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Flashcard 1417416412428

Question
The M2 muscarinic receptors are located in the [...]
Answer
heart


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The M 2 muscarinic receptors are located in the heart

Original toplevel document

Muscarinic acetylcholine receptor M2 - Wikipedia
] Contents [hide] 1 Function 1.1 Heart 1.2 IQ 1.3 Olfactory behavior 2 Mechanism of action 3 Ligands 3.1 Agonists 3.2 Antagonists 4 See also 5 References 6 Further reading 7 External links Function[edit] Heart[edit] <span>The M 2 muscarinic receptors are located in the heart, where they act to slow the heart rate down to normal sinus rhythm after positive stimulatory actions of the parasympathetic nervous system, by slowing the speed of depolarization. They







Flashcard 1417417985292

Question
Vilken receptor binder ACh till i hjärtat?
Answer
M2 receptorn


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The M 2 muscarinic receptors are located in the heart

Original toplevel document

Muscarinic acetylcholine receptor M2 - Wikipedia
] Contents [hide] 1 Function 1.1 Heart 1.2 IQ 1.3 Olfactory behavior 2 Mechanism of action 3 Ligands 3.1 Agonists 3.2 Antagonists 4 See also 5 References 6 Further reading 7 External links Function[edit] Heart[edit] <span>The M 2 muscarinic receptors are located in the heart, where they act to slow the heart rate down to normal sinus rhythm after positive stimulatory actions of the parasympathetic nervous system, by slowing the speed of depolarization. They







Flashcard 1417422179596

Tags
#obgyn
Question
List 5 factors which appear to predispose fetus to breech position
Answer
-uterine relaxation assc w/ great parity
-mult fetuses
-hydramnios
-oligohydramnios
-hydrocephalus
-anencephalus
-prev breech delivery
-uterine anomalies
-pelvic tumours


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Flashcard 1417424014604

Tags
#has-images #obgyn
Question
What is a frank breech?
Answer

foot to mouth


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Flashcard 1417427422476

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#has-images #obgyn
Question
What is a complete breech?
Answer

buddah baby (knees & hips flexed)


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Flashcard 1417430830348

Tags
#has-images #obgyn
Question
What is an incomplete breech?
Answer

one/both hips not flexed and one/both feet/knees lie below buttocks (footling/kneeling breech)


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Flashcard 1417434238220

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#obgyn
Question
With twin pregnancy, when can you do a footling delivery? with which baby? how much time do you have?
Answer
can footling deliver the 2nd baby since first baby will dilate cervix, but need to do w/i 15 min (if past, can't do vag delivery)


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Flashcard 1417436073228

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Question
which breech position has best chance of safe vaginal delivery?
Answer
frank breech


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Flashcard 1417437908236

Tags
#obgyn
Question
Which breech position is the least safe for vaginal delivery? What are they more likely to cause?
Answer
incomplete breech; more likely to experience birth trauma & death from head not delivering


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Flashcard 1417439743244

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#obgyn
Question
List 5 complications that can be anticipated with a breech presentation compared to a cephalic presentation
Answer
-perinatal morbidity & mortality from birth trauma/asphyxia (r/t head entrapment)
-low birth wt from preterm delivery and/or growth restriction
-prolapsed cord
-placenta previa
-fetal, neonatal, and infant anomalies
-uterine anomalies & tumours
-multiple fetuses
-operative intervention, esp c/s


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Flashcard 1417441578252

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Question
What factors indicate mother may be able to safely deliver a breech baby vaginally?
Answer
-labour occurs at term (40 weeks)
-baby is correct weight
-baby is complete/frank breech
-mom & baby are otherwise healthy w/ no abnormalities


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Flashcard 1417443413260

Tags
#obgyn
Question
with breech presentation, c/s is recommended if:
Answer
-labour not progressing normally
-umbilical cord comes out before baby
-baby not in complete/frank breech


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Flashcard 1417445248268

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Question
At what week(s) should you recognize & confirm breech presentation?
Answer
35-36 weeks to have adequate time for discussion of management options


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Flashcard 1417447083276

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Question
What are 2 options to offer a woman with breech baby?
Answer
-external cephalic version (ECV)
-planned lower segment c/s


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Flashcard 1417448918284

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Question
When is the ideal time (GA) to perform external cephalic version (ECV)?
Answer
after 36 weeks


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Flashcard 1417450753292

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Question
Why is it ideal to perform an external cephalic version after 36 weeks?
Answer
-spontaneous version often occurs prior to 36 wks
-turning back to breech after 36 wks is uncommon
-and if complications requiring immediate delivery, fetus mature after 36 wks


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Flashcard 1417453374732

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Question
What are risks of ECV (external cephalic version)?
Answer
-intrauterine death secondary to cord accident
-feto-maternal hemorrhage (rare)
-abruption
-rupture of membranes
-labour
-fetal bradycardia necessitating immediate c/s (<1%)
-alloimmunization


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Flashcard 1417455209740

Tags
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Question
What should be done to prevent alloimmunization when performing an ECV?
Answer
give Rhogam if mom Rh -ve


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Flashcard 1417457044748

Tags
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Question
vag breech birth can be assc w/ higher risk of what than elective c/s?
Answer
perinatal mortality & short-term neonatal morbidity (e.g. seizures)


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Flashcard 1417458879756

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Question
what outcome doesn't differ b/w vag breech birth & elective c/s?
Answer
long-term neurologic infant outcomes don't differ even when serious short-term morbidities present (through vag deliv)


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Flashcard 1417460714764

Tags
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Question
do a pre/early labour US in breech presentation to assess:
Answer
-type of breech
-estimated fetal wt (EFW)
-attitude of fetal head (flexion preferred)


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Flashcard 1417462549772

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Question
What should you do if US is not available in breech presentation?
Answer
c/s


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Flashcard 1417464384780

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Question
List 5 contraindications for labour in breech:
Answer
-cord presentation
-fetal growth restriction
-macrosomia
-any presentation other than frank/complete
-inadequate maternal pelvis
-fetal anomaly incompatible w/ vag deliv (e.g. hydrocephalus)
-woman refuses trial of vag breech birth


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Flashcard 1417466219788

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Question
At what range of estimated fetal wt (EFW) can we offer vag breech deliv?
Answer
2500-4000g (normal wt)


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Flashcard 1417468054796

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Question
List 7 steps in labour management of vag breech deliv
Answer
-check maternal pelvis for any abn pelvic contraction
-good labour progress is best indicator that there's adequate room for fetus (c/s advised if labour progress inadequate)
-continuous fetal monitoring preferred
-check for prolapsed cord when membranes ruptured
-induction of labour is not recommended
-oxytocin augmentation of labour is acceptable if contractions are infreq/weak
-active 2nd stage (pushing) should be done near OR, prepared to perform C/S
-hcp for vag breech birth needs the skills & experience
-hcp skilled in neonatal resusc should be in attendance for deliv in case head is trapped or nuchal arms are irreducible (arms stuck behind head)
-once active pushing occurs, c/s recommended if deliv not imminent after 60 min


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Flashcard 1417469889804

Tags
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Question
What are methods of intrauterine resusc?
Answer
-change maternal position
-IV fluid
-O2
-stop oxy if abn tracing while in labour


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Flashcard 1417471724812

Tags
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Question
if fetal head doesn't restitute spontaneously in delivery, probably [...]
Answer
shoulder dystocia


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Flashcard 1417473559820

Tags
#obgyn
Question
List 5 risk factors for shoulder dystocia
Answer
-post-term pregnancy
-maternal obesity
-fetal macrosomia
-prev shoulder dystocia
-operative vag deliv (c/s)
-prolonged labour
-poorly controlled DM


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Flashcard 1417475394828

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Question
maternal complications of shoulder dystocia (list 4)
Answer
-PPH
-uterine atony
-maternal lacerations
-uterine rupture


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Flashcard 1417477229836

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Question
fetal complications of shoulder dystocia (list 5)
Answer
-birth injuries
-fractures (clavicle, humerus)
-brachial plexus palsy
-hypoxic ischemic encephalopathy (HIE)
-death


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Flashcard 1417479064844

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Question
What causes brachial plexus palsy in a delivery with shoulder dystocia? what's affected?
Answer
-extreme lateral traction on head at C5,6 level
-forearm flexors & supinators affected, so arm will be extended & pronated (erb's palsy)


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Flashcard 1417480899852

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Question
What is the pneumonic for a successful shoulder dystocia delivery?
Answer
A - ask for help (call for 'shoulders')
L - lift/hyperflex legs (McRobert's) - gives extra space at inlet (knees to ears)
A - ant shoulder disimpaction (mom should not be pushing during this)
---suprapubic presure (mazzanti)
- ask nurse to do
---vaginal shoulder pressure (Rubin)
R - rotation of posterior shoulder (Woods' corkscrew maneuver) - also get mom to stop pushing
M - manual removal of posterior arm (delivering post arm can slide ant shoulder out)
E - episiotomy (just helps w/ access to post arm/shoulder)
R - roll over on all 4 (increases size of inlet)


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Flashcard 1417485094156

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Question
If ALARMER maneuver doesn't deliver fetus with shoulder dystocia, other suggestions are:
Answer
-deliberate fracture of clavicle (very hard to do)
-symphysiotomy
-zavanelli maneuver (put fetus back in uterus & do c/s) - stop oxy, flex baby's head and push back as high as can


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Flashcard 1417486929164

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Question
DO NOT do what with shoulder dystocia delivery?
Answer
-pull (on head)
-push (on fundus)
-panic
-pivot (severely angulate head)


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Flashcard 1417488764172

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Question
What should you document for a shoulder dystocia delivery?
Answer
-severity of shoulder dystocia
-maneuvers necessary to deliver
-recommendation (or not) of future vag deliv


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Flashcard 1417556397324

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Question
What is the gold standard method of assessment of baby in labour?
Answer
intermittent auscultation (IA)


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Flashcard 1417558232332

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Question
early decels are due to?
Answer
vasovagal stimulation from pressure on head (scallop shaped decels)


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Flashcard 1417560067340

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Question
List 5 maternal factors that reduce availability of oxygen to fetus which may result in abnormal fetal tracing.
Answer
(decreased maternal oxygen carrying capacity)
-significant anemia
-carboxyhemoglobin
(decreased uterine blood flow)
-hypotension
-regional anesthesia
-maternal poisoning
(chr maternal conditions)
-vasculopathies (SLE, T1DM, chr HTN)
-antiphospholipid syndrome


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Flashcard 1417561902348

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Question
List 4 utero-placental factors that can result in abnormal fetal tracings, due to reduced availability of oxygen to fetus.
Answer
(uterine hypertonus)
-hyperstimulation d/t oxytocin/prostaglandins/normal labour
-placental abruption
(uteroplacental dysfn)
-placental abruption
-placental infarction/dysfn marked by oligohydramnios/abn doppler studies
-chorioamnionitis


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Flashcard 1417563737356

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Question
List 5 fetal factors that can result in abnormal fetal tracings due to decreased oxygen delivery to the fetus.
Answer
-cord compression
-oligohydramnios
-cord prolapse/entanglement
-decreased fetal oxygen carrying capability
-significant anemia (isoimmunization, fetomaternal bleed)
-carboxyhemoglobin (smokers)


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Flashcard 1417565572364

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Question
What must be present to declare intrapartum fetal asphyxia?
Answer
-apgar score 0 to 3 for >5 min
-neonatal neurologic sequelae (hypotonia, seizures, coma)
-evidence of multi-organ system dysfn in the immediate neonatal period
-umbilical cord arterial pH <7.0 and base deficit > 16 mmol/L


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Flashcard 1417567407372

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Question
respiratory acidosis (in pregnancy) develops [how fast] ​ and disappears following [...]
Answer
rapidly; the first neonatal breaths


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Flashcard 1417569242380

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Question
List 5 causes of fetal bradycardia (<110 bpm)
Answer
• Maternal hypotension
• Drug effects
• Maternal position
• Umbilical cord occlusion
• Fetal hypoxia
• Fetal vagal stimulation (head compression)
• Fetal hypothermia
• Fetal acidosis
• Fetal cardiac conduction or structural defect


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Flashcard 1417571077388

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Question
respiratory acidosis (in preg) occurs in vessels when [...] is disrupted (e.g. cord compression). It's a part of normal delivery.
Answer
CO2 transport from fetus to placenta


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respiratory acidosis (in preg) occurs in vessels when CO2 transport from fetus to placenta is disrupted (e.g. cord compression). It's a part of normal delivery.







Flashcard 1417572650252

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Question
respiratory acidosis (in preg) occurs in vessels when CO2 transport from fetus to placenta is disrupted (e.g. [...]). It's a part of normal delivery.
Answer
cord compression


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respiratory acidosis (in preg) occurs in vessels when CO2 transport from fetus to placenta is disrupted (e.g. cord compression). It's a part of normal delivery.







Flashcard 1417575533836

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Question
Metabolic acidosis (in preg) develops as a result of [...] that causes the fetus to shift to anaerobic metabolism to maintain positive energy balance. Metabolic acidosis is generated in hypoxic tissues, takes longer to develop and disappear, and has the potential to cause significant fetal damage.
Answer
fetal hypoxia


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Metabolic acidosis (in preg) develops as a result of fetal hypoxia that causes the fetus to shift to anaerobic metabolism to maintain positive energy balance. Metabolic acidosis is generated in hypoxic tissues, takes longer to develop and disappear, a







Flashcard 1417577106700

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Question
Metabolic acidosis (in preg) develops as a result of fetal hypoxia that causes the fetus to shift to [...] to maintain positive energy balance. Metabolic acidosis is generated in hypoxic tissues, takes longer to develop and disappear, and has the potential to cause significant fetal damage.
Answer
anaerobic metabolism


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Metabolic acidosis (in preg) develops as a result of fetal hypoxia that causes the fetus to shift to anaerobic metabolism to maintain positive energy balance. Metabolic acidosis is generated in hypoxic tissues, takes longer to develop and disappear, and has the potential to cause significant fetal damage.







Flashcard 1417578679564

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Question
Metabolic acidosis (in preg) develops as a result of fetal hypoxia that causes the fetus to shift to anaerobic metabolism to maintain positive energy balance. Metabolic acidosis is generated in [...], takes longer to develop and disappear, and has the potential to cause significant fetal damage.
Answer
hypoxic tissues


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Metabolic acidosis (in preg) develops as a result of fetal hypoxia that causes the fetus to shift to anaerobic metabolism to maintain positive energy balance. Metabolic acidosis is generated in hypoxic tissues, takes longer to develop and disappear, and has the potential to cause significant fetal damage.







Flashcard 1417580252428

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Question
Metabolic acidosis (in preg) develops as a result of fetal hypoxia that causes the fetus to shift to anaerobic metabolism to maintain positive energy balance. Metabolic acidosis is generated in hypoxic tissues, takes [...] to develop and disappear, and has the potential to cause significant fetal damage.
Answer
longer


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<head>Metabolic acidosis (in preg) develops as a result of fetal hypoxia that causes the fetus to shift to anaerobic metabolism to maintain positive energy balance. Metabolic acidosis is generated in hypoxic tissues, takes longer to develop and disappear, and has the potential to cause significant fetal damage.<html>







Flashcard 1417581825292

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Question
Metabolic acidosis (in preg) develops as a result of fetal hypoxia that causes the fetus to shift to anaerobic metabolism to maintain positive energy balance. Metabolic acidosis is generated in hypoxic tissues, takes longer to develop and disappear, and has the potential to cause [...].
Answer
significant fetal damage


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s a result of fetal hypoxia that causes the fetus to shift to anaerobic metabolism to maintain positive energy balance. Metabolic acidosis is generated in hypoxic tissues, takes longer to develop and disappear, and has the potential to cause <span>significant fetal damage.<span><body><html>







Flashcard 1417584708876

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Question
List 5 causes for fetal tachycardia (>160 bpm)
Answer
• Maternal: fever, infection, dehydration, hyperthyroidism, anxiety, drugs, anemia
• Fetal: infection, prolonged fetal activity, chronic hypoxemia, cardiac abnormality, congenital anomalies, anemia


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Flashcard 1417587330316

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Question
What are the characteristics of variable decels (FHR)?
Answer
Abrupt decrease in FHR > 15 bpm below baseline for at least 15 sec but < 2 min


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Flashcard 1417589165324

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Question
[...] decel (FHR) is reflex vagal response due to head compression; not normally associated with fetal acidemia
Answer
Early


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Early decel (FHR) is reflex vagal response due to head compression; not normally associated with fetal acidemia







Flashcard 1417590738188

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Question
Early decel (FHR) is reflex vagal response due to [...]; not normally associated with fetal acidemia
Answer
head compression


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Early decel (FHR) is reflex vagal response due to head compression; not normally associated with fetal acidemia







Flashcard 1417592311052

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Question
Early decel (FHR) is reflex vagal response due to head compression; not normally associated with [...]
Answer
fetal acidemia


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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Early decel (FHR) is reflex vagal response due to head compression; not normally associated with fetal acidemia







Flashcard 1417595194636

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Question
What are the characteristics of abn variable decels (FHR)?
Answer
Abnormal variable decelerations if: <70 bpm, >60 sec, prolonged return to baseline, loss of variability in baseline FHR


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scheduled repetition interval               last repetition or drill






Flashcard 1417597029644

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Question
What are variable decels associated with? What about abn variable decels?
Answer
Associated with vagal stimulation due to cord compression or head compression in 2nd stage
If abnormal variable decels, may be associated with fetal acidemia


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill






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Question
Late decels indicate poor oxygenation and can occur with: (list 5 causes)
Answer
altered maternal blood flow to placenta (maternal hypotension); reduced maternal oxygen saturation; placental insufficiency; uterine hypertonus; fetal academia


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill