Antepartal Tests and FHR Assessments (Week 3)

Question 1

What are types of risk factors are there for woman and fetuses for developing antepartum, intrapartum, postpartum or neonatal complications?

Answer 1

Biophysical factors
Psychosocial factors
Sociodemographic factors
Environmental factors

Question 2

What are the INDICATIONS for an ultrasound imaging?

Answer 2

Presence of gestational sac
Gestational age
Fetal growth
Fetal anatomy and presentation (2nd and 3rd trimester)
Placental location and possible abnormalities
Fetal activity
Number of fetuses
Viability
Amount of amniotic fluid
Visual assistance for some invasive procedure

Question 3

What are the RISKS and ADVANTAGES of ultrasound imaging?

Answer 3

Advantages:
- Accurate gestational age, fetal growth, detection of fetal and placental abnormalities.
- Noninvasive.
- Provides information on fetal structures and status.
- Safe for fetus.

Risks: - None.

Question 4

What are some nursing responsibilities associated with the ultrasound imaging procedure?

Answer 4

Nursing Care:
- Review procedure.
- Assess for latex allergy (transvaginal).
- Comfort measures- pillows, warm blanket.
- Explain that pressure but no pain should be felt.

Question 5

What are the RISKS and ADVANTAGES of 3D and 4D ultrasound?

Answer 5

Advantages:
- More detailed assessment of the fetal structures
- Measurement of the fetal organs
- Placental blood flow (3D)
- Brain morphology, can identify if any lesions are present (4D)

Risk:
- None

Question 6

What are some of the nursing responsibilities associated with 3D and 4D ultrasound procedure?

Answer 6

Nursing Care:
(Same as standard ultrasound)
- Review procedure.
- Assess for latex allergy (transvaginal).
- Comfort measures- pillows, warm blanket.
- Explain that pressure but no pain should be felt.

Question 7

What are the RISKS and ADVANTAGES of a Magnetic Resonance Imaging (MRI)?

Answer 7

Advantages:
- Very detailed images of the fetal anatomy.
- Useful for brain, thorax, GI/GU system, placenta abnormalities.

Risks:
- None

Question 8

What are some of the nursing responsibilities associated with Magnetic Resonance Imaging (MRI) procedure?

Answer 8

Nursing Care:
- Review procedure with pt and family.
- Instruct to remove all metallic objects before test.
- Answer the questions/address concerns, provide support.

Question 9

What are the RISKS and ADVANTAGES of Doppler Flow/Doppler Velocimetry?

Answer 9

Advantages:
- Noninvasive.
- Allows for assessment of placental profusion.

Risks:
- None.

Question 10

What are some of the nursing responsibilities associated with a Doppler Flow/Doppler Velocimetry procedure?

Answer 10

Nursing Care:

• Review procedure with patient.
• Answer any questions or concerns.
• Provide comfort measures.

Question 11

What are the tests included in a Biochemical Assessment?

Answer 11

• Chorionic sampling
• Amniocentiesis
• Fetal/Percutaneous umbilical blood sampling
• Maternal assays

Question 12

What is the gestational age range for performing a Chorionic Villus Sampling (CVS) procedure?

Answer 12

10-13 weeks gestation

Question 13

What is a Chorionic Villus Sampling procedure?

Answer 13

It a procedure that occurs between the 10th and 13th weeks of gestation. The procedure entails a biopsy of placental tissue for prenatal genetic testing.

Question 14

What are the RISKS and ADVANTAGES of Choronic Villus Sampling (CVS)?

Answer 14

Advantages:
- Performed earilier in pregnancy term than amniocentesis.
- Shorter specimen processing time (1 week vs. 2 weeks).
- Examiniation of fetal chromosomes.

Risks:
- 0.22% fetal loss (bleeding, infection, ROM).
- 10% of woman have bleeding afterwards.
- If the woman has Hep B, Hep C, or HIV there is an increased risk of transfer to the fetus.

Question 15

What are some of the nursing responsibilities associated with Chorionic Villus Sampling (CVS) procedure?

Answer 15

Nursing Care:
- Review procedure.
- Guide pt in breathing and relaxation technique.
- Positioning lithotomy or supine.
- Comfort measures/support.
- Label specimen.
- Auscultate FHR twice in 30 minutes.
- Educate to report abdominal pain/cramping, leaking of fluid, bleeding, fever or chills to provider.
- Administer RhoGAM to Rh- woman post procedure to prevent antibody formation.

Question 16

What gestational age range do you perform an Amniocentesis?

Answer 16

15-20 weeks gestation.

Question 17

What is an amniocentesis?

Answer 17

A test that removes amniotic fluid and cells from the uterus for genetic testing, testing for infection, and fetal lung development.

Question 18

What are the RISKS and ADVANTAGES of an Amniocentesis?

Answer 18

Advantages:
- Examines fetal chromosomes for genetic disorders.
- Direct examination of biochemical specimens.
- Can assess fetal lung maturity- L/S ratio (lecithin/sphingomyelin ratio).
Risks:
- Loss rate of 0.1-0.3%.
- Trauma to fetus or placenta.
- Bleeding or leaking of amniotic fluid 1-2%.
- Preterm labor.
- Maternal infection.
- Rh sensitization from fetal blood into maternal circulation.
- If woman has Hep B, Hep C, or HIV she has an increase risk of transfer to fetus.

Question 19

What are some of the nursing responsibilities associated with an Amniocentesis procedure?

Answer 19

Nursing Care:
- Review procedure.
- Guide pt in breathing and relaxation techniques.
- Comfort measures/support.
- Prep abdomen with antiseptic.
- Label specimen.
- Auscultate FRH twice in 30 minutes.
- Educate to report abdomen pain/cramping, leaking of fluid, bleeding, fever or chills to provider.
- No heavy lifting for 2 days.
- Administer RhoGAM to Rh- woman post procedure to prevent antibody formation.

Question 20

What gestational age is Fetal/Percutaneous Umbilical Blood Sampling performed?

Answer 20

Performed after 18 weeks gestation.

Question 21

What is a Fetal/Percutaneous Umbilical Blood Sampling?

Answer 21

AKA Cordocentesis, is when fetal blood is taken directly from the umbilical cord to check for disorders in the fetus.

Question 22

What are the RISKS and ADVANTAGES of Fetal/Percutaneous Umbilical Blood Sampling?

Answer 22

Advantages:
- Direct examination of fetal blood sample for fetal anomalies.
Risks:
- Bleeding, hematomas, maternal-fetal hemorrhage.
- Fetal bradycardia.
- Infection.
- Fetal death rate 1.4%

Question 23

What are some of the nursing responsibilities associated with Fetal/Percutaneous Umbilical Blood Sampling procedure?

Answer 23

Nursing Care
- Review procedure.
- Questions/concerns.
- Have Terbutaline ready just in case.
- FHR monitoring 1-2 hours post procedure.
- Educate pt on how to count fetal movement.

Question 24

What are the components of a Maternal Assay?

Answer 24

• Cell-Free DNA Screening- 9 to 10 weeks gestation.
• Alpha-Fetoprotein (AFP)- 15 to 20 weeks gestation.
• Quadruple Marker Screen (quad screen)- 15 to 22 weeks gestation.
• 4 Maternal serum analytes- human chorionic gonadotropin, AFP, dimeric inhibin A, unconjugated estriol.

Question 25

What is a Daily Fetal Movement Count? What are the normal parameters?

Answer 25

• Fetal surveillance during pregnancy.
• Fetal activity is diminished in the compromised fetus.
• Woman counts fetal movements in a specified time.
• 1 hour minimum of 4 movements (kicks, flutters).
• 2 hours => 10 movements.

Question 26

What are some of the nursing responsibilities associated with a Daily Fetal Movement Count procedure?

Answer 26

Nursing Care:
- Teaching patient how to perform this themselves.
- If movement decreased instruct to eat, rest, and try again.
- Educate on when to report to provider.

Question 27

What is a Nonstress Test (NST)?

Answer 27

It is a test in pregnancy that measures fetal heart rate in response to movement and contractions. Results are either reactive or nonreactive. Nonreactive results dont mean theres a problem, just that more tests may be necessary.

-Screening test uses FHR patterns as an indicator of fetal well-being.
- Acceleration is a sign of fetal well-being.
- Most common method of antepartum fetal surveillance.
- Considered reactive when FHR increases 15 beats above baseline for 15 seconds twice or more in 20 minutes (32 weeks and above)
- Reactive vs. nonreactive.

Question 28

What are some of the nursing responsibilities associated with a Nonstress Test (NST) procedure?

Answer 28

Nursing Care:
- Explain procedure.
- Void before, place in semi fowlers or lateral position.
- Interpret and report to MD.
- Documentation- timing, reason, VS.

Question 29

What is a Vibroacoustic Stimulaton?

Answer 29

Its a screening tool that uses auditory stimulation (buzzer) to assess fetal well-being. It is performed with NST. Only used when FHR baseline is WNL, not with bradycardia.

Question 30

What are some of the nursing responsibilities associated with Vibroacoustic Stimulation procedure?

Answer 30

Nursing Care:
- Explain procedure.
- Void before, semi-fowlers or lateral.
- Interpret and report to MD.
- Documentation: timing, reason, VS.

Question 31

What is the Contraction Stress Test?

Answer 31

It is a screening tool to assess the ability of the fetus to maintain normal FHR in response to uterine contractions with a nonreactive NST at term gestation. Monitor FHR for 20 minutes if no contractions they can be initiated with IV oxytocin.
If negative= Normal, no variable or late decelerations in 10 minutes with 3 contractions.

Question 32

What are some of the nursing responsibilities associated with Contraction Stress Test procedure?

Answer 32

Nursing Care:
- Void before, semi-fowler position.
- VS q 15 minutes.
- Comfort measures.
- Safety administer Oxytocin, avoid uterine tachysystole.
- Documentation.

Question 33

What is Amniotic Fluid Index (AFI)? What is the normal and abnormal ranges for this test?

Answer 33

A screening tool that measures volume of amniotic fluid with ultrasound to assess fetal well-being and placental function. Its based on fetal urine production.

The normal range is 8-24 cm.
Oligohydramnios-increased prenatal mortality (less than 5 cm).
Polyhydramnios- possible fetal malformation (NTDs, GI onstruction, fetal hydrops (edema), greater than 24 cm)

Question 34

What are some of the nursing responsibilities associated with Amniotic Fluid Index (AFI) procedure?

Answer 34

Nursing Care:
- Explain procedure.
- Comfort measures.
- Schedule follow-up.

Question 35

What is a Biophysical Profile (BPP)? What is its scoring criteria?

Answer 35

BPP is an ultrasound assessment of fetal status based off of 5 variables: NST reactive, fetal movement, tone, breathing, amniotic fluid volume. Its used for pregnacies with increased risk of fetal hypoxia and placental insufficiency (diabetes and hypertension)

• A score of 8/10 iss reassuring

Question 36

What is a Modified Biophysical Profle? What is normal/abnormal for this test?

Answer 36

It combines an NSF with an AFI. Its considered normal when NST is reactive and amniotic fluid volume is greater than 2 cm in deepest vertical pocket or AFI is normal. Usually followed up 1x2 weekly.

Question 37

What are the purpose and goals of fetal monitoring?

Answer 37

• Electronic Fetal Monitoring is used for all woman during labor.
• Support maternal coping and labor progress.
• Maximize uterin and umbilical blood flow.
• Maximize oxygenation.
• Goal is to interpret and continually assess fetal oxygenation and prevent fetal acidemia.

Question 38

LEFT OFF AT SLIDE 25

Answer 38

Terminology
Baseline FHR- rounded to increments of 5 bpm during 10 minutes

Baseline variability- fluctuations in baseline FHR irregular in amplitude

Indeterminant FHR- does not meet criteria of baseline FHR

Accelerations- abrupt increase in FHR above baseline, 15 bpm above baseline x 15 seconds or more

Deceleration- decrease in FHR below baseline

Variation in baseline- sinusoidal pattern (wave-like), cycle 3-5 min lasting 20 min or greater

Tachycardia- greater than 160 bpm lasting 10 min or longer

Bradycardia- less than 110 bpm lasting 10 min or longer

Normal FHR- Category I = absence of metabolic acidemia

Abnormal FHR- Category II & III = unfavorable