CH 6 Assessment Of Fetal Well Being Flashcards
What does an ultrasound allow for
For early diagnosis of complications, permits earlier interventions, and thereby decreases neonatal,and maternal morbidity and mortality
What are the 3 types of ultrasounds
Internal transvaginal ultrasound
External abdominal ultrasound
Transvaginal ultrasound
What is a external transvaginal ultrasound
An invasive procedure in which a probe is inserted vaginally to,allow for a more accurate evaluation
The advantage of this procedure is that it does not reunite a full bladder
What is a external abdominal ultrasound
A safe, non invasive, painless procedure whereby a transducer is moved over a clients abdomen to produce an image
It is more useful especially during after the 1st trimester when the gravid uterus is larger
What is a transvaginal ultrasound
It may also be used in the 3rd trimester in conjunction with abdominal scanning to evaluate for preterm labor
What is a ultrasound blood flow analysis
A non invasive external ultrasound method to study the maternal fetal blood flow by measuring the velocity at which RBCs travel in the uterine and fetal vessels using a handheld ultrasound device that reflects sound waves fro a moving target
What should the client be advised about before having a ultrasound
Drink 1-2 quarts of fluid prior to ultrasound to fill the bladder, lift and stabilize the uterus, displace the bowel, and act as an echolucent to better reflect sound waves to obtain a better image of the fetus
How should the client be placed prior to an ultrasound
Assist the client In A supine position with a wedge placed under her right hip to displace the uterus ( prevents supine hypotension)
How should the client be positioned for a transvaginal ultrasound
Assist the client into a lithotomy position
What’s a biophysical profile ( BPP)
A BPP uses a real time ultrasound to visualize physical and physiological characteristics of the fetus and to observe for fetal biophysical responses to stimuli
How does the BPP assess for fetal wellbeing
By measuring 5 variables with a score of 2 for each normal finding and 0 for each abnormal finding
How does a nurse interpret a BPP
A total,score of 8-10 is normal with a low risk for chronic fetal asphyxia.
4-6 is abnormal; suspect chronic fetal asphyxia
A score below 4 is abnormal; strongly suspect chronic fetal asphyxia
What is a no stress test (NST)
It is the mostly used technique for antepartum evaluation of fetal wellbeing.
It is a non invasive procedure that monitors response of the FHR TO FETAL MOVEMENT!
How is a non stress test performed?
A Doppler transducer used to monitor the FHR and a tocotransducer used to monitor uterine contractions are attached externally to the woman’s abdomen to obtain tracing strips. The client pushes a button attached to the monitor whenever she feels fetal movement so it can be recorded.
This allows the nurse to assess the FHR in relationship to the fetal movement
What is an ultrasound
A procedure lasting approx 20 min that consists of high wage frequency sound waves used to visualize internal organs and tissues producing a real time 3 dimensional image of the developing fetus and maternal structures (FHR, pelvic anatomy)
What are potential diagnosis for a nonstress test
Assessing for an intact fetal CNS during the third trimester.
Ruling out the risk for fetal death in clients who have DM, it is used 2x week until after 28 weeks gestation.
What is the interpretation of findings for a nonstress test
The NST is interpreted as REACTIVE if the FHR is a normal baseline rate with modern variability,accelerates to 15bpm for at least fifteen seconds and occurs 2 or more times during a 20 min period.
A NON REACTIVE indicates that the FHR does not accelerate adequately with fetal movement. It does not meet the above criteria after 40 min, if this is so, a further assessment such as a contraction stress test ( CST) or biophysical profile (BPP) is indicated.
What is a nipple stimulated contraction stress test?
It consists of a woman lightly brushing her palm across her nipple for 2 min!; which causes the pituitary gland to release endogenous oxytocin,and the. Stopping the nipple stimulation when the contractions begin. The same process is repeated after a ( min rest period.
What is the analysis of a nipple stimulated CST?
Analysis of FH Response to contractions ( which decreases placental blood flow) determines how the fetus will tolerate the stress of labor. A pattern of 3 contractions within a 10 mi. Time period with a duration of 40-60 seconds each must be obtained to use for assessment data.
What is CST
Contraction stress test
What is a oxytocin (pitocin) CST?
It is used if nipple stimulation fails and consists of the IV administration of oxytocin to induce uterine contractions. ( contractions starred with oxytocin at be difficult to stop and can lead to preterm labor)
What is the interpretation of findings for a CST
A negative CST ( normal finding) is indicated if within a 10 min period, with 3 uterine contractions, and there are also no late decelerations of the FHR
A positive CST ( abnormal finding ) is indicated with persistent and consistent late decelerations on more than 1/2 the contractions. This is suggestive of uteroplacental insufficiency. Variable decelerations may indicate cord compression, and early decelerations may indicate fetal head compression. Based on the findings the dr. May induce labor or perform a C section!
What is amniocentesis
The aspiration of amniotic fluid for analysis by insertion of a needle transabdominally into a clients uterus and amniotic sac under direct ultrasound guidance locating the placenta and determining the position of the fetus.
When Can an amniocentesis be performed?
After 14 weeks gestation
What are potential diagnosis for a amniocentesis
Previous birth with a chromosomal anomaly
Parent who is a carrier of a chromosomal anomaly
Family he of neural tube defects
Prenatal diagnosis of a genetic disorder at congenital anomaly
Alpha veto protein level for fetal abnormalities
Luna maturity assessment
Fetal hemolytic disease
Meconium in the amniotic fluid
What is the interpretation of findings for alpha fetoprotein (AFP) In amniocentesis
Alpha fetoprotein can Be measured from the amniotic fluid between 16-18 weeks gestation and may be used to assess for neural tube defects in the fetus or chromosomal disorders
It may be evaluated to follow up a high level of AFP in maternal serum
What may high levels of alpha fetoprotein be assoc with
Neural tube defects, such as anencephaly, spina bifida, or omphalocele.
What is anencephaly
Incomplete development of fetal skull and brain
What is spina bifida
Open spine
What is omphalocele
Abdominal wall defect
When may high levels of AFP be present?
With normal multi fetal pregnancies
What are low levels of AFP assoc with
Chromosomal disorders ( Down syndrome) or gestational trophoblastic disease ( hydatidiform mole)
When may tests for fetal lung maturity be performed
If gestation is less than 37 weeks, in the event of rupture of the membranes, preterm labor, or a complication indicating a caesarean birth. Amniotic fluid is tested to determine whether the fetal lungs are mature enough to adapt to extra uterine life or if the fetus will have respiratory distress
What class of drugs promote fetal lung maturity
Corticosteroids
The absence of what is assoc with respiratory distress
Phosphatidylglycerol ( PG)
What is the preprocedure for a amniocentesis
Instruct client to empty her bladder prior to the procedure to reduce its size and reduce risk of inadvertent puncture
What is percutaneous umbilical blood sampling
PUBS- the most common methods used for fetal blood sampling and transfusion. This procedure obtains fetal blood from The umbilical cord by passing a fine guage, fiber optic ( fetoscope) into the amniotic sac using the amniocentesis technique. The needle is advanced into the umbilical cord under ultrasound guidance, and blood is aspirated from the umbilical vein.
What test determines if fetal blood was obtained during a percutaneous umbilical blood sampling?
Kleihauer- betke test ensures fetal blood as obtained
What is chorionic villus sampling ( CVS)
It is assessment of a portion of the developing placenta ( chorionic villi) which is aspirated through a thin sterile catheter or syringe inserted thru the abdominal wall or intravaginally thru the cervix under ultrasound guidance and analyzed.
What is chorionic villus sampling a alternative to? ( CVS)
CVS is a 1st trimester alternative to amniocentesis with one of its advantages being an earlier diagnosis of any abnormalities. It can be performed at 10-12 weeks gestation, and rapid results with chromosome studies are available in 24-48 hr following aspiration
What should the nurse instruct the client about regarding an chorionic villus sampling?
Instruct the client to drink plenty of fluid to fill the bladder prior to the procedure to assist in positioning the uterus for catheter insertion.
What is quad marker screening
A blood test that ascertains information about the likelihood of fetal birth defects. It does not diagnose the actual defect. It may be performed INSTEAD of the maternal serum alpha- fetoprotein yielding more reliable findings!..!!!!
What does the quad marker screening test for?
- Human chorionic gonadotropin ( hCG)- a hormone produced by the placenta.
- Alpha- fetoprotein (AFP) a protein produced by the fetus.
- Estriol- a protein produced by the fetus and placenta
- Inhibit A- a protein produced by the ovaries and placenta
What time frame is the quad marker preferred?
16-18 weeks gestation
What 2 tests indicates a risk for Down syndrome
High levels of hCG and inhibit -A indicates a risk for Down syndrome
A test that shows low levels of what May indicate a risk for Down syndrome?
Lower than Expected reference range for estriol may indicate a risk for Down syndrome
What is a screening tool used to identify neural tube defects
Maternal serum alpha fetoprotein (MSAFP) is a screening tool used to detect neural tube defects.
Clients who have abnormal findings should be referred for a quad marker screening, genetic counseling, ultrasound and an amniocentesis
What findings in a fetus indicate analysis of a BPP
Fetal breathing movement
Fetal tone
Reactive FHR
Amniotic fluid volume
Name a test for fetal lung maturity
The L/S ratio is done as a part of an amniocentesis to determine fetal lung maturity.
What are indicators of the need for a CST
Decreased fetal movement
IUGR
Post maturity
Advanced maternal age
What is a complication of amniocentesis
Amniotic fluid emboli
