Antepartum and Intrapartum Fetal Assessment -Castro Flashcards
When is antepartum fetal testing indicated?
Pregnancies at risk for a poor outcome
Maternal obstetrical/medical/ behavioral conditions that can affect fetal growth/placental blood flow (ie diabetes, hypertension/preeclampsia, renal disease, SLE or other autoimmune disease, maternal drug use, previous fetal demise, Rh sensitization, decreased fetal movements
Fetal/Placental conditions: IUGR, oligohydramnios, abruptio/previa, fetal anomaly
How can fetal well being be assessed antepartum? What are these often used to determine?
- fetal movement counting
- fundal height
- US for growth, anomalies, BPP, amniotic fluid volume, uterine and umbilical doppler flow.
- fetal heart rate monitoring (non stress test and contraction stress test)
Used to determine if the pregnancy can safely be carried out for the next week
What should the fundal height be 18-36 weeks? What is considered an abnormal number? What should be ordered next?
equal to the gestational age in weeks
if > 3 cm’s off –> refer for an ultrasound
small height might indicate oligohydraminos or IUGR
increased fundal height could be LGA, polyhydraminos, multiple gestations, or maternal obesity
OR an error in pregnancy dating
What is a normal amount of kicks/hour/day? If the fetal movements are decreased, what should be ordered next?
10/hour, 2-3x/day
if decreased–> NST
if the fetus is reactive (heart rate changes with contractions), the NST is reassuring and the fetus should be alive in 1 week.
Reactive NST=normal baseline, normal variability, no deceleration (2 x 15 beat accelerations, each lasting 15 seconds with fetal movement in a 20 min period)
What is a contraction stress test? What is a concerning finding?
determines the adequacy of uteroplacental blood flow under “stress”
- need 3 contractions in 10 minutes
- a positive CST has decelerations, late in timing, after each contraction and is very concerning
What is a normal fetal heart rate?
110-160
What is the Biophysical Profile composed of? What is the score equivalent to a reactive NST?
- an in-utero apgar score comprised of the NST, fetal movement, breathing, tone and amniotic fluid volume
- maximum score is 10
8-10 is good and is equivalent of a reactive NST
What does reverse diastolic flow on an umbilical artery doppler suggest?
lack of placental perfusion and a need for delivery*
How is fetal lung maturity determined? What finding indicates mature lungs?
L:S ratio (lecithin: sphingomyelin ratio)
if L:S >2 –> lungs are mature
can also use the PG test
What are the goals of fetal heart rate monitoring antepartum? Intrapartum?
antepartum: decide if fetus can safely stay in utero for 3-4 days (avoid intrauterine fetal demise)
intrapartum: determine if fetus can tolerate labor or if needs a c-section
What is a late deceleration? What does this finding suggest? Is it concerning?
- smooth decelerations, start after contraction starts, ends after contraction finishes
- suggests uteroplacental insufficiency
- concerning*
see in clinical settings such as: hypertension, preeclampsia, abruption, growth restriction, cocaine use
(peak of contraction=least blood flow –> hypoxia can cause deceleration –> do NOT want to continue labor –> baby might not tolerate)
What are early decelerations? Are these concerning?
-smooth, start with contraction, end with contraction
- from: vagal reflex, head compression
- benign, see in 2nd stage especially with pushing
What are variable decelerations? What can cause this? Are these concerning?
- abrupt drop in fetal heart rate with return to baseline, angular, variable in timing with respect to contraction
- cord compression (nuchal cord, prolapse, knot, oligohydramnios, ruptured membranes)
- may be concerning
What could a sinusoidal fetal heart rate pattern associated with?
severe fetal anemia
fetal-maternal hemorrhage
What should happen to the fetal heart rate if you apply fetal scalp stimulation?
15 bpm acceleration –> HR increase=good
