ch. 26: high risk assessment Flashcards
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
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
What is considered a score of 2 for fetal movements?
at least THREE (3) trunk/limb movements in 30 min
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
What is considered a score of 2 for amniotic fluid index (AFI)?
deepest vertical pocket > 2cm
What is considered a score of 2 for nonstress test?
reactive
What is considered a score of 0 for fetal breathing movements (FBM)?
ABSENT fbm or <30 sec of sustained FBM in 30 min
What is considered a score of 0 for fetal movements?
< 3 episodes of trunk/limb movement in 30 min
What is considered a score of 0 for fetal tone?
ABSENCE of movement or slow extension/movement
What is considered a score of 0 for amniotic fluid index (AFI)?
deepest vertical pocket ≤ 2 cm
What is considered a score of 0 for nonstress test?
nonreactive
What does a BPP score of 10 or 8 mean?
-normal, low risk for chronic asphyxia
-repeat test at weekly to twice weekly intervals
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
What does a BPP score of 4 mean?
-suspected chronic asphyxia
-if ≥ 36 weeks, DELIVER
-if < 32 weeks, REPEAT SCORE
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
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
