Assessment of Fetal Development Flashcards
What is the typical fundal (top of the uterus) measurement at 12 weeks?
Over the symphysis pubis
What is the typical fundal (top of the uterus) measurement at 20 weeks?
At the umbilical
What is the typical fundal (top of the uterus) measurement at 36 weeks?
At the xiphoid process
another symphysis-fundal height measurement (although, again, not documented to be thorough growth
McDonald’s rule
A fundal height greater than the standard
multiple pregnancy, a miscalculated due date, a large-for-gestational-age (LGA) infant, hydramnios, or possibly even gestation trophoblastic disease
A fundal height measurement less than suggests
falling to thrive (intrauterine growth restriction, the pregnancy length was miscalculated , or an anomaly interfering with growth.)
When do McDonald’s become inaccurate?
During the third trimester of pregnancy because the fetus is growing more weight than height.
FHR can be heard in doppler ultrasound during?
10-12 weeks of pregnancy
Normal FHR
120 -160 or 110 - 160 bpm
FHR is checked during?
Every prenatal visit (10 weeks)
FHR can be heard in stethoscpe during?
4th lunar month
When do quickening starts?
18 - 20 weeks and peak at 28 to 38 weeks
Healthy fetus moves with a degree of consistency of at least
10 times per hour
decreases the movements of the fetus
Placental insufficiency and poor nutrition
Best position of the mother during sleeping
Left lateral Position
measures the response of FHR to fetal movement.
nonstress testing
What happened to the FHR if fetus moves?
FHR increases about 15 beats/min and remains elevated for 15 seconds.
How long do Nonstress testing lasts?
20 minutes
How to know if fetus is reactive of healthy?
if there’s two accelerations of FHR by 15bpm and lasts for 15 sec.
What happened if fetus is nonreactive
fetal health may be affected if no acceleration occurs with fetal movements.
Means the response of sound waves against solid objects, is a much-used tool for the fetal health assessments.
Ultrasonography
When can ultrasonography diagnose pregnancy?
as early as 6 weeks
Can ultrasonography confirm the presence, size and location of the placenta and amniotic fluid?
YES
Can ultrasonography establish if a fetus is growing and has no gross anomalies such as hydrocephalus, anencephaly, or spinal cord, heart, kidney and bladder concerns
YES
Other uses of ultrasonography:
Establish the sex if a penis is revealed.
Know presentation and position of the fetus
Predict maturity by measurement of the biparietal; diameter of the head or crown-to-rump measurement.
Discover complications
May be used to detect a retained placenta or poor uterine involution in the new mother.
Sonogram
How to prevent supine hypotension
Placing a towel under the right buttock to tip her body slightly and so the uterus will roll away from the vena cava.
Why gel at a room temperature is applied during ultrasound?
avoid uterine cramping of the abdomen to improve the contact of the transducer.
Can ultrasound be perform in intravaginal technique
YES but not necessary
Placentas can be graded by ultrasound based on the particular amount of calcium deposits present in the base.
Placental Grading for Maturity
What weeks of pregnancy is with a score of 0?
12 to 24 weeks
What weeks of pregnancy is with a score of 1?
30 to 32 weeks
What weeks of pregnancy is with a score of 2?
36 weeks
What weeks of pregnancy is with a score of 3?
38 weeks (fetal lungs are mature)
the total pockets of amniotic fluid revealed by sonogram between 28 and 40 weeks?
average 12 to 15 cm
Amounts of Amniotic fluid that is considered as hydramnios
20 to 24 cm
Amounts of Amniotic fluid that is considered as oligohydramnios
Less than 5 - 6 cm
Parameters of Biophysical Profile combined in one assessment
fetal reactivity, fetal breathing movements, fetal body movement, fetal tone, and amniotic fluid volume
Fetal Breathing is in the score of 2 in sonogram if
at least one episode of 30 sustained fetal breathing movements within 30 min of observation.
Fetal movement is in the score of 2 in sonogram if
at least separate episodes of fetal limb or trunk movement within a 30 min observation
Fetal tone is in the score of 2 in sonogram if
the fetus must extend and then flex the extremities or spine at least once in 30 min.
Amniotic fluid volume is in the score of 2 in sonogram if
a pocket of fluid measuring more than 2 cm in vertical diameter must be present.
fetal heart reactivity is in the score of 2 in nonstress test if
two or more accelerations of fetal heart rate of 15 bpm lasting 15s or more ff. Fetal movements in a 20min period.
What is the fetal score if fetus is healthy
8 to 10
What is the fetal score of suspicious
6
What is the fetal score if fetus is potentially in jeopardy
4
Replace or complement ultrasonography and identify anomalies or soft tissue disorders.
Magnetic Resonance Imaging
Invasive Fetal Testing
Chorionic Villi Sampling, Amniocentesis, L/S ratio, Percutaneous Umbilical Blood Sampling, Fetoscopy
is a biopsy and chromosomal analysis of chorionic villi done at 10 to 20 weeks of pregnancy but rarely necessary
Chorionic Villi Sampling
Aspiration of amniotic fluid from the pregnant uterus for examination
Amniocentesis
Meaning of Amniocentesis
Amnion - sac, centesis - puncture
When is Amniocentesis done
14th and 16th weeks so amniotic fluid is generous
What to check and attach for Amniocentesis
Attach FHR and uterine contraction monitors
and Take BP and FHR levels
is done to determine the position of the fetus, loc. Of a pocket of amniotic fluid and the placenta
Sonogram
How many inches of needle is used in amniocentesis for aspiration?
3 - 4 inches
How many amniotic fluid is withdrawn during amniocentesis?
15mL
How many amniotic fluid is withdrawn during amniocentesis?
15 mL
Amniotic fluid can be analyzed for:
AFP, Acetylcholinesterase, Bilirubin determination, Chromosomal analysis, Color of water, Fibronectin, Inborn errors of metabolism
rises in high levels if neutral tube anomaly is present
Acetylcholinesterase
late in pregnancy amniotic fluid will be
slightly yellow tinge
Strong color of amniotic fluid means
blood incompatibility
Green color of amniotic fluid means
Meconium staining
is glycoprotein that plays a part in helping the placenta attach to the uterine decidua.
Fibronectin
A number of inherited diseases can be detected by amniocentesis
Inborn errors of metabolism
protein components of the lung enzyme surfactant that the alveoli begin to form at the 22nd and 24th weeks of pregnancy.
L/S ratio
is the aspiration of blood from umbilical vein for analysis
Percutaneous Umbilical Blood Sampling or cordocentesis of funicentesis
An invasive exam that can visualize fetus, which can be yet another way to assess fetal well-being.
Fetoscopy
an extremely narrow, hollow tube inserted by amniocentesis technique
Fetoscope
Earliest time for a fetoscopy is
16th or 17th week.
Reasons for fetoscopy
Confirm the intactness of the spinal column
Obtain biopsy samples of fetal tissue and fetal blood samples
Determine meconium staining is not present.
Perform elemental surgery.
The woman and her partner both spend time recovering from the surprise of learning they are pregnant and concentrate on what it feels like to be pregnant.
First trimester task: Accepting the pregnancy
A common reaction is ambivalence, or feeling both pleased and not pleased about the pregnancy
First trimester task: Accepting the pregnancy
The woman and her partner move through emotions such as narcissism and introversion as they concentrate on what it feels like to be a parent, roleplaying and increase dreaming are common
Second trimester task: Accepting the fetus
As soon as fetal movement can be felt, psychological responses of both partners usually begin to change
Second trimester task: Accepting the fetus
Prepare clothing and sleeping arrangements for the baby but also grow impatient as they ready themselves for birth.
Third trimester task: Preparing for the baby and end of pregnancy
Nest building activities and ensuring safe passage
Third trimester task: Preparing for the baby and end of pregnancy
First symptoms of pregnancy, especially when exposed to cold air
Breast Tenderness
caused by increased estrogen levels
Palmar Erythema or Palmar Pruritus
used to sooth palmar erythema
Calamine lotion
are GI symptoms
Nausea, Vomiting, Constipation, Pyrosis
caused by increased metabolic requirements
Fatigue
Cause by decreased serum calcium levels, Increased serum phosphorus levels, Interference with circulation
Muscle Cramps
This supplement can lower phosphorus level
Calcium supplement
Symptom that occurs when woman lies on her back and the uterus pressed on vena cava, impairing blood return to heart
Supine Hypotension
commonly form in pregnancy because the weight of the distended uterus puts pressure on the veins returning from lower extremities.
Varicosities
Position when you have varicosities
Sim position
A varicose of rectal veins caused by pressure of veins from the bulk of growing uterus.
Hemorrhoids
Position to use when you have hemorrhoids
Modified sims position and Knee chest position for 10-15 minutes
is recommended for pregnant woman with hemorrhoids
Docusate sodium (colace)
Caused by Circulatory adjustments to accommodate her increased blood supply. Slow movements prevent this from happening
Heart Palpitations
Happens during early pregnancy when the Uterus presses the anterior bladder and returns in late pregnancy.
Frequent Urination
strengthen urinary control
Kegel’s exercise
Many women experience uncomfortable feelings of abdominal pressure in pregnancy. Causes Pride of pregnancy
Abdominal Discomfort
Increased White viscous vaginal discharge
Leukorrhea
Minor Body Changes of Pregnancy: The First Trimester
Breast Tenderness, Palmar Erythema, Nausea, Vomiting, Constipation, Pyrosis, Fatigue, Muscle Cramps, Supine Hypotension, Varicosities, Hemorrhoids, Heart Palpitations, Frequent Urination, Abdominal Discomfort, Leukorrhea
Minor Body Changes: 2nd and 3rd Trimester
Muscular/Skeletal Discomfort, Headache, Dyspnea, Ankle Edema, Braxton Hicks Contraction
Lumbar lordosis develops; lead to backache
Muscular/Skeletal Discomfort
Caused by Expanding blood volume put pressure on cerebral arteries
Headache
Uterus put pressure on the diaphragm lung compression and shortness of breath result
Dyspnea
Caused by Fluid retention and reduced blood circulation in lower extremities because of uterine pressure.
Ankle Edema
Begins 8th to 12th week of pregnancy, the uterus periodically contracts and relaxes (Painless contractions)
Braxton Hicks Contraction
