chapter 26: assessment of high risk pregnancy

Question 1

biophysical risk factors

Answer 1

originates in mother or fetus

Question 2

biophysical examples

Answer 2

high BP, diabetes, hx of pre eclampsia, hx of preterm delivery, hx of stillbirth, multifetal gestations, too much/too little amniotic fluid, 2 vessel umbilical cordsm

Question 3

DFMC

Answer 3

daily fetal movement count
kick counts

Question 4

when are DFMCs done ?

Answer 4

32 to 34 weeks

Question 5

what is DFMC ?

Answer 5

mom pays attention to fetal movements and keeps a log of it …
sits and pays attention to how many kicks are felt

Question 6

(DFMC) how many kicks should be felt in an hour ? 2 hours ?

Answer 6

in 1 hour = 5 or more kicks felt
in 2 hours = 8 or more kicks felt

Question 7

how many kicks in 1 hour requires further evaluation ?

Answer 7

fewer than 3 kicks

Question 8

fetal alarm signal

Answer 8

alarm mom uses to indicate movement is felt

Question 9

ultrasounds

Answer 9

useful but not diagnostic
used in conjunction w/ other tests to make sure baby is okay

Question 10

abdominal ultrasonography

Answer 10

mom should have full bladder
best done in 2nd trimester and beyond

Question 11

transvaginal ultrasonography

Answer 11

mom should have empty bladder
done in first trimester
better if looking at cervix

Question 12

BPP

Answer 12

biophysical profile
looks at babies breathing movements in utero via ultrasound

Question 13

biophysical profile components

Answer 13

in 30 minutes:
-looking for 1 episode of breathing
-looking for 3 or more limb movements
-(tone) looking to move from flexion to extension at least once
-(amniotic fluid index) measure pockets of amniotic fluid, at least one pocket of 5cm or >

Question 14

BPP scoring

Answer 14

0 or 2 in each category
highest is 8
high score of 10 if NST is included

Question 15

biochemical assessment

Answer 15

amniocentesis, PUBS, CVS, maternal sampling

Question 16

when can amniocentesis be done ?

Answer 16

as early as 14 wks embryonically
16-18 weeks

Question 17

chorionic villus sampling (CVS)

Answer 17

used for genetic studies, removal of small tissue from fetal portion of placenta
done transcervically or transabdominally

Question 18

when is chorionic villus sampling done ?

Answer 18

10-12 wks
potential for deformities at wk 13

Question 19

percutaneous umbilical blood sampling (PUBS)
cordocentesis

Answer 19

fetal blood sampling and transfusion
direct access to fetal circulation during 2nd/3rd trimesters

Question 20

PUBS procedure

Answer 20

with ultrasound guidance, guide needle to gain blood from umbilical cord

Question 21

Coombs’ test

Answer 21

test for Rh incompatibility
(mom Rh- and baby Rh+)

Question 22

maternal assays:
cell-free DNA screening in maternal blood

Answer 22

can be done as early as 10 wks gestation
-for fetal Rh status, fetal gender, and some gene disorders

Question 23

vibroacoustic stimulation

Answer 23

vibration is placed on mom’s belly
stimulates baby
used if no fetal movement is seen