OB Final Exam Review: APGAR Score

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Questions and Answers

Which component is NOT part of the APGAR score assessment?

Blood pressure (correct)

Heart rate

Respiratory effort

Reflex activity

What is the primary purpose of external fetal heart rate monitoring?

To perform invasive blood tests during labor

To interpret and assess fetal oxygenation (correct)

To diagnose potential genetic disorders

To predict the baby's weight at birth

When is the APGAR score typically calculated?

Only after 10 minutes have passed since delivery

At birth and every hour thereafter

Immediately after birth and during the first feeding

At 1 and 5 minutes after birth (correct)

Which method of fetal heart rate monitoring is considered non-invasive?

Continuous electrical fetal monitoring (CEFM) Signup and view all the answers

What are common contraindications for internal fetal heart rate monitoring?

Chorioamnionitis and placenta previa Signup and view all the answers

What does the 'grimace' response in the APGAR score indicate?

The baby's reflexes and neurological integrity Signup and view all the answers

In which situation would internal monitoring be preferred over external monitoring?

When external methods provide unclear results Signup and view all the answers

What do cord blood gases assess in a newborn?

Fetal hypoxia during labor Signup and view all the answers

How is muscle tone assessed in the APGAR score?

By evaluating the baby's physical strength and posture Signup and view all the answers

Which of the following is a key indicator of oxygenation in a newborn?

Skin color and appearance Signup and view all the answers

What is the normal range for fetal heart rate (FHR)?

110-160 bpm Signup and view all the answers

What defines fetal tachycardia?

FHR > 160 bpm for 10 minutes Signup and view all the answers

Which type of fetal heart rate deceleration begins after the peak of a contraction?

Late decelerations Signup and view all the answers

What is indicated by absent variability in fetal heart rate?

Severe fetal distress Signup and view all the answers

What is the primary purpose of assessing uterine activity during labor?

To gauge contraction effectiveness Signup and view all the answers

What are the characteristics of variable decelerations?

They are rapid drops and V-shaped. Signup and view all the answers

Which category of fetal heart rate tracing is considered normal?

Category I Signup and view all the answers

Which intervention is most appropriate for managing tachysystole?

Reduce or stop oxytocin Signup and view all the answers

What does fetal heart rate variability indicate?

Balance between the nervous systems Signup and view all the answers

What is an acceleration in fetal heart rate monitoring?

Abrupt increase of at least 15 bpm lasting 15 seconds Signup and view all the answers

Study Notes

APGAR Score

Standardized assessment for newborn health, scored from 0 to 10.
Measures five criteria: Respiratory effort, heart rate, muscle tone, reflex activity, and skin color.
Evaluated at 1 and 5 minutes post-delivery to assess adaptation to life outside the womb.
Indicates the need for immediate medical intervention based on score.

External Fetal Heart Rate Monitoring

Primary goal: Continuous assessment of fetal oxygenation to prevent fetal acidemia.
External monitoring methods include Continuous Electrical Fetal Monitoring (CEFM) and intermittent Doppler.
Uses a toco transducer on the abdomen to measure uterine contractions.
Non-invasive with real-time data on fetal well-being during labor.

Internal Fetal Heart Rate Monitoring

Involves electrode or catheter placement for more precise fetal heart rate readings.
Utilizes fetal/internal scalp electrode (F/ISE) for direct heart rate assessment.
Requires ruptured membranes and should avoid infections (e.g., chorioamnionitis, GBS+, genital herpes).

Cord Blood Gases

Collected after birth to assess for fetal hypoxia during labor.
Analyzing gases provides insight into potential oxygen deprivation, affecting newborn management.

Normal and Abnormal Fetal Heart Rate Baselines

Normal fetal heart rate (FHR) is between 110-160 bpm, assessed over a 10-minute period.
Tachycardia: FHR > 160 bpm lasting over 10 minutes, possibly due to maternal fever or infection.
Bradycardia: FHR < 110 bpm lasting over 10 minutes, often indicating fetal hypoxia or umbilical cord issues.
Indeterminate FHR cannot be assessed due to excessive fetal movement or signal interference.

FHR Variability

Indicates fluctuations in FHR, excluding accelerations and decelerations.
Types of variability:
- Absent: No detectable amplitude, may suggest severe distress.
- Minimal: Less than 25 bpm, possibly indicating fetal tachycardia.

FHR Accelerations

Abrupt increases in FHR of at least 15 bpm lasting 15 seconds but under 2 minutes.
Generally sign of fetal well-being, often occurring due to fetal movement or contractions.

FHR Decelerations

Decrease in FHR that helps assess fetal tolerance during labor.
Early Decelerations: Gradual drops, correlated with contractions, often non-threatening.
Variable Decelerations: Rapid drops corresponding to umbilical cord compression, may require intervention.
Late Decelerations: Occur after contraction peak, signaling potential fetal hypoxia and need for immediate action.

FHR Tracing Categories

Category I: Normal tracing indicating a well-oxygenated fetus without acidemia.
Category II: Indeterminate tracing requiring further evaluation; includes minimal variability or tachycardia.
Category III: Abnormal tracing necessitating immediate delivery to prevent fetal harm.

Uterine Activity Assessment

Evaluated for frequency, intensity, duration of contractions via palpation and monitoring.
Tachysystole: Excessive contractions (>5 in 10 minutes) risk compromising fetal oxygenation.
Management may include reducing or halting oxytocin administration.

Intrauterine Resuscitation Strategies

Position changes to enhance uteroplacental perfusion.
IV fluid bolus to address maternal hypotension.
Oxygen supplementation to improve fetal oxygen delivery.
Sterile vaginal exam (SVE) to monitor labor progress and promote fetal movement.

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Description

This quiz focuses on the APGAR score, a crucial tool for evaluating a newborn's health immediately after birth. It covers the components of the score, its calculation, and its significance in determining the need for medical intervention. Review your understanding of fetal heart rate monitoring and newborn assessments.