ch. 26: high risk assessment Flashcards by Adilene Torquemada

What are the components of a BPP?

1) fetal breathing movements
2) fetal movements
3) fetal tone
4) amniotic fluid index (AFI)
5) nonstress test

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What is considered a score of 2 for fetal breathing movements?

at least ONE (1)episode of FBM of at least 30 sec duration in a 30 min observation

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What is considered a score of 2 for fetal movements?

at least THREE (3) trunk/limb movements in 30 min

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What is considered a score of 2 for fetal tone?

at least ONE (1) episode of active extension w/ return to flexion of fetal limb/trunk; opening and closing of hand considered normal tone

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What is considered a score of 2 for amniotic fluid index (AFI)?

deepest vertical pocket > 2cm

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What is considered a score of 2 for nonstress test?

reactive

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What is considered a score of 0 for fetal breathing movements (FBM)?

ABSENT fbm or <30 sec of sustained FBM in 30 min

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What is considered a score of 0 for fetal movements?

< 3 episodes of trunk/limb movement in 30 min

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What is considered a score of 0 for fetal tone?

ABSENCE of movement or slow extension/movement

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What is considered a score of 0 for amniotic fluid index (AFI)?

deepest vertical pocket ≤ 2 cm

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What is considered a score of 0 for nonstress test?

nonreactive

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What does a BPP score of 10 or 8 mean?

-normal, low risk for chronic asphyxia
-repeat test at weekly to twice weekly intervals

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What does a BPP score of 6 mean?

-suspected chronic asphyxia
-if ≥ 36-37 weeks or < 36 weeks w/ positive testing for fetal pulm maturity, CONSIDER DELIVERY
-if < 36 weeks &/or neg pulmonary maturity test, REPEAT BPP in 4-6 h
-DELIVER if oligohydramnios present

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What does a BPP score of 4 mean?

-suspected chronic asphyxia
-if ≥ 36 weeks, DELIVER
-if < 32 weeks, REPEAT SCORE

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What does a BPP score of 2 mean?

-STRONGLY suspected chronic asphyxia
-extend testing time to 120 min
-if persistent score ≤ 4, DELIVER, regardless of gest age

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What are recommended methods to monitor kick counts (daily fetal movements)?

-count ONCE a day at same time for 1 hr
OR
-count 2-3 times daily for 2 hrs
OR
-count kicks for 12 hrs

What is the normal amount of kicks per hour?

10 kicks/hr

What does a kick count < 3 kicks/hr require?

further evaluation by NST

What fetal kick count is a FETAL ALARM SIGN?

NO MOVEMENT for 12 hrs

What is the best method for assessing gestational age?

ultasound

What is a nuchal translucency (NT) screening?

measures the amount of fluid behind baby’s neck during 1st trimester

What NT screening result is abnormal?

if fluid collection > 3mm

What does a widened NT ALONE mean?

fetus has congenital heart defect

What does a widened NT WITH ↑ serum markers mean?

possible ↑ risk for chromosomal (trisomy 13, 18, 21) abnormalities

How is a nonstresst test (NST) performed?

-woman sits in reclining chair or semi fowlers -FHR is recorded w/ doppler & a toco is applied to detect uterine ctx or fetal movement -lasts 20-30 min

What is considered a reactive response in a NST?

2 accelerations in 20 min lasting at least 15 sec & peaking at least bpm above baseline - < 32 weeks: rise of 10 bpm lasting 10 sec

What is considered a nonreactive response in a NST?

DOES NOT demonstrate at least 2 qualifying accelerations within 20 min

When is a ctx stress test CONTRAINDICATED?

-preterm labor, placenta previa, cervical insufficiency, multiple gestation, previous c section

What is a negative ctx stress test result?

-DESIRED -3 ctx in 10 min, no late decels or variable

What is a positive ctx stress test result?

-BAD -late decels w/ 10 or more ctxs

What is amniocenteses?

procedure where a needle is inserted transabdominally into the uterus and amniotic fluid is withdrawn -ONLY > 14 weeks

What are the indications for amniocenteses?

-prenatal dx of genetic disorders -congenital anomalies -assessment of pulmonary maturity -(rarely) dx of fetal hemolytic disease

What are adolescent mothers at increased risk for?

-preeclampsia -CPD - ↓ edu

What complications do mature mothers have?

-chronic dx (DM, HTN) -preeclampsia -chromosomal/congenital abnormalities

What are the risks of a women during her 1st pregnancy?

-↑preeclampsia -dystocia

What are mothers with a hx of multiple pregnancies at risk for?

uterine atony

What are environmental risk factors for high risk pregnancies?

-infections -radiation -chemicals (mercury, lead) -drugs -pollution -cigarette smoke -STRESS/DIET