Review Practice Exercise 6

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Practice Exercise 6

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Question 1:

What is the purpose of weekly nonstress tests in women with GDM requiring insulin?

A. To assess maternal glucose levels B. To monitor fetal well-being C. To measure amniotic fluid volume D. To evaluate placental size

Answer and Explanation

Choice A:

Nonstress tests do not assess maternal glucose levels. Glucose monitoring is done via capillary blood glucose testing or continuous glucose monitoring systems. NSTs are fetal assessments and do not provide any data on maternal glycemic control.

Choice B:

Weekly nonstress tests are used to monitor fetal well-being in pregnancies complicated by GDM requiring insulin. Insulin-dependent GDM increases the risk of placental insufficiency, which can lead to fetal hypoxia. NSTs detect fetal heart rate accelerations, indicating intact autonomic and oxygenation status. A reactive NST confirms adequate fetal oxygenation.

Choice C:

Amniotic fluid volume is measured using ultrasound, specifically the amniotic fluid index (AFI) or single deepest pocket. NSTs do not visualize or quantify fluid levels. Oligohydramnios or polyhydramnios requires sonographic evaluation, not cardiotocography.

Choice D:

Placental size is evaluated via ultrasound imaging, not NST. NSTs assess fetal heart rate patterns, not anatomical features. Placental morphology, calcifications, or size abnormalities require direct imaging for assessment.

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Question 2:

Which antenatal test primarily monitors fetal heart rate accelerations in response to fetal movement?

A. Biophysical Profile (BPP) B. Contraction Stress Test (CST) C. Non-Stress Test (NST) D. Amniocentesis

Answer and Explanation

Choice A:

Biophysical profile includes NST as one of its 5 components but does not primarily monitor heart rate accelerations. It evaluates fetal tone, movement, breathing, amniotic fluid, and NST. The composite score reflects overall fetal well-being, not just cardiac reactivity.

Choice B:

Contraction stress test evaluates fetal heart rate response to induced uterine contractions, not spontaneous movement. It assesses placental reserve and risk of late decelerations. CST is used when NST is nonreactive and requires oxytocin or nipple stimulation to induce contractions.

Choice C:

Non-stress test directly monitors fetal heart rate accelerations in response to fetal movement. It is the primary tool for assessing fetal oxygenation and neurologic status. A reactive NST indicates intact autonomic regulation and adequate placental perfusion. It is performed without inducing contractions and is repeated weekly or biweekly in high-risk pregnancies.

Choice D:

Amniocentesis is an invasive test used to assess fetal genetics, lung maturity, or infection, not heart rate. It involves aspiration of amniotic fluid under ultrasound guidance. It does not provide any data on fetal movement or cardiac accelerations.

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Question 3:

What is the purpose of a biophysical profile in GDM pregnancies?

A. To measure maternal glucose levels B. To assess fetal growth and well-being C. To evaluate placental hormone levels D. To monitor maternal blood pressure

Answer and Explanation

Choice A:

BPP does not measure maternal glucose levels. Glucose monitoring is done via capillary blood glucose testing or continuous glucose monitoring. BPP is a fetal assessment tool and does not provide maternal metabolic data.

Choice B:

Biophysical profile assesses fetal growth and well-being in GDM pregnancies. It evaluates fetal movement, tone, breathing, amniotic fluid volume, and heart rate reactivity. These parameters reflect fetal oxygenation and neurologic status. GDM increases risk of placental insufficiency and fetal hypoxia, making BPP essential for monitoring.

Choice C:

BPP does not evaluate placental hormone levels. Hormonal assays such as human placental lactogen or estriol are separate tests. BPP assesses fetal behavior and amniotic fluid, not endocrine function.

Choice D:

BPP does not monitor maternal blood pressure. Blood pressure is assessed using sphygmomanometry and is part of maternal surveillance. BPP is focused on fetal parameters and does not include maternal hemodynamics.

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Question 4:

Which of the following are components assessed in a Biophysical Profile (BPP) for fetal surveillance in a client with Gestational Diabetes Mellitus? Select all that apply

A. Fetal heart rate accelerations (NST) B. Fetal breathing movements C. Maternal blood pressure D. Amniotic fluid volume E. Fetal kidney function

Answer and Explanation

Choice A:

Fetal heart rate accelerations are assessed via non-stress test, which is one of the 5 components of BPP. It evaluates autonomic function and oxygenation by detecting accelerations in response to fetal movement. A reactive NST confirms intact neurologic status.

Choice B:

Fetal breathing movements are assessed using ultrasound during BPP. Presence of rhythmic diaphragmatic movements lasting ≥30 seconds within 30 minutes indicates intact central nervous system function and adequate oxygenation.

Choice C:

Maternal blood pressure is not part of BPP. It is monitored separately using sphygmomanometry and is part of maternal surveillance. BPP focuses exclusively on fetal parameters and does not include maternal hemodynamics.

Choice D:

Amniotic fluid volume is measured by ultrasound, either via amniotic fluid index (AFI) or single deepest pocket. Adequate fluid reflects placental perfusion and fetal renal function. Oligohydramnios may indicate chronic hypoxia or placental insufficiency.

Choice E:

Fetal kidney function is not directly assessed in BPP. While amniotic fluid reflects fetal urine output, BPP does not evaluate renal anatomy or function. Detailed renal assessment requires targeted ultrasound or biochemical testing.

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Question 5:

Which of the following are included in fetal surveillance for GDM? Select all that apply

A. Nonstress tests B. Biophysical profiles C. Maternal glucose monitoring D. Ultrasound for fetal growth E. Maternal blood pressure checks

Answer and Explanation

Choice A:

Nonstress tests are used to assess fetal oxygenation and autonomic function by evaluating heart rate patterns in response to fetal movement. In GDM, especially when insulin is used, NSTs are initiated weekly or biweekly from 32 weeks to detect early signs of hypoxia.

Choice B:

Biophysical profiles combine ultrasound parameters (fetal tone, movement, breathing, amniotic fluid) with NST results to quantify fetal well-being. In GDM, BPPs help detect placental insufficiency and guide timing of delivery, especially when NSTs are nonreactive or amniotic fluid is reduced.

Choice C:

Maternal glucose monitoring is a maternal surveillance tool, not fetal surveillance. It guides insulin therapy and dietary adjustments but does not directly assess fetal status. While critical for glycemic control, it does not evaluate fetal oxygenation or growth.

Choice D:

Ultrasound for fetal growth is essential in GDM to monitor for macrosomia and growth restriction. Serial ultrasounds are performed every 3 to 4 weeks to track estimated fetal weight, abdominal circumference, and amniotic fluid index.

Choice E:

Maternal blood pressure checks are part of maternal monitoring, especially to detect preeclampsia, which may coexist with GDM. However, blood pressure measurement does not provide any direct information about fetal well-being or intrauterine status.

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Practice Exercise 6

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