Ch 9-12 Lecture

Question 1

chorionic villi sampling

Answer 1

Small sample of chorionic villi taken from developing placenta (the villi arise from the trophoblast cells, their chromosome structure is the same as the fetus)

Done Vaginally, with abdominal ultrasound

early in pregnancy 10-12 weeks

Performed in some medical centers for first-trimester diagnosis of genetic and deoxyribonucleic acid (DNA) studies
-Used for genetic testing

Question 2

amniocentesis

Answer 2

A small amount of amniotic fluid is removed by a needle aspiration

Early detection can evaluate for Chromosome Analysis-Genetic Disease (Trisomy 21) 15-18 weeks

1. Down’s Syndrome
2. Smaller trisomy #’s (16, 18) not compatible with life

L/S ratio Can determine lung maturity-Later in pregnancy
-Lecithin and sphingomyelin are the components of the lung enzyme surfactant

Question 3

alpha fetal protein

Answer 3

a non-specific test taken at around 15-20 weeks that can detect spinal or abdominal wall defects and genetic disorders

Not a definitive test, will need another test to confirm

Question 4

ultrasound

Answer 4

transabdominal and transvaginal (probe into vagina)

Used to:

i. Identifying pregnancy and determining gestational age as early as 5 or 6 weeks
ii. Identifying fetal heart rate and fetal breathing movements
iii. Detect fetal death – via absent FHR
iv. Estimating size of the fetus: Measure biparietal diameter of head, femur length, estimate weight
v. Screen for fetal anomalies such as facial, anencephaly, hydrocephalus
vi. Identify placental location and grading
vii. Detect fetal position and presentation
viii. Assist with accompanying procedures (Amniocentesis)

Question 5

maternal assessment of fetal activity

Answer 5

Count fetal movements at the same time each day/Kick counts

Begins at approximately 28 gestational weeks

Reduction in movement may indicate fetal hypoxia, growth restriction, or fetal death

Question 6

McDonald’s Rule

Answer 6

a measurement of fundal height

Measurement is from the notch of the symphysis pubis to over the top of the uterine fundus. Usually done in cm which correlates to weeks pregnant.
Example 34 weeks = tape measure should be 34 cm

Question 7

Non-Stress Test (NST)

Answer 7

Widely used method of evaluating fetal status (alone or as part of biophysical profile [BPP)

Requires electronic monitor to observe and record fetal heart rate accelerations

Adequately oxygenated fetus with intact fetal central nervous system should demonstrate accelerated fetal heart rate (FHR) in response to fetal movement

Question 8

Reactive results of non-stress test

Answer 8

Desired result

Shows at least two accelerations of FHR with fetal movements of 15 beats/min, lasting 15 seconds or more, over 20 minutes

In preterm fetuses, rate is 10 beats above baseline for 10 seconds in a 20-minute window

Question 9

Fetal Acoustic and Vibroacousting Simulation test (FAST and VST)

Answer 9

used in conjunction with NST

Handheld, battery-operated device applied to woman’s abdomen over fetal head. Device generates low-frequency vibration and buzzing sound.

Stimulation induces movement and accelerations of fetal heart rate (FHR) in fetuses with nonreactive NST

1. Stimulus lasts for 2‒5 seconds;
2. if no accelerations, then repeated at 1-minute intervals up to 3 times

Question 10

Biophysical Profile (BPP)

Answer 10

an ultrasound that uses 5 variables to score a baby. It helps either to identify the compromised fetus or to confirm the healthy fetus and provides an assessment of placental functioning

Performed after 28 weeks

Question 11

BPP is scored on 5 variables. They are:

Answer 11

1. Fetal breathing movement
2. Fetal movements of body or limbs
3. Fetal tone (extremity extension and flexion)
4. Fetal reactivity (Reactive fetal heart rate (FHR) with activity (reactive non-stress test [NST])
5. Amniotic fluid volume (pockets of fluid around the fetus)

BPP Scoring Criteria
(Score of 2 assigned to each of the 5 areas):
1. A Score of 8-10 is a normal finding
2. A score of 6 is suspicious
3. A score of 4 denotes a fetus potentially in jeopardy
4. Maximum score of 10

Question 12

Contraction Stress Test (CST)

Answer 12

test done during contractions that a. evaluates placental respiratory function (oxygen and carbon dioxide exchange).

A positive test shows late decels with each contraction. NOT A DESIRED RESULT.

A negative CST implies normal placental function, adequate fetal oxygenation, and that the fetus will likely withstand the stress of labor.

In many settings, CST has been replaced by biophysical profile (BPP)

Question 13

Before pregnancy the uterus is small, solid, weighs about 60grams and can hold about 10 ml. During pregnancy it increases in size, and at the end of pregnancy it weighs about __.

Answer 13

1100 grams and can hold 5000ml

Question 14

Hegar’s sign

Answer 14

Cervix (normally stiff) becomes loose and pliable

Question 15

Goodell Sign

Answer 15

softening of the cervix

Question 16

chadwick’s sign

Answer 16

bluish discoloration of the cervix

Question 17

___ progressively increases beginning in the first trimester, increases rapidly until about 30-34 weeks.

Answer 17

Blood volume

Cardiac output and blood volume increases with an increased workload-pulse may increase 10-15 beats per minute.

Increased CO and blood volume is the reason they advise some women with complex heart issues NOT to get pregnant.

Question 18

Supine hypotensive syndrome

Answer 18

Pregnant women lies supine, the uterus presses on the vena cava.

This may reduce blood flow to the right atrium, lowering blood pressure and causing dizziness, pallor and diaphoresis.

This can be corrected by lying on her left side or placing a pillow under the right hip .

Question 19

facial chloasma

Answer 19

also known as the “mask of pregnancy” a darkening of the skin over the forehead and around the eyes.

Question 20

linea nigra

Answer 20

line in the middle of the abdomen which usually extends from the pubic area to the umbilicus or higher

Question 21

recommended weight gain during pregnancy

Answer 21

25 to 35 lb

Overweight: Recommended gain is 15 lb
Underweight: May gain up to 40 lb

Question 22

subjective or presumptive changes indicating pregnancy that a woman experiences. These could be caused by other conditions and are NOT PROOF OF PREGNANCY.

Answer 22

a. Amenorrhea
b. Nausea and vomiting
c. Fatigue
d. Urinary frequency
e. Breast changes
f. Quickening (felt fetal movement)

Question 23

objective or probably changes indicating pregnancy that an examiner can perceive. These could be caused by other conditions and are NOT PROOF OF PREGNANCY.

Answer 23

a. Goodell and Chadwick signs
b. Hegar and McDonald signs
c. Enlargement of the abdomen
d. Braxton Hicks contractions
e. Uterine soufflé
f. Skin pigmentation changes
g. Pregnancy tests:
Serum (blood) tests- (detect hCG)
Urine tests

NOTE: Hydatidiform mole has positive pregnancy test, but is not a real pregnancy
Therefore a pregnancy test is not a definitive proof of pregnancy.

Question 24

Definitive proof of pregnancy. These three things offer conclusive proof of pregnancy:

Answer 24

Fetal heartbeat
Fetal movement (visualized)
Visualization of the fetus

Question 25

TPAL

Answer 25

(1) T - Number of term infants born (completion of at least 37 weeks’ gestation)
(2) P - Number of preterm infants born (after 20 weeks’ but before 37 weeks’ gestation)
(3) A - Number of pregnancies ending in spontaneous or therapeutic abortion
(4) L - Number of currently living children

Question 26

Nägele’s rule

Answer 26

used to determine due date

First days of LMP, subtract 3 months, add 7 days

Question 27

quickening

Answer 27

fetal movement, usually felt around 20 weeks

Question 28

fetal heart rate

Answer 28

usually found about 12 weeks by doppler

Question 29

teratogens

Answer 29

Maternal infections that affect fetus: Malaria, Rubella (German measles), Toxoplasmosis, Herpes simplex virus (HSV), Cytomegalovirus – found in cat litter, Syphilis

Infections that cause illness at birth: Gonorrhea, Candidiasis, Chlamydia, Streptococcus B, Hepatitis B,

also:
Live virus vaccines
Herbs
Alcohol
Tobacco
Environmental: Metal and chemical hazards, Radiation, Hyperthermia and hypothermia
Maternal stress
Medications