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NURS 372 (Midterm) > Antepartum 3 (Uterine Assessment) > Flashcards

Antepartum 3 (Uterine Assessment) Flashcards

1
Q

What physical parameters of a pregnant women are measured at each doctor visit? Why?

A

1.) BP - This is taken on the same arm with the arm at the same level of the heart

2.) Weight - Used to evaluate/ensure the patients weight gain is appropriate to their BMI

3.) Assess for edema

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2
Q

When examining a patients abdomen and having them lie flat/supine what should we do to avoid supine hypotension?

A

1.) Lay the patient flat with their arms by their side and their head supported by a pillow

2.) A small wedge should be placed under the right hip

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3
Q

What is supine hypotension?

A

Occurs when the patient lies on their back and the weight of the abdominal contents compress the vena cava and part, causing a decrease in Bp and feeling of faintness

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4
Q

What are the signs and symptoms of Supine Hypotension? What intervention can we do to fix it?

A

S+S:
Pallor
Dizziness, faintness, breathlessness
Tachycardia
Nausea
Clammy skin, sweating

Intervention:
Position Pt on their side (left) until their S+S subside and vital stabilize within normal limits

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5
Q

What is Funal Height? What is its indicator used for?

A

It is a measurement of the height of the uterus above the symphysis pubis, it is used as one indicator or fetal growth after 20 weeks.

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6
Q

What is Aneuploidy?

A

It is defined as having one or more extra or missing chromosomes in the 23 pairs each individual normally possesses

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7
Q

What is eFTS? When is it done?

A

Enhanced First Trimester Screening

It is done typically between 11 - 14 weeks

Ex.) Nuchal Translucenty test combined with maternal serum biomarkers testing

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8
Q

What is a Nuchal Translucenty? What does it detect?At what weeks gestaition is it typically done?

A

It is a test that is typically done at 11 - 14 weeks gestation

-Genetic disorder is indicated if more than 3mm of fluid is found in neck of fetus
>3.5mm = congenital heart defect

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9
Q

At what week of gestation should a patient be screened for open neural tube defects?

A

Weeks 18 - 22

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10
Q

What are examples of common maternal and fetal indications for antepartum testing?

A

Diabetes
Pre-existing HTN
Pre-eclampsia
Systemic lupus erythematosus
Renal disease
Cholestasis of pregnancy (liver issue that produces itching)
Multiple gestation
Oligohydramnios (decreased amniotic fluid)
Preterm premature rupture of membranes
Postdate or post-term gestation
Previous stillbirth
Fetal growth restriction
Decreased fetal movement

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11
Q

What is being examined during “Second trimester Serum Screening”? At what weeks is this testing typically done?

A

Mothers blood is taken between 15 - 20 weeks gestation and The “Maternal Serum Alpha Fetoprotein levels” are evaluated to look for neural tube defects

It is a screening tool and only identifies candidates for more definitive procedures of amniocentesis

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12
Q

At what week can fetal heartbeat be detected?

A

Week 6 with transvaginal ultrasound

at week 13 we are able to visually start seeing the heart beat

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13
Q

What is the patient required to have during an abdominal ultrasound? Why?

A

A full bladder to push the uterus up in order ro get a better image of the funds

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14
Q

What are the standard set of measurements for determining gestational age in the first, second trimester and third

A

The crown-rump length in the first trimester

In the second and third trimester a combination is biparietal diameter, head circumference, abdominal circumference, and fetal length

-Fetal growth is determined by measuring the head and abdominal circumference

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15
Q

At what weeks gestation during the second trimester is it recommended for patients to be offered a routine ultrasound?

A

Weeks 18 - 22

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16
Q

What is Placenta Previa?

A

Placenta previa is where the placenta covers the opening of the cervix

Typically occurs in 2% of pregnancys between week 18 and 23 of gestation

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17
Q

What is the role of the nurse for ultrasounds?

A

Nurse’s role in ultrasound is to provide counselling and education on the patients ultrasound scans

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18
Q

Examples of biomedical Assessment Tools?

A

Amniocentesis
Percutaneous Umbilical Blood Sampling (PUBS)
Chronic Villus Sampling

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19
Q

What does the Coombs Test test for?

A

Rh incompatibility

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20
Q

What is Amniocentesis?At what week of pregnancy can it be done?

A

Test that is done by administering a needle into the amniotic sac after week 14 of gestation

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21
Q

Indications of use for Amniocentesis?

A

Prenatal diagnosis of genetic disorders or congenital anomalies (NTD), assessment of pulmonary maturity, and in rare cases a diagnosis of fetal hemolytic diseases

1.) Genetic concerns - Incidence of genetic disorders increases after age 35 - Previous child with chromosomal abnormality - Familial Hx of chromosomal abnormality

2.) Fetal Maturity - Late in pregnancy, accurate assessment of fetal lung maturity is possible

3.) Fetal Hemolytic Disease - In rare cases

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22
Q

What is Chorionic Villus Sampling?

A

It is a test that can be done in the first or second trimester and it involves removal of a small specimen from the fetal portion of the placenta and is “ideally” done between 10 - 13 weeks

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23
Q

What is the indications for Chorionic Villus Sampling??What can’t it be used for?

A

Similar to those for Amniocentesis , although CVS cannot be used for maternal serum marker screening because no fluid is obtained

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24
Q

What is the goal of Third Trimester Testing?

A

Is to determine whether the intrauterine environment continues to be supportive to the fetus

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25
Q

What is assessment/testing in the first and second trimester directed at?

A

Primarily at the diagnosis of fetal anomalies

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26
Q

What is the fetal movement counting test?

A

The patient concentrates on the movements in a reclined (not supine) position and is to count 6 movements.

If 6 movements are not felt within 2 hours, further evaluation of maternal and fetal status is required

*Brief mom about fetal sleep schedule where baby may not kick a lot

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27
Q

What is the basis for a nonstress test?

A

measures the fetus’ heart rate to see if it changes when it moves or during uterine contractions

The normal fetus produces characteristic heart rate patterns in response to fetal movement

-Most widely used antepartum test

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28
Q

What is the biggest disadvantage to the Nonstress test?

A

It has a high rate of false positive results for atypical or abnormal tracings as a result of fetal sleep cycles, chronic tabasco use, medications, and fetal immaturity

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29
Q

What is the purpose of the contraction stress test?

A

Its purpose is to evaluate the response of the fetus to induced contractions and to thus identify poor placental function

Uterine contraction decrease uterine blood flow and placental perfusion, If this decrease is sufficient enough to produce hypoxia in the fetus, a declaration in FHR results

30
Q

What does the Contraction Stress Test provide easier as opposed to the Nonstress test?

A

The CST provides an earlier warning of fetal compromise than the NST and produces fewer false-positive results

31
Q

Contraindications for Contraction Stress Test?

A

1.) Preterm Labour
2.) Placenta Previa
3.) Vasa Previa
4.)Cervical Insufficiency
5.)Multiple Gestation
6.) Previous classic uterine incision for caesarean birth

32
Q

During the second trimester, what is amniotic fluid volume balance between?

A

Balance between fetal urine output and fetal swallowing

33
Q

As pregnancy continues, what does the amniotic fluid also include?

A

fetal urine, lung secretions, and GI fluids

34
Q

What is the doppler blood flow analysis?

A

It involves the use of systolic/diastolic flow ratios and resistance indices to estimate blood flow in various arteries

35
Q

What does the doppler blood flow analysis provide?

A

It provides an indication of fetal adaptation and reserve

36
Q

What does the term “presentation” refer to?

A

It refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labour at term

37
Q

What are the 3 main “presentations”?

A

1.) Cephalic Presentation - Head down (normal position)

2.) Breech presentation - buttock, feet, or both first)

3.) Shoulder presentation - Shoulder is in inlet with both feet and head up

38
Q

What does the term fetal “Lie” refer to?

A

It refers to which way the fetus spine is in relation to the mothers spine

39
Q

What are the two primary fetal lie positions? What is the third not common one?

A

1.) Longitudinal/vertical - Long axis of the fetus is parallel with the long axis of the mother (spine is parallel with spine)

2.) Transverse/horizontal - Long axis (spine) of fetus is at a right angle diagonal to the long axis of the mother (shoulder presentation)

3.) Oblique - Long axis of the fetus is lying at an angle to the long axis of the mother (baby’s spine is at an angle to the mothers) - less common and usually converts to a longitudinal or transverse lie during labour

40
Q

What does the term “fetal attitude” refer to?

A

Fetal attitude is the relation of the fetal body parts to one another - The fetus assumes a characteristic posture (attitude)

The way the baby is curled up

41
Q

What can deviations in fetal Attitude cause?

A

May cause challenges for the labour and birth process

-Head extension may have larger diameter and more difficult to get out

42
Q

What is “general flexation?”?

A

The normal posture of the baby

-Back of the fetus is rounded so that the chin is flexed on the chest, the thighs are fleed on the abdomen, and the legs are flexed at the knees. The arms are crossed over the throax, and the umbilical cord lies between the arms and legs?

43
Q

What does the term “Fetal Position” refer to?

A

Refers to the relationship between a designated landmark on the presenting fetal part (usually the baby’s head) to the front, sides, or back of the maternal pelvis

It is the relationship of a referance point on the presenting part to the four quadrants of the mothers pelvis

44
Q

What does each of the 3 letters refer to when look at Fetal Positioning?

A

1.) First letter - Which side of the pelvis the baby is facing (Right or Left)

2.) Presenting part of the fetus - (Occipult, Sacrum, Mentum (chin), and Sc for Scapula)

3.) The location of the presenting part - Anterior, Posterior, or Transverse) - look at where the baby back is…

*Chosen landmarks differ according to presentations

45
Q

What does the term “Fetal Station” refer to?

A

-The relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spine and is a measure of the degree of descent of the presenting part of the fetus through the birth canal

The relationship of the presenting fetus part and decent through the birth canal

46
Q

With regards to Fetal station, at what point/measurement is birth imminent?

A

When presenting part is +4cm or +5cm

-The higher up the baby is in the iliac crest and spine the less likely hood of birth there is*

47
Q

What does the term “Fetal Engagement” refer to?

A

Indicates the largest transverse part has reached station 0

Textbook: Indicates that the largest transverse diameter of the presenting part has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to station 0

48
Q

True Pelvis Vs False Pelvis?

A

False Pelvis: Is the part above the brim and plays NO part in childbearing

True: Is the part that is involved in birth and divided into 3 planes (Inlet, Midpelvis, and Outlet)

49
Q

What are the 3 planes of the True Pelvis?

A

1.) Inlet - Upper border of true pelvis is formed anteriorly by the upper margins of the public bone

2.) Mid Pelvis (Pelvic Cavity) - It is a curved passage with a short anterior wall and much longer concave posterior wall

3.) Outlet - It is the lower border of the true pelvis

50
Q

What 4 things does the Leoplod’s Manoeuver tell us?

A

(1) determine number of fetuses
(2) determine fetal presentation, fetal lie and fetal attitude
(3) determine degree of descent of the presenting part into the pelvis, and
(4) locate the point of maximal intensity of the FHR on the woman’s abdomen

51
Q

What is the procedure for performing Leopold’s Manoeuvers?

A

1.) Identify fetal part that occupies the fundis - Head or Buttocks

2.) Identify on which maternal side the fetal back is located - This helps identify fetal presentation

3.) What is the presenting part over the inlet to the true pelvis - If the head is presenting and not engaged, determine fetal attitude

4.) Turn to face patient’s feet. With palmar surface of fingertips when presenting part has descended deeply, only a small portion of head may be outlined - This helps identify the attitude of the head - is it flexed or extended? Engaged or Free floating?

52
Q

At what week can the hand-held doppler ultrasound detect a heartbeat?

A

At 12 weeks gestaiton

53
Q

What does Leopols manoeuver help locate?

A

It helps located the location of the fetal heart rate

54
Q

Where is the fetal heartbeat heard?

A

It is heard best through the fetal back

55
Q

What is the normal baseline fetal heart rate?

A

110-160 bpm

56
Q

When is fetal heart considered fetal tachycardia? When does is most commonly occur?

A

Fetal tachycardia is a baseline fetal haert rate greater then 160 bpm that lasts for longer then 10min

-most commonly occurs as a result of maternal fever

57
Q

What happens to fetal heart rate with scalp stimulation?

A

Accelerations in the heart rate on an intrapartum EFM tracing

-It is Atypical to have an absence of accelrtation with scalp stimulation

58
Q

Are accelerations present on a normal intrapartum EFM tracing?

A

-Spontaneous accelerations present but not required

59
Q

What is a Biophysical Profile?What is it based on/off of?

A

It is a noninvasie dynamic assesment of a fetus that is based on the assessment of acute and chronic markers of fetal disease

60
Q

What is a biophysical profile used to assess?
(Assesses 4 things)

A

-Used to assess current fetal well-being by observing fetal breathing movements, fetal movements, fetal tone, and Amniotic fluid volume

1.) Fetal Breathing movement
2.) Fetal movements - body or limb
3.) Fetal tone (Extremities)
4.) Amniotic fluid volume

61
Q

What is performed over 30 min and assesses fetal bahvour and is an evaluation of current fetal well-being?

A

-A Biophysical Profile (BPP)

62
Q

How is the score measured for a biophysical profile?

A

Each of the 4 ultrasound assessed variables is scored 0 (if abnormal) or 2 (if normal)

A score of 10 is used if NST is included

63
Q

How long should tracing be done for a Non-Stress Test (NST?

A

Minimum of 20 min

64
Q

What is a Non-Stress Test (NST)
(Slide answer)

A

In a NST, an electronic fetal monitor provides a tracing of the fetal heart rate (FHR) and accelerations of the FHR with movement during the period when the uterus is relaxed and no contractions are present

65
Q

When might a Non-Stress Test be considered?

A

May be considered when risk factors for adverse perinatal outcomes are present

66
Q

What are the normal interpretations of the baseline, Accelerations, Variabililty, and Decelerations of a Non-Stress test be?

A

Baseline 110-160 bpm

Accelerations: 2 accelerations with acme of ≥ 15 bpm, lasting 15 sec < 40 min of testing

Variability: 6-25 bpm (moderate); ≤ 5 bpm (absent or minimal) for < 40 min

Decelerations: None or occasional variable < 30 sec

67
Q

What are the 4 assumptions that fetal movement counting is based on?

A

1.) A distressed fetus will move significantly less than a healthy fetus

2.) A pregnant woman can consistently perceive the movements

3.) Further testing can distinguish between a compromised and healthy fetus

4.) In the case of a compromised fetus, timely obstetrical intervention may improve outcome and reduce stillbirth

68
Q

What are 2 risk factors for a decrease in fetal movement?

A

1.) Decreased placental perfusion
2.) Fetal Acidemia

69
Q

In what position should women count when counting fetal movements?

A

From a reclined position

70
Q

What are the side effects of ultrasound?

A

No known side effects

71
Q
A

NURS 372 (Midterm) (8 decks)

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