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Flashcards in Assessment of Fetal Well-being Deck (78):
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At risk pregnancy

Evaluate fetal status

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Low risk pregnancy

Evaluate normal growth and development

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What should be performed by all pregnant women

Maternal evaluation of fetal movement (kick counts 10 in 10)

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When should mother perform evaluation of fetal movement

After 27 weeks

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DFMC

Daily Fetal Movement Count

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How should mother perform DFMC?

Lying sideways - 1 hour after meal

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Number of times fetus should move in one hour

4

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Number of times a fetus should moved in 2 hours

10

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If a baby doesn't moved much what are they usually?

Hypoxic

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If baby doesn't move in the morning time, what should mother do?

Call the doctor

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Use of high frequency sound waves to create an image of the fetus

Ultrasound

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Limited obestric ultrasound

Basic screening

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Ultrasound for women suspected of caring an abnormal fetus

Comprehensive ultrasound

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What color is bone on an ultrasound?

White

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What color is soft tissue on an ultrasound?

Gray

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What color is fluid on an ultrasound?

Black

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If you see nuchal thickening and flattened nasal brindge on a baby in an ultrasound, what does the baby have?

Trisomy 21 or down syndrome

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The amount of amnionic fluid in the uterus is an indicator for what?

Fetal well-being

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Excess amniotic fluid

Polyhydramnios

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Decreased amounts of amniotic fluid

Oligohydramnios

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What is polyhydramnios associated with?

Diabetes or baby may have a neurological disorder and isn't able to swallow

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What is Oligohydramnios associated with?

The fetus may be swallowing but are not urinating - when baby is hypoxic, their kidneys shut off to support the heart and therefore - no urine

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How much fluid should a mother drink before having the amniotic fluid assessed?

1 to 1 1/2 quarts of water

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Amniotic fluid volume (AFV)

Measures only one pocket

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Amniotic fluid index (AFI)

A measure of 4 quandrants or pockets

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Biophysical Profile (BPP)

Fetal breathing movements
Gross body movements
Fetal tone
Reactive fetal heart rate
Amniotic fluid

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How many possible points can you get from a BPP?

10 (2 points each)

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What is the normal BPP score?

8-10

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What BPP score do you evaluated for possible delivery?

BPP score of 4 or less

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If a mom is 32 weeks pregnant and the BPP score is 4 or less, what action takes place?

They induce labor

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If baby is not flexed in the womb, what is wrong?

The baby is hypoxic and therefore has lack of muscle fetal tone

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What are the 2 most important components of BPP?

Amniotic fluid index (AFI)

Reactivity of the fetal heart rate

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Observe for accelerations of fetal heart rate in response to fetal movement

Nonstress Test (NST)

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What indicates an intact nervous system, not effected by hypoxia?

Accelerations

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How and when is an NST given?

Can be performed after 30 weeks gestation - in semi-fowlers position with an empty bladder

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What does NST require?

The use of an electronic fetal monitor

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EFM

Electronic fetal monitor

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Two or more accelerations of fetal heart rate within 20 minutes

Reactive NST (good)

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Does not meet criteria for reactive NST

Nonreactive NST

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Acceleration of fetal heart rate

An increase in heart rate of 15 bpm or more lasting 15 seconds (15 by 15 rule)

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Fetal Acoustic Stimulation test (FAST)

Horn to wake up baby - sound stimulus

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Vibroacoustic stimulation test (VST)

Vibrator to wake up baby for NST

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When would you NOT buzz to wake up a baby?

When baby is nonreactive - when their heart rate keeps dropping

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This test is to observe the response of the fetal heart rate to contractions

Contraction stress test (CST)

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What do they give mothers in a contraction stress test (CST)?

Oxytocin or Pitacin

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What does the CST evaluate?

Uteroplacental sufficiency

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When is the CST used?

In at risk pregnancies

- non reactive NST
- post dates

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What does the CST require?

Three contractions of 40 seconds duration in a 10 minute period

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How are contractions induced?

By IV oxytocin or breast nipple) stimulations

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No late decelerations occur after any contraction

Negative CST (good)

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Late decelerations occur with at least 2 out of the 3 contractions

Positive CST (bad)

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Late decelerations with a single contractions or late decelerations occur with hyperstimulation pattern

Equivocal CST (don't know, keep watching)

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Needle is inserted into uterine cavity through the abdomen

Amniocentesis

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When giving an amniocentesis, what do you do with it?

An Ultrasound is used to identify locations of placental, fetal parts

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What is amniocentesis determining?

Karyotype (DNA)

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What is amniocentesis used to determine in early pregnancy?

Chromosomal abnormalities

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What is amniocentesis used to determine in late pregnancy?

Fetal lung maturity or intrauterine infections

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This is necessary for normal respirator functioning of the newborn - to prevent RDS

Surfactant

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What should the L/S ration be at 35 weeks to indicate lung maturity?

2:1 (even 1.7:1 is bad)

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What appears in amniotic fluid at about 36 weeks gestation and indicates fetal lung maturity?

Phosphatidylglycerol (PG +)

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Test for neural tube defects

AFP

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This is present in maternal serum and amniotic fluid

Alpha-fetoprotein (AFP)

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This rises throughout pregnancy and peaks at 30 weeks gestation

Maternal serum AFP (MSAFP)

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When does amniotic fluid AFP (AFAFP) peak?

At 15 weeks

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What is AFP produced by in the first 6 weeks?

Fetal Yoke

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What is AFP produced by after the first 6 weeks?

Fetal Liver

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When is MSAFP most accurate?

Between 16-18 weeks

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What does increased levels of AFP indicate?

Open neural tube defect (anencephaly or spina bifida)

Abdominal wall defect

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Anencephaly

Lacking upper part of brain

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Increased AFP

Fetal death
Multiple gestation

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Decreased levels of AFP

Down's syndrome

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Components of Penta screen

AFP
Unconjugated estriol
HcG
H-HcG
Inhibin A (a hormone)

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H-HcG (what is added to the Quad screen to make it Penta screen)

Hyperglyosated human chorionic gonadotropin

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Sample of the chorionic villi from the edge of the placenta is obtained

Chorionic Villus Sampling (CVS)

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When is CVS done?

Between 8 and 12 weeks gestation

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Glue that holds the placenta down

Fetal fibronectin

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The presence of vaginal fibronectin between 20-34 weeks is a strong indicator of what?

Preterm delivery

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What protein is produced by fetal tissues that is the glue that holds the placenta down?

Glycoprotein