Antepartum Assessment & Assessing the Fetus: Flashcards
(53 cards)
1
Q
Antepartum
A
conception to labor- prenatal
2
Q
Intrapartum
A
onset of labor until birth of infant and placenta (on L&D unit)
3
Q
Postpartum
A
birth until woman’s body returns to prepregnant condition (after delivery)
4
Q
Gravida
A
any pregnancy- regardless of duration- *including present pregnancy
5
Q
Nulligravida
A
never been pregnant
6
Q
Primigravida
A
pregnant for the first time
7
Q
Multigravida
A
second or any subsequent pregnancy
8
Q
Gestation
A
number of weeks since the first day of the last menstrual period (LMP)
9
Q
Abortion
A
birth that occurs before the end of 20 weeks gestation (miscarriage)
10
Q
Term
A
normal duration of pregnancy 40 weeks gestation or greater
11
Q
Preterm or premature labor
A
labor that occurs after 20 weeks but before the completion of 37 weeks (20-36.6 weeks)
12
Q
Post term labor
A
after 42 weeks
13
Q
Para
A
birth after 20 weeks, regardless if born alive or dead (still birth)
14
Q
Nullipara
A
woman who has not given birth at more than 20 weeks gestation
15
Q
Primipara
A
one birth >20 weeks regardless of alive or dead
16
Q
Multipara
A
two or more births >20 wks
17
Q
Stillbirth
A
fetus born dead after 20 wks gestation
18
Q
Nageles rule
A
Determines the estimated date of delivery:
1.) determine the first day of the LMP
2.) subtract 3 months
3.) add 7 days
- need to know how many days are in each month
19
Q
Fundal Height: McDonald’s Method
Between what weeks?
A
- Used as an indicator of uterine size.
- Fundal height in cm is equal to weeks of gestation. (between 22-34 weeks)
20
Q
Ultrasounds
Provide what information:
A
- Maternal anatomy
- Placental location
- Amniotic fluid volume
- Number of fetuses
- Survey of fetal anatomy
- Biometry-Fetal measurements for gestational age
- Fetal cardiac activity
- Fetal abnormalities
21
Q
Most common ultra sound
A
Transabdominal Ultrasound
22
Q
Transabdominal Ultrasound:
A
- Drink 8 oz water- dont urinate
- Pushes uterus to side so you can see better
- 8 weeks gestation: determine if there is a pregnancy/ FHR/ fluid
- 16 weeks gestation: can see the anatomy and sex of baby
23
Q
Measurement of the crown-rump length:
A
- most accurate measurement for dating gestational age in 1st trimester
- Measures crown to rump
- Done using ultra sound
24
Q
Nuchal Translucency Testing
A
- Nuchal fold testing- done at 11.1- 13.6 gestation (1st trimester) to test for trisomy 13, 18, 21 (Down’s syndrome).
- If positive, the fetus will have an excess accumulation of fluid at the back of the neck
25
Chorionic Villus Sampling (CVS)
- 1st trimester: 9-11 weeks gestation
- Sample from placenta- can be done in the first trimester- to diagnose genetic, metabolic and DNA studies.
- Does not detect neural tube defects.
26
Polyhydramnios
1% of all pregnancies Measured by AFI(Amniotic Fluid Index): 25 or > and 2,000ml or >
27
What causes
Polyhydramnios: Fetal
- Fetal Abnormalities such as: hydrocephaly, anencephaly, esophageal atresia (esophagus ends in a blind pouch. Reconnects itself into the trachea), spina bifida, diaphragmatic hernia
- Fetal Anemia
- Chromosomal Abnormalities
- Fetal macrosomia (large fetus)
28
What causes
Polyhydramnios: Placental
- Twin-to-Twin Transfusion : one identical twin receives excessive amounts of amniotic fluid while the other has little
- Placental Blood Vessel Abnormality
29
What causes
Polyhydramnios: Maternal
- Infectious Conditions: Toxoplasmosis, parvovirus, herpes simplex, rubella or cytomegalovirus infections
- Maternal Diabetes Mellitus (gestational or pre-existing):
- Maternal Rhesus Disease: Rhesus disease causes the mother’s antibodies to cross the placenta, often resulting in fetal anemia
- Blood incompatibilities between the mother and the baby
- Hypertension & Pre-eclampsia
30
Symptoms of Polyhydramnios: maternal
- Difficulty breathing & ambulating
- Decreased urine production
- Larger abdominal size for one’s gestational age
- Swelling of abdomen, vulva, legs
- Excessive weight gain
- May be suspected if it’s difficult to assess the body contours and heart beat of the baby despite an enlarged size of the uterus.
31
Polyhydramnios Effects: on Mother:
GI discomfort
- Indigestion
- Constipation
- Abdominal pain
- Heartburn
- Striae & varicose veins
- Premature labor, PROM, postpartum hemorrhage, placental abruption, umbilical cord prolapse
32
Polyhydramnios Effects: on Newborn
- Preterm Birth
- Birth Defects: (Down’s syndrome, cleft palette)
- Still birth: death of the baby in the uterus after the 20th week gestation
- fetal malposition
33
Treatment of Polyhydramnios
If harmful to fetus:
- Complete Bed rest
- Amnioreduction
- Indomethocin- Prostaglandin inhibitor-prior to 31 weeks only
34
Oligohydramnios
not enough amniotic fluid
35
What Causes:
Oligohydramnios:
- PROM
- Post term gestation
- Placental Insufficiency
- Antihypertensive medications: drys out amniotic fluid
- Fetal urinary tract abnormalities
36
Oligohydramnios Treatment
Amnioinfusion: sterile water
Increased fluid intake
37
Amniocentesis
- done with ultrasound
- 35 years or older(geri pregnancy)= amniocentesis to check for abnormalities
- preterm labor: check LS ratio
38
Amniotic Fluid Tests
- * a-Fetoprotein (alpha-fetoprotein) (AFP)– fetal serum protein produced in the yolk sac for the first 6 weeks of gestation and then by the fetal liver- can diagnose genetic abnormalities
- L/S Ratio- Lecithin/Sphingomyelin- 2 components of surfactant
- 30-32 weeks the ratio=1:1
- 35 weeks=2:1
39
Percutaneous Umbilical Blood Sampling -PUBS
- Aspiration of fetal blood from the umbilical cord to assess for Rh disease, clotting disease, acid- base status of fetus, fetal infection
40
Prenatal Blood Tests
- Blood type
- CBC
- Hepatitis
- HIV
- PAPP-A-Plasma pregnancy associated plasma protein A
- Rh Factor
- Rubella
- Syphilis
41
Group B Strep
- Vaginal/rectal swab at 35-37 weeks
- Leading cause of meningitis, sepsis, pneumonia in newborns
- Treat with Penicillin or Ampicillin within 4 hours of labor
— **If severe allergy to PCN- may use Clindamycin or Erythromycin
42
Nonstress Test [NST]
- Measure the ability of the fetal heart to accelerate in association with fetal movement
— Reactive=good
— Non-Reactive=no fetal movement.
43
Reactive nonstress test.
At least 2 Accelerations of 15 bpm lasting 15 seconds with each fetal movement, over 20 minutes
44
Nonreactive NST
Accelerations not present or do not meet normal criteria.
45
Biophysical Profile
- Noninvasive assessment of the fetus
- It consists of Five Variables (4 by ultrasound; 1 by NST).
- It is usually done when there is a sequella of nonreassuring findings on the nonstress test.
- It provides a reflection of CNS activity because CNS is among the tissues sensitive to altered oxygen supply. Based on the gradual hypoxia principle, progressive fetal hypoxia* is manifested as loss of biophysical function.
46
Biophysical Profile: Five Variables
- Fetal breathing movements
- Fetal movements of body or limbs
- Fetal tone
- Amniotic fluid volume
- Reactive fetal heart rate with activity
-
— Maximum score is 10; 10/10 or 8/10 norm.
— Interventions vary with lower scores.
—— 4 or below =immediate delivery & resuscitation of the newborn
47
Contraction Stress Test (CST)
CST measures the response of the fetal heart to the stress of uterine contractions(caused by Oxytocin) .
It is indicated for pregnancies at risk for placental insufficiency or fetal compromise because of any of the following:
- IUGR (intrauterine growth restriction)
- Diabetes mellitus
- Postdates (42 or more weeks’ gestation)
- Nonreactive NST
48
Interpretation of CST Results
- Negative: Desired result. No decels with contraction. 3 contractions of good quality lasting 40 sec. in 10 minutes without decels. (fetus can handle hypoxia of contraction)
- Positive: repetivitve late decels with more than 50% of contractions. Hypoxia causes decreased FHR
- Equivocal or suspicious: nonpersistant decels
49
Contraction Stress Test (CST): Negative CST:
- good;
The example shows: the baseline FHR is 130 with acceleration of FHR of at least 15 bpm lasting 15 seconds with each fetal movement. Uterine contractions indicate 3 in 8 minutes
- May indicate the possibility of insufficient placental respiratory reserve
50
Contraction Stress Test (CST): Positive CST
- Positive contraction stress test: bad; Repetitive late decelerations occur with each contraction.
This example shows: No accelerations of FHR with 3 fetal movements. Baseline FHR is 120 bpm. Uterine contractions occurred 4 times in 12 minutes
51
Equivocal Suspicious Result
- FHR decelerations in presence of contractions that are more frequent than every 2 minutes or last longer than 90 seconds
- Often times c-section
52
Fetal hypoxia: as it progresses
- loss of fetal heart rate reactivity
- Reduced, then absent, fetal breathing movements
- Reduced then absent gross (large) fetal movement
- Reduced fetal tone
- Prolong hypoxemia: reduced amniotic fluid volume
53
Umbilical Velocimetry:
- Doppler measures the red blood cells from the umbilical artery.
- How well the ambilical artery is perfusing
- Highest peak is systolic and lowest is diastolic.
— pic: normal- no gaps
- abnormal: gaps
