ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT Flashcards
HEALTH HISTORY
Nutritional intake
Personal habits
HISTORY OF ACCIDENTS, INTIMATE PARTNER ABUSE
a symphysis-fundal height measurement
McDonald’s Rule
the distance from the uterine fundus to the
symphysis pubis in centimeters is equal to the
week of gestation between the _____ and _____
weeks of pregnancy.
20TH
31ST
Typical measurements
12 weeks -the _______ ______
20 wks - At the ________
36 wks - At the _________ _______
Typical measurements
12 weeks -the symphysis pubis
20 wks - At the umbilicus
36 wks - At the xiphoid process
fetal movement that can be felt
by the mother
quickening
– occurs at approximately 18 to 20 weeks of
pregnancy and
– peaks in intensity at 28 to 38 weeks.
Quickening
A healthy fetus moves with a degree of
consistency, or at least
10 times a day.
The Sandovsky Method
• ask the woman to lie in a left recumbent
position after a meal and
• record how many fetal movements she feels
over the next hour
• a fetus normally moves a minimum of twice
every 10 minutes or an average of 10–12
times an hour.
• If less than 10 movements occur within an
• hour, the woman repeats the test for the next
hour.
The Cardiff method (“Count-to-Ten”)
a woman records the time interval it takes for
her to feel 10 fetal movements within 60
minutes.
Fetal Heart Rate
120 to 160 beats per minute throughout
pregnancy.
Methods of acquiring FHR:
✓Rhythm Strip Testing
✓Nonstress Testing
✓Vibroacoustic Stimulation
✓Contraction Stress Testing
assessment of the fetal heart rate for whether a good baseline
rate and a degree of variability are present.
Rhythm Strip Testing
refers to the average rate of the
fetal heartbeat per minute.
Baseline reading
refers to small changes in rate that occur if
the fetal parasympathetic and sympathetic nervous
systems are receiving adequate oxygen and
nutrients
Variability
Rhythm Strip Testing CATEGORY
1) absent (none apparent);
2) minimal (extremely small fluctuations);
3) moderate (amplitude range of 6–25
beats per minute);
4) marked (amplitude range over 25 beats
per minute)
measures the response of the fetal heart
rate to fetal movement
Nonstress Testing
TEST RESUlTS FOR Nonstress Testing
- Reactive
– if two accelerations of fetal heart rate (by 15 beats or
more) lasting for 15 seconds occur after movement within
the chosen time period. - Nonreactive
– if no accelerations occur with the fetal movements.
– The results also can be interpreted as nonreactive if no
fetal movement occurs
– or if there is low short-term fetal heart rate variability (less
than 6 beats per minute) throughout the testing period
a specially designed acoustic stimulator is applied to
the mother’s abdomen to produce a sharp sound of
approximately 80 decibels at a frequency of 80 Hz,
Vibroacoustic Stimulation
the fetal heart rate is analyzed in conjunction with
contractions.
Contraction Stress Testing
Contraction Stress Testing test result
• Negative (normal)
– if no fetal heart rate decelerations are present
with contractions.
• Positive (abnormal)
– if 50% or more of contractions cause a late
deceleration (a dip in fetal heart rate that occurs
toward the end of a contraction and continues
after the contraction)
measures the response of sound
waves against solid objects,
Ultrasonography
Predict maturity by measurement of the biparietal diameter of
the head
Ultrasonography
Woman should have a full bladder at the time of the
procedure.
Ultrasonography
Uses of Ultrasound for assessing fetal growth and
development:
- Biparietal Diameter
- Doppler Umbilical Velocimetry
- Placental Grading
- Amniotic Fluid Volume Assessment
used to predict fetal maturity by measuring the __________ _________ (side-to-side measurement) of the fetal head.
Biparietal Diameter.
measures the velocity at which red blood cells in the uterine
and fetal vessels travel.
Doppler Umbilical Velocimetry.
Based particularly on the amount of calcium deposits in the
base of the placenta, placentas can be graded by ultrasound
as
• 0 (a placenta 12–24 weeks),
• 1 (30–32 weeks),
• 2 (36 weeks),
• 3 (38 weeks)
ased particularly on the amount of calcium deposits in the
base of the placenta
Placental Grading
Amniotic Volume Index (AFI) or total is the sum of the two
measurements.
– For gestations of less than 20 weeks, the uterus is
hypothetically divided along the midpoint (the linea nigra
on the woman’s abdomen) into two vertical halves.
– The vertical diameter of the largest pocket of amniotic
fluid present on each side is measured in centimeters.
• For gestations of 20 weeks or more, the uterus is dividedinto
four quadrants, using the linea nigra again as the vertical
dividing line and the level of the umbilicus as the horizontal
dividing line.
• The vertical diameter of the largest pocket of fluid in each
quadrant is obtained, and the four values are then added to
produce the amniotic fluid index.
The average Amniotic Fluid index is approximately
12–15 cm between 28 and 40 weeks.
An index greater than 20–24 cm indicates
hydramnios
An index less than 5–6 cm indicates
oligohydramnios
may be recorded as early as the 11th
week of pregnancy.
• inaccurate before the 20th week,
• however, because until this time fetal electrical
conduction is so weak that it is easily masked by
the mother’s
Electrocardiography
t may be most helpful in diagnosing
complications such as ectopic pregnancy or
trophoblastic.
Magnetic resonance imaging (MRI)
– substance produced by the fetal liver
– present in both amniotic fluid and maternal serum.
Alpha-Fetoprotein (AFP)
f the level is abnormally high, it indicates fetal defects
Maternal Serum (MSAFP)
80% of Down syndrome babies can be detected by this
method
Maternal Serum (MSAFP)
• may be performed in place of simple AFP
testing to yield even more reliable results.
• it requires only a simple venipuncture of the
mother.
Triple screening, or analysis of three
indicators (MSAFP, unconjugated estriol, and
hCG)
is a biopsy and
chromosomal analysis of
chorionic villi that is done
at 10–12 weeks of
pregnancy.
Chorionic villi sampling (CVS)
an alternative method to
remove cells for fetal
analysis.
Coelocentesis
(transvaginal aspiration of
fluid from the
extraembryonic cavity)
is the aspiration of amniotic
fluid from the pregnant
uterus for examination.
Amniocentesis
Amniocentesis
Fetal complications
• hemorrhage from
penetration of the placenta,
• infection of the amniotic
fluid
• puncture of the fetus.
ormal amniotic fluid is the color of
water
lso called cordocentesis or funicentesis
Percutaneous Umbilical Blood Sampling (PUBS )
s the aspiration of blood from the umbilical vein for analysis.
Percutaneous Umbilical Blood Sampling (PUBS )
is the visual inspection of the amniotic
fluid through the cervix and membranes with an
amnioscope (a small fetoscope).
Amnioscopy
The main use of the technique is to detect meconium
staining.
Amnioscopy
in which the fetus is visualized by inspection through a
fetoscope (an extremely narrow, hollow tube inserted
by amniocentesis technique)
Fetoscopy
infection of the amniotic fluid) may occur.
Amnionitis
Biophysical Profile
Combines five parameters into one assessment
- fetal reactivity,
- fetal breathing movements,
- fetal body movement,
- fetal tone, and
- amniotic fluid volume
Biophysical Profile
fetus score on a complete profile
❑ 8–10, the fetus is considered to be doing well
❑ 6 is considered suspicious
❑ 4 denotes a fetus probably in jeopardy
Modified biophysical profile
A healthy fetus should
• show a reactive nonstress test
• AFI range between 5 and 25 cm
