Antepartum Assessment & Assessing the Fetus: Flashcards
Antepartum
conception to labor- prenatal
Intrapartum
onset of labor until birth of infant and placenta (on L&D unit)
Postpartum
birth until woman’s body returns to prepregnant condition (after delivery)
Gravida
any pregnancy- regardless of duration- *including present pregnancy
Nulligravida
never been pregnant
Primigravida
pregnant for the first time
Multigravida
second or any subsequent pregnancy
Gestation
number of weeks since the first day of the last menstrual period (LMP)
Abortion
birth that occurs before the end of 20 weeks gestation (miscarriage)
Term
normal duration of pregnancy 40 weeks gestation or greater
Preterm or premature labor
labor that occurs after 20 weeks but before the completion of 37 weeks (20-36.6 weeks)
Post term labor
after 42 weeks
Para
birth after 20 weeks, regardless if born alive or dead (still birth)
Nullipara
woman who has not given birth at more than 20 weeks gestation
Primipara
one birth >20 weeks regardless of alive or dead
Multipara
two or more births >20 wks
Stillbirth
fetus born dead after 20 wks gestation
Nageles rule
Determines the estimated date of delivery:
1.) determine the first day of the LMP
2.) subtract 3 months
3.) add 7 days
- need to know how many days are in each month
Fundal Height: McDonald’s Method
Between what weeks?
- Used as an indicator of uterine size.
- Fundal height in cm is equal to weeks of gestation. (between 22-34 weeks)
Ultrasounds
Provide what information:
- Maternal anatomy
- Placental location
- Amniotic fluid volume
- Number of fetuses
- Survey of fetal anatomy
- Biometry-Fetal measurements for gestational age
- Fetal cardiac activity
- Fetal abnormalities
Most common ultra sound
Transabdominal Ultrasound
Transabdominal Ultrasound:
- Drink 8 oz water- dont urinate
- Pushes uterus to side so you can see better
- 8 weeks gestation: determine if there is a pregnancy/ FHR/ fluid
- 16 weeks gestation: can see the anatomy and sex of baby
Measurement of the crown-rump length:
- most accurate measurement for dating gestational age in 1st trimester
- Measures crown to rump
- Done using ultra sound
Nuchal Translucency Testing
- Nuchal fold testing- done at 11.1- 13.6 gestation (1st trimester) to test for trisomy 13, 18, 21 (Down’s syndrome).
- If positive, the fetus will have an excess accumulation of fluid at the back of the neck
Chorionic Villus Sampling (CVS)
- 1st trimester: 9-11 weeks gestation
- Sample from placenta- can be done in the first trimester- to diagnose genetic, metabolic and DNA studies.
- Does not detect neural tube defects.
Polyhydramnios
1% of all pregnancies Measured by AFI(Amniotic Fluid Index): 25 or > and 2,000ml or >
What causes
Polyhydramnios: Fetal
- Fetal Abnormalities such as: hydrocephaly, anencephaly, esophageal atresia (esophagus ends in a blind pouch. Reconnects itself into the trachea), spina bifida, diaphragmatic hernia
- Fetal Anemia
- Chromosomal Abnormalities
- Fetal macrosomia (large fetus)
What causes
Polyhydramnios: Placental
- Twin-to-Twin Transfusion : one identical twin receives excessive amounts of amniotic fluid while the other has little
- Placental Blood Vessel Abnormality
What causes
Polyhydramnios: Maternal
- Infectious Conditions: Toxoplasmosis, parvovirus, herpes simplex, rubella or cytomegalovirus infections
- Maternal Diabetes Mellitus (gestational or pre-existing):
- Maternal Rhesus Disease: Rhesus disease causes the mother’s antibodies to cross the placenta, often resulting in fetal anemia
- Blood incompatibilities between the mother and the baby
- Hypertension & Pre-eclampsia
Symptoms of Polyhydramnios: maternal
- Difficulty breathing & ambulating
- Decreased urine production
- Larger abdominal size for one’s gestational age
- Swelling of abdomen, vulva, legs
- Excessive weight gain
- May be suspected if it’s difficult to assess the body contours and heart beat of the baby despite an enlarged size of the uterus.
Polyhydramnios Effects: on Mother:
GI discomfort
- Indigestion
- Constipation
- Abdominal pain
- Heartburn
- Striae & varicose veins
- Premature labor, PROM, postpartum hemorrhage, placental abruption, umbilical cord prolapse
Polyhydramnios Effects: on Newborn
- Preterm Birth
- Birth Defects: (Down’s syndrome, cleft palette)
- Still birth: death of the baby in the uterus after the 20th week gestation
- fetal malposition
Treatment of Polyhydramnios
If harmful to fetus:
- Complete Bed rest
- Amnioreduction
- Indomethocin- Prostaglandin inhibitor-prior to 31 weeks only
Oligohydramnios
not enough amniotic fluid
What Causes:
Oligohydramnios:
- PROM
- Post term gestation
- Placental Insufficiency
- Antihypertensive medications: drys out amniotic fluid
- Fetal urinary tract abnormalities
Oligohydramnios Treatment
Amnioinfusion: sterile water
Increased fluid intake
Amniocentesis
- done with ultrasound
- 35 years or older(geri pregnancy)= amniocentesis to check for abnormalities
- preterm labor: check LS ratio
Amniotic Fluid Tests
- a-Fetoprotein (alpha-fetoprotein) (AFP)– fetal serum protein produced in the yolk sac for the first 6 weeks of gestation and then by the fetal liver- can diagnose genetic abnormalities
- L/S Ratio- Lecithin/Sphingomyelin- 2 components of surfactant
- 30-32 weeks the ratio=1:1
- 35 weeks=2:1
Percutaneous Umbilical Blood Sampling -PUBS
- Aspiration of fetal blood from the umbilical cord to assess for Rh disease, clotting disease, acid- base status of fetus, fetal infection
Prenatal Blood Tests
- Blood type
- CBC
- Hepatitis
- HIV
- PAPP-A-Plasma pregnancy associated plasma protein A
- Rh Factor
- Rubella
- Syphilis
Group B Strep
- Vaginal/rectal swab at 35-37 weeks
- Leading cause of meningitis, sepsis, pneumonia in newborns
- Treat with Penicillin or Ampicillin within 4 hours of labor
— **If severe allergy to PCN- may use Clindamycin or Erythromycin
Nonstress Test [NST]
- Measure the ability of the fetal heart to accelerate in association with fetal movement
— Reactive=good
— Non-Reactive=no fetal movement.
Reactive nonstress test.
At least 2 Accelerations of 15 bpm lasting 15 seconds with each fetal movement, over 20 minutes
Nonreactive NST
Accelerations not present or do not meet normal criteria.
Biophysical Profile
- Noninvasive assessment of the fetus
- It consists of Five Variables (4 by ultrasound; 1 by NST).
- It is usually done when there is a sequella of nonreassuring findings on the nonstress test.
- It provides a reflection of CNS activity because CNS is among the tissues sensitive to altered oxygen supply. Based on the gradual hypoxia principle, progressive fetal hypoxia* is manifested as loss of biophysical function.
Biophysical Profile: Five Variables
- Fetal breathing movements
- Fetal movements of body or limbs
- Fetal tone
- Amniotic fluid volume
- ## Reactive fetal heart rate with activity— Maximum score is 10; 10/10 or 8/10 norm.
— Interventions vary with lower scores.
—— 4 or below =immediate delivery & resuscitation of the newborn
Contraction Stress Test (CST)
CST measures the response of the fetal heart to the stress of uterine contractions(caused by Oxytocin) .
It is indicated for pregnancies at risk for placental insufficiency or fetal compromise because of any of the following:
- IUGR (intrauterine growth restriction)
- Diabetes mellitus
- Postdates (42 or more weeks’ gestation)
- Nonreactive NST
Interpretation of CST Results
- Negative: Desired result. No decels with contraction. 3 contractions of good quality lasting 40 sec. in 10 minutes without decels. (fetus can handle hypoxia of contraction)
- Positive: repetivitve late decels with more than 50% of contractions. Hypoxia causes decreased FHR
- Equivocal or suspicious: nonpersistant decels
Contraction Stress Test (CST): Negative CST:
- good;
The example shows: the baseline FHR is 130 with acceleration of FHR of at least 15 bpm lasting 15 seconds with each fetal movement. Uterine contractions indicate 3 in 8 minutes - May indicate the possibility of insufficient placental respiratory reserve
Contraction Stress Test (CST): Positive CST
- Positive contraction stress test: bad; Repetitive late decelerations occur with each contraction.
This example shows: No accelerations of FHR with 3 fetal movements. Baseline FHR is 120 bpm. Uterine contractions occurred 4 times in 12 minutes
Equivocal Suspicious Result
- FHR decelerations in presence of contractions that are more frequent than every 2 minutes or last longer than 90 seconds
- Often times c-section
Fetal hypoxia: as it progresses
- loss of fetal heart rate reactivity
- Reduced, then absent, fetal breathing movements
- Reduced then absent gross (large) fetal movement
- Reduced fetal tone
- Prolong hypoxemia: reduced amniotic fluid volume
Umbilical Velocimetry:
- Doppler measures the red blood cells from the umbilical artery.
- How well the ambilical artery is perfusing
- Highest peak is systolic and lowest is diastolic.
— pic: normal- no gaps - abnormal: gaps
