosis Metabolic acidosis ✔✔Accumulation of lactic acid in the body (Low pH) The body then tries to use buffer bases (bicarbonate) to help increase the pH to a more basic/neutral level Eventually the buffering capacity is exceeded and the pH is low and cannot be raised to a normal level Sustained metabolic acidosis leads to _ ✔✔Metabolic acidemia When the body cannot raise the pH to a normal level with buffering bases, sustained low pH What will sustained hypoxia & metabolic acidosis lead to? ✔✔Loss of peripheral vascular smooth muscle contraction, which decreases peripheral vascular resistance >>>>> Leads to Fetal Hypotension >>>>>>>>>>Hypoxic injuries to fetal heart & brain Distinguish between metabolic & respiratory academia ✔✔Metabolic acidemia is ^ lactic acid Respiratory academia is ^ CO2 Causes of respiratory acidemia ✔✔increased CO2 cord compression/true knot -can develop rapidly and can correct rapidly Intermittent Auscultation done with 4 devices ✔✔Stethoscope Fetoscope Doppler US TVUS - Transvaginal US Stethoscope for IA ✔✔Dome on maternal abdomen over fetal back Fetoscope ✔✔Worn on listener's head Bone conduction for HR A reliable method for confirming presence of irregular HR Doppler US ✔✔Transmits ultra high-frequency sound waves to the moving interface of the fetal heart valves, this is deflected back to US Transvaginal US ✔✔2 dimensional video using M-wave imaging Procedure for Intermittent Auscultation ✔✔1. Leopold's 2. Gel, devices on fetal back 3. Count maternal radial pulse 4. Palpate ctxs so that you can count the FHR between contractions 5. Count FHR 30-60 seconds after ctxs 6. Auscultate before, during & after ctx 7. If HR discrepancies then auscultate for longer, consider need for EFM Leopold's maneuver ✔✔Before Leopold's: empty bladder, knees flexed, towel under right hip to prevent supine hypoTN 1. Fundus 2. Fetal back / Fetal parts 3. Over true pelvis inlet head not engaged > Pallach's maneuver Pallach's maneuver ✔✔If head is not engaged use this maneuver to determine if head is flexed or extended -Cephalic prominence on side with small parts = vertex -Cephalic prominence on side with back = fac